Evaluation of gefitinib efficacy according to body mass index, body surface area, and body weight in patients with EGFR-mutated advanced non-small cell lung cancer.

PURPOSE: In patients with epidermal growth factor receptor (EGFR)-mutated, advanced, non-small cell lung cancer (NSCLC), common gefitinib-sensitive EGFR mutations that predict a greater response to therapy include the exon 19 deletion and L858R point mutation. The objective of this study was to evaluate whether body surface area (BSA), body weight (BW), and body mass index (BMI) affect gefitinib efficacy in such patients. METHODS: The medical charts of 138 consecutive patients with advanced NSCLC harboring sensitive EGFR mutations, who underwent gefitinib treatment, were reviewed. The median BSA and BW were used as cutoff values to evaluate their impact on gefitinib efficacy. BMI was categorized as underweight (<18.5 kg/m2), normal (18.5-25 kg/m2), and overweight (≥25 kg/m2). RESULTS: The median BSA and BW were 1.48 m2 and 53 kg, respectively. The overall response rate, progression-free survival (PFS), and overall survival (OS) were 65.2%, 12.2, and 24.2 months, respectively. There were no significant differences in clinical outcomes according to BSA, BW, or BMI alone. Subgroup analysis based on the mutation type and BSA revealed no significant differences in PFS between the groups; however, the median OS in those with exon 19 deletion combined with low BSA was significantly favorable compared with the other groups. CONCLUSIONS: Gefitinib efficacy in patients with NSCLC harboring sensitive EGFR mutations did not differ according to BSA, BW, and BMI. However, OS was superior in patients with both the exon 19 deletion and low BSA.

First-line gefitinib treatment in elderly patients (aged ≥75 years) with non-small cell lung cancer harboring EGFR mutations.

PURPOSE: The efficacy of gefitinib [an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor] in elderly patients with non-small cell lung cancer (NSCLC) and EGFR mutation has not been elucidated. Therefore, the objective of this study was to investigate the efficacy and feasibility of gefitinib in elderly chemotherapy-naive patients with NSCLC harboring sensitive EGFR mutations. METHODS: We retrospectively evaluated the clinical effects of gefitinib as a first-line treatment for elderly (≥75 years) NSCLC patients with EGFR mutations (exon 19 deletion or exon 21 L858R mutation). All patients were initially treated with gefitinib (250 mg/day) at seven institutions. RESULTS: Between January 2006 and December 2012, 62 patients (17 men, 45 women) with a median age of 80 years (range, 75-89 years) were included in our analysis. The overall response and disease control rates were 61.2 and 83.8 %, respectively, and the median progression-free survival and overall survival were 13.2 and 19.0 months, respectively. Common adverse events included rash, diarrhea, and liver dysfunction. Major grade 3 or 4 toxicities included skin rash (3.2 %) and increased levels of aspartate aminotransferase or alanine aminotransferase (21.0 %). Gefitinib treatment was discontinued owing to adverse events of liver dysfunction in 3 patients, drug-induced pneumonitis in 2, and diarrhea in 1. CONCLUSION: First-line gefitinib could be a preferable standard treatment in elderly patients with advanced NSCLC harboring sensitive EGFR mutations.

[Neoadjuvant chemotherapy with intra-arterial infusion in the treatment of advanced cervical cancer].

Neoadjuvant chemotherapy (NAC) with intra-arterial infusion was performed in the treatment for 53 patients with advanced cervical squamous cell carcinoma. After NAC with intra-arterial infusion of the anticancer agents including cisplatin via internal iliac artery or uterine artery, 42 patients received radical hysterectomy. The response to therapy was observed in 45 of all patients (84.9%) clinically, and 36 of 42 patients (85.7%) pathologically. Cancer cells disappeared in 11.9% of patients with cervical invasion, 69.2% with vaginal wall invasion and 39.4% with parametrium invasion after NAG. Five-year survival rates were 100% in stage I, 71.5% in stage II, 52.2% in stage II and 0% in stage IV. The group of patients without cancer in the parametrium after NAC showed a significantly better 5-year survival rate than the group with residual cancer in the parametrium. According to the results, the elimination of cancer invasion to the parametrium by NAC is thought to be important for improvement of the prognosis in advanced cervical cancer.

Mature ovarian cystic teratoma with a highly differentiated homunculus: a case report.

BACKGROUND: Mature ovarian cystic teratomas, which are commonly observed benign ovarian tumors, consist of ectodermal, mesodermal, and endodermal components that are generally disorganized. In this report, we document a case in which the solid portion of an ovarian teratoma demonstrated considerable differentiation, forming a doll-like structure. CASE: A 25-year-old virginal Japanese woman underwent surgery for an ovarian tumor that was diagnosed as a mature teratoma. A solid mass within the tumor was found to have a head, trunk, and extremities. Consequently, this mass was diagnosed as a mature fetiform teratoma (homunculus). Brain, eye, spinal nerve, ear, teeth, thyroid gland, bone, bone marrow, gut, trachea, blood vessels, and phallic cavernous tissue were confirmed microscopically. Distinctive features were the clear anterior-posterior, ventral-dorsal, and left-right axes, with a spatially well-organized arrangement of the organs. An eye was located on the front of the head, a spinal nerve lay dorsal to the spinal bones, the thyroid gland was anterior to the trachea, and the gut was deep inside the trunk. CONCLUSIONS: These findings indicate that the information necessary for organization of the body plan may be conserved and transmitted, even with parthenogenesis. Mature cystic teratomas of the ovary are mostly benign and do not always attract detailed attention. However, precise analyses of such tumors may significantly enhance our understanding of both parthenogenetic and normal human development.

Interleukin-5 messenger RNA expression in peripheral blood mononuclear cells from patients with bronchial asthma and eosinophilia.

Interleukin-5 (IL-5) plays an important role in allergic diseases accompanied by eosinophilia. We examined IL-5 messenger RNA (mRNA) expression in peripheral blood mononuclear cells (PBMC) isolated from 13 patients with bronchial asthma, 1 patient with chronic eosinophilic pneumonia, 2 patients with idiopathic eosinophilia, and 5 control subjects. IL-5 mRNA was expressed in PBMC from 2 of 13 patients with asthma, 1 patient with chronic eosinophilic pneumonia, and 1 of 2 patients with idiopathic eosinophilia. IL-5 mRNA expression was not detected in PBMC from control subjects. PBMC from a patient with chronic eosinophilic pneumonia expressed IL-5 mRNA spontaneously. Prednisolone treatment decreased his clinical symptoms and IL-5 mRNA expression. IL-5 mRNA expression preceded revival of the disease. These observations show that IL-5 plays a role in the condition, accompanied by eosinophilia, and IL-5 mRNa examination in PBMC by means of reverse transcription-polymerase chain reaction may be useful to predict the activity of eosinophilia.