[Effect of capecitabine therapy on the blood levels of antiepileptic drugs - report of two cases].

We report the cases of 2 breast cancer patients who received capecitabine(CAP)and concomitant anticonvulsant therapy with either phenytoin(PHT)or valproate(VPA)for brain metastasis. The effect of CAP on the blood levels of the 2 anticonvulsants was different and it depended on the variation in metabolism of each drug. Case 1 involved a 59-year-old woman with recurrent breast cancer. After radiation therapy for brain metastases, the patient received PHT(400mg/day)to prevent convulsions. After 5 days of PHT administration, CAP therapy was initiated, and her blood PHT levels increased to 33.8 mg/mL. Although the PHT dose was reduced to 300mg/day, the blood PHT levels markedly increased to 45.5 mg/mL 7 days after the withdrawal of CAP. Case 2 involved a 60-year-old woman with breast cancer who underwent surgery for brain metastases and subsequently received controlled-release VPA tablets(400mg/day). No remarkable change was observed in her blood VPA levels during CAP treatment or after CAP withdrawal(the blood VAP level after 7 days of treatment was, 78.4 mg/mL; after 14 days of treatment, 73.2 mg/mL; and 7 days after withdrawal, 79.7 mg/mL). CAP has been reported to inhibit nucleic acid synthesis and/or folic acid activity rather than cytochrome P450(CYP)directly. CAP had a significant effect on the blood levels of PHT, which is metabolized via the CYP pathway. However, VPA levels remained unchanged because VPA metabolism involves other pathways, such as the beta-oxidation and conjugation pathways.

Does primary tumor resection improve outcomes for patients with incurable advanced breast cancer?

BACKGROUND: Metastatic breast cancer (MBC) is considered incurable, and surgery has only limited benefit in the treatment of this disease. However, recent reports have indicated that primary tumor resection may improve patient outcomes. We retrospectively analyzed the surgical benefits and prognostic factors for patients with MBC who were treated at our center. METHODS: Ninety-two women, who had tumors of greater than 5 cm and distant metastasis at diagnosis, were included in this study. The effect of surgical treatment on survival was evaluated. Patient demographics and tumor characteristics were also investigated. RESULTS: Thirty-six patients had surgery for resection of primary tumors. There were no substantive differences between individuals, or between tumor characteristics, for patients who underwent surgery versus patients who did not. The median survival time for surgically treated patients was 25.0 months versus 24.8 months for patients who did not undergo surgical resection (P=0.352). Only three patients relapsed within three months of surgery. For the remaining majority of patients, primary tumor resection gave some relief from the often severe symptoms that come from harboring a large tumor for an extended time. In univariate and subsequent multivariate analyses of predictive indicators, a diagnosis of triple-negative breast cancer and/or metastasis to more than three sites was significantly associated with a severe prognosis. CONCLUSION: Primary tumor resection failed to prolong overall survival times in patients with incurable advanced breast cancer that was greater than 5 cm. However, surgery did improve the quality of life in patients who were expected to have a relatively long prognosis.

[Safety and tolerance of docetaxel (especially 75 mg/m2) with cyclophosphamide (TC therapy) as adjuvant chemotherapy for Japanese patients with operable breast cancer].

The safety and tolerance of docetaxel (especially 75 mg/m/2) plus cyclophosphamide (600 mg/m2) (TC therapy) as adjuvant chemotherapy for Japanese patients (n=47) with operable breast cancer was evaluated. Among 47 patients who received TC therapy, 38 patients (80.8%) were treated as scheduled for 4 courses every three weeks, and 6 patients (12.8%) were dose-reduced or the interval between courses was extended due to neutropenia or wound infection. Three patients (6.4%) quit TC therapy due to stomatitis or skin toxicities of grade 3. Although febrile neutropenia of grade 3 or 4 was observed in 2 patients (4.3%), TC therapy could be prescribed for these patients. Non-hematological side effects(such as edema, myalgia and arthralgia), occurred in relatively many cases, but were not remarkable. From these results, TC therapy (75/600 mg/m2) is considered to be a safe and tolerable regimen in Japanese patients operated for breast cancer.

Venovenous extracorporeal membrane oxygenation as an adjunct to surgery for empyema: report of a case.

Empyema is a serious and often life-threatening condition. We report the case of a 45-year-old man with severe hypoxia caused by empyema after streptococcal pneumonia, which we successfully treated by surgical drainage assisted by a venovenous extracorporeal membrane oxygenation (ECMO) device. This device provided sufficient oxygenation during the perioperative period and was not associated with excessive bleeding under systemic heparinization. This case report shows the effectiveness of ECMO in allowing surgery and enhancing its benefits in patients with serious hypoxia.