[A Case of Recurrent Breast Cancer with Complete Response to Eribulin Monotherapy after Bevacizumab plus Paclitaxel Combination Therapy].

A 65-year-old woman underwent mastectomy and dissection of a level I axillary lymph node in January 2002 for left breast cancer. The diagnosis was T1N0M0 scirrhous carcinoma that was estrogen receptor-positive, progesterone receptorpositive, and human epidermal growth factor receptor 2-negative. After 3 years 10 months, during which the patient underwent adjuvant therapy with oral aromatase inhibitors, she developed bilateral multiple lung metastases. These were treated with the anticancer agents anthracycline and taxane. Progressive disease(more and larger lung metastases)was diagnosed in April 2013, and bevacizumab plus paclitaxel combination therapy was started. After completion of 4 courses, a lung abscess appeared, which was conjectured to represent rapid tumor necrosis that had become infected. As several tumors remained solid even after the lung abscess improved, the patient received 18 courses of eribulin monotherapy. Computed tomography in April 2016 revealed only patches of linear or cord-like scarring in both lungs, with no metastatic or recurrent foci. In this case, a patient with recurrent breast cancer responded to the sequential administration of bevacizumab plus paclitaxel combination therapy followed by eribulin monotherapy.

[Total Gastrectomy for Advanced Gastric Cancer after Coronary Artery Bypass Grafting Using the Right Gastroepiploic Artery: Report of a Case].

An 82-year-old man, who had undergone coronary artery bypass grafting(CABG) with the right gastroepiploic artery( RGEA) 13 years previously, suffered with abdominal pain after meal and tarry stools, and was diagnosed with advanced gastric cancer. Gastroscopy revealed an advanced Borrmann type 4 cancer at the lesser curvature of the gastric body to the pyloric ring. The gastrogram showed poor extension and stenosis at the same part. Abdominal computed tomography showed the tumor reached the subserosal layer and infrapyloric lymph nodes were swollen. Abdominal angiography showed the RGEA graft remained well patent. Total gastrectomy with D2 lymph nodes dissection and arterial reconstruction between the splenic artery and the RGEA graft was performed. He has been well without any sign of cancer recurrence since the operation. Recently, more patients with CABG using RGEA are found to have gastric cancer and require the resection of RGEA for lymph nodes dissection as this case. We consider this procedure one of the options for advanced gastric cancer after coronary bypass grafting using RGEA.

Expression of acetylated and dimethylated histone H3 in colorectal cancer.

AIM: The expression of acetylated and dimethylated histone H3 in colorectal cancer was examined by immunohistochemistry and chromatin immunoprecipitation (ChIP)/Western blot (WB) assay. The correlation between the expression of histone H3 and clinicopathological findings was analyzed. METHODS: Formalin-fixed and paraffin-embedded sections obtained from 80 operated cases of colorectal cancer were immunostained with anti-acetylated histone H3 (H3Ac) antibody and anti-dimethylated histone H3 lysine 4 (H3K4) antibody. Positive immunoreactivity was evaluated using the Allred scoring system. Furthermore, the expression was confirmed by ChIP/WB assay using formalin-fixed and paraffin-embedded sections. RESULTS: There was good correlation between immunostaining and expression on ChIP/WB assay (p = 0.0005). There was a significant difference between the Allred score of H3K4 and the depth of tumor invasion (p = 0.0003) and the pathological stages (p = 0.0065). In overall survival classified by Allred scores of H3Ac (p = 0.0072) and H3K4 (p = 0.0187), the highest scores represented significantly worse prognoses than the other scores. Specifically, in stages II and III, the highest scores represented significantly worse prognoses than the other scores (p < 0.0001 and p = 0.0173, respectively). CONCLUSION: The expression of H3Ac and H3K4 may estimate patient prognosis.

[A case of relapsed colon cancer successfully treated by capecitabine].

We report a case of advanced relapsed colon cancer, which had multiple liver and spleen metastasis, controlled for about two years by capecitabine therapy. A 60-year-old female had been diagnosed with ileus due to sigmoid colon cancer in August, 2005. She received sigmoidectomy and adjuvant chemotherapy (Leucovorin/5-fluorouracil therapy). In postoperative observation, multiple liver and spleen metastasis were detected by computed tomography in February, 2008. Therefore, she was administered twenty courses of FOLFOX therapy. However, a peripheral nerve disturbance appeared. There fore chemotherapy was changed from FOLFOX therapy to FOLFIRI therapy. After 2 courses of FOLFIRI therapy, she had severe nausea, vomiting, appetite loss and diarrhea. Therefore, chemotherapy was changed from FOLFIRI therapy to capecitabine therapy. After capecitabine therapy, her multiple liver and spleen metastasis disappeared, and complete response has continued for about 2 years. She has remained on capecitabine therapy and has a good quality of life.

Analysis of genetic and epigenetic alterations of the PTEN gene in gastric cancer.

The PTEN tumor suppressor gene on 10q23.3, responsible for the Cowden and Bannayan-Zonana syndromes, encodes a dual-specificity phosphatase able to dephosphorylate both tyrosine phosphate and serine/threonine phosphate residues. Mutational inactivation of PTEN has been reported in various malignancies, including endometrial cancers, ovarian cancers, and glioblastomas. In this study, we investigated PTEN gene mutations in 10 gastric cancer cell lines and 58 primary gastric cancers by polymerase chain reaction single strand conformation polymorphism (PCR-SSCP). Hypermethylation of promoter region CpG islands, an alternative mechanism of gene inactivation to coding region mutations, was also evaluated by methylation specific PCR (MSP). Only one (1.7%) of the 58 primary tumors carried a somatic 5-bp deletion in intron 7 of PTEN, which did not alter the mRNA sequence, and no mutations were detected in any of the cell lines. Similar levels of PTEN mRNA expression were observed in all cell lines and primary tumors studied by RT-PCR, and PTEN promoter CpG islands remained unmethylated. Therefore, we conclude that PTEN does not participate in gastric carcinogenesis as a tumor suppressor gene.

Evaluation of salvage surgery for type 4 gastric cancer.

Patients with type 4 gastric cancer and peritoneal metastasis respond better to chemotherapy than surgery. In particular, patients without gastric stenosis who can consume a meal usually experience better quality of life (QOL). However, some patients with unsuccessful chemotherapy are unable to consume a meal because of gastric stenosis and obstruction. These patients ultimately require salvage surgery to enable them to consume food normally. We evaluated the outcomes of salvage total gastrectomy after chemotherapy in four patients with gastric stenosis. We determined clinical outcomes of four patients who underwent total gastrectomy as salvage surgery. Outcomes were time from chemotherapy to death and QOL, which was assessed using the Support Team Assessment Schedule-Japanese version (STAS-J). Three of the patients received combination chemotherapy [tegafur, gimestat and otastat potassium (TS-1); cisplatin]. Two of these patients underwent salvage chemotherapy after 12 and 4 mo of chemotherapy. Following surgery, they could consume food adequately and their STAS-J scores improved, so their treatments were continued. The third patient underwent salvage surgery after 7 mo of chemotherapy. This patient was unable to consume food adequately after surgery and developed surgical complications. His clinical outcomes at 3 mo were very poor. The fourth patient received combination chemotherapy (TS-1 and irinotecan hydrochloride) for 6 mo and then underwent received salvage surgery. After surgery, he could consume food adequately and his STAS-J score improved, so his treatment was continued. After the surgery, he enjoyed his life for 16 mo. Of four patients who received salvage total gastrectomy after unsuccessful chemotherapy, the QOL improved in three patients, but not in the other patient. Salvage surgery improves QOL in most patients, but some patients develop surgical complications that prevent improvements in QOL. If salvage surgery is indicated, the surgeon and/or oncologist must provide the patient with a clear explanation of the purpose of surgery, as well as the possible risks and benefits to allow the patient to reach an informed decision on whether to consent to the procedure.