[Three cases of patients in their eighties who received anti-EGFR antibody mono-therapy as first-line treatment for metastatic colorectal cancer].

We report three cases of patients in their eighties who received anti-EGFR antibody mono-therapy as first-line treatment for metastatic colorectal cancer. CASE 1: An 86-year-old woman who received cetuximab after a colostomy for unresectable rectal cancer with synchronous liver and lung metastases. Serum levels of CEA and CA19-9 showed a significant decrease at 2 months, after which they showed a gradual increase. Computed tomography (CT) revealed a reduction in the rectal tumor. CASE 2: An 82-year-old woman who received cetuximab for peritoneal metastases after a transverse colectomy. Serum levels of CEA and CA19-9 decreased to normal levels at 2 months, and CT imaging revealed disappearance of the tumor in the peritoneal cavity. CASE 3: A 79-year-old man who received panitumumab for lung, liver and para-aortic lymph node metastases after a descending colectomy. Serum levels of CEA and CA19-9 showed a decrease at 1 month, after which they showed a gradual increase. No marked change in the tumor was observed by CT. No change was observed in performance status or Vulnerable Elders Survey( VES-13) score, and the effect on overall condition was minimal. Grade 1-2 acneiform skin rash, paronychia, and desquamation, and grade 2-3 dry skin and pruritis were observed. More precise instructions on measures for dealing with skin rash are necessary to obtain higher drug compliance.

[The efficacy of cetuximab for metastatic colorectal cancer].

Cetuximab (Erbitux) is a targeted therapy that used to treat metastatic colorectal cancer. It is classified as a "monoclonal antibody" and "signal transduction inhibitor" by binding to epidermal growth factor receptors (EGFR). We report 6 patients who responded well to cetuximab out of 8 patients with recurrent/advanced colorectal cancer who have received the drug at our hospital since November 2008. Four patients were men and 2 were women, with their ages ranging from 48 to 77 years. The primary cancers were located in the rectum (n=1), sigmoid colon (n=4), and ascending colon (n=1). Performance status (PS) was 0-1. These patients were treated with cetuximab as second-line (n=1), third-line (n=3), fifth-line (n=1), or seventh-line (n=1) therapy. Three patients received cetuximab monotherapy, while the other 3 were given CPT-11 (150 mg/m2, every 2 weeks) as concomitant therapy. Among the 3 patients receiving combination therapy, 2 patients had already received treatment with FOLFIRI. Even in the cetuximab monotherapy group, a partial response (PR) was observed in 2 patients, demonstrating a strong cytoreductive effect. Tumor markers also showed large decreases, with the percent decrease at 1 month being 31.7% and 60.8% in the monotherapy and combination therapy groups, respectively, while it was respectively 14.1% and 29.5% at 2 months. The mean progression-free survival (PFS) time and the time to treatment failure (TTF) were respectively 3.0 months and 4.5 months in the monotherapy group versus 7.3 months and 9.3 months in the combination therapy group. Acneiform rash and paronychia occurred in all 6 patients.

[Multimodal therapy for juvenile advanced rectal carcinoma].

A 37-year-old male with locally advanced rectal carcinoma and liver metastasis was treated by multimodal therapy. Since he had severe anemia and perineal abscess, sigmoid colostomy was constructed. After his general condition was recovered, the patient received systemic chemotherapy with mFOLFOX6 (6 courses) and whole pelvic irradiation (40 Gy). The rectal tumor showed a reduction in size, total pelvic evisceration combined with reconstruction of ileal conduit and rectus abdominus myocutaneous (RAM) flap were performed. He was followed by 7 courses of systemic chemotherapy with mFOLFOX6 and bevacizumab. After partial hepatic resection, he was followed by systemic chemotherapy with FOLFIRI and bevacizumab as an outpatient. Recent studies for outcomes in young colorectal carcinoma patients showed that the poor prognosis was not caused by its proper aggressiveness in biologic behavior but just the late diagnosis.

[A case of abdominal wall metastases detected after 2 years and 5 months from gastric cancer operation].

A 68-year-old woman underwent distal gastrectomy for gastric cancer in February 2003. The Histological type was poorly differentiated adenocarcinoma, and the final finding was T3 (se, INF gamma, ly1, v0), pN1, sH0, sP0, pCY0; fStage IIIA. Two years and 5 months after the operation, a painless tumor was noticed on the upper abdomen. Biopsy specimen showed adenocarcinoma. A CT scan detected abdominal tumors, and there was no other distant metastasis. Fourteen courses of systemic chemotherapy (IRIS) were performed for sixteen months. We detected several abdominal metastases, but no distant metastasis was occurred during IRIS.

High expression of two genes selected by iAFLP: a new prognostic factor of estrogen receptor-positive breast cancer.

To detect patients with poor prognosis among those with estrogen receptor (ER)-positive breast cancer, who generally show good prognosis, we analyzed gene expression profiles of 35 ER-positive tumors by using a high through-put RT-PCR technique, iAFLP. High expression of six genes out of 7,508 was related to poor prognosis in this group. From these six genes, NFE2L2 and TIAL1 were selected as genes associated with poor prognosis by means of a validation study with another set of 56 ER-positive breast cancers. High expression of these two genes was determined to be significantly predictive for poor prognosis of patients with ER-positive breast cancer, and may help to achieve optimal selection of adjuvant treatment for such patients.

Loss of heterozygosity on chromosome 16p and 18q in anaplastic thyroid carcinoma.

The aim of this study was to clarify the genetic alterations in anaplastic transformation of the thyroid cancer. A total of 17 thyroid cancers including 7 anaplastic and 10 papillary cancers were analyzed for loss of heterozygosity (LOH) on chromosome 16p and 18q. All the samples from anaplastic cancer showed LOH at one or more loci out of ten markers on 16p, and only two showed one LOH at two loci out of five markers on 18q. No LOH was found on either 16p or 18q in papillary cancers. D16S423, D16S418 and D16s406 on 16p13.3 were the most frequently deleted loci in anaplastic cancers, and the region around these may harbor the putative tumor suppressor gene related to anaplastic transformation of thyroid cancer.