[A Case of HER2-Positive Esophagogastric Junction Cancer with Perforation Curatively Resected after Neoadjuvant Chemotherapy plus Trastuzumab].

A 60-year-old man was diagnosed with adenocarcinoma of the esophagogastric junction with lymph node metastasis along the left gastric artery. The clinical stage was determined to be T4b, N1, M0, Stage IIIB, and a neoadjuvant chemotherapy (NAC)regimen of capecitabine/CDDP plus trastuzumab was selected for treatment. Before 3 courses of chemotherapy, the patient developed perforated gastric cancer. With conservative therapy, we were able to obtain closure of the perforation without affecting the curability of the cancer. We changed the chemotherapy regimen to S-1/CDDP plus trastuzumab, and the patient underwent curative resection.

[Tumor markers of hepatocellular carcinoma].

There are three tumor markers of hepatocellular carcinoma (HCC); alpha-fetoprotein (AFP), Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L 3), and protein induced by vitamin K absence or antagonist-II (PIVKA-II). AFP is low in specificity but is not correlated with PIVKA-II and is important for HCC screening and decision making as to treatment effectiveness. AFP-L3 is high in HCC specificity, and after treatment it is used for malignancy when AFP-L3 is positive. Specificity in PIVKA-II is higher than that of AFP. And PIVKA-II positive means possibly the highest risk of future portal venous invasion. These three markers complement each other, but since these are not measured simultaneously upon insurance, it is necessary to measure them independently and inspect the imaging modalities regularly when HCC screening.

[Mass surveys for detection of colorectal cancer].

In Japan, an immunochemical fecal occult test is the first step in mass surveys for detection of a colorectal cancer. A person with false-negative fecal occult blood has early cancer and/or cancer less than 3 cm in diameter. If the end of the mass survey is mp cancer (cancer involvement to the colonic wall), the false-negative rate for colorectal cancer is less than 10%. A person with a positive reaction on the fecal occult test is taken forward to the second step. The second step in the mass survey consists of barium enema or/and endoscopy. Endoscopic false-negative cancers are located behind the physical flexure section or the colonic haustra. Radiologic false-negative cancers are type II cancer or cancer less than 1 cm in diameter or on the right side of the colon. In our experience, we have rarely overlooked cancer more than 2.1 cm in diameter by colonoscopy or barium enema. Most mp cancers are more than 2 cm in diameter. Thus, with colonoscopy or radiology we overlooks less than 10% of mp cancer.

Effectiveness of doxifluridine (5'-DFUR)/docetaxel against advanced/recurrent gastric cancer showing resistance to various anticancer drug regimens.

A 58-year-old man was diagnosed as having type 3 gastric cancer (poorly differentiated adenocarcinoma). He underwent total gastrectomy with splenectomy, as well as D3 dissection, and received postoperative chemotherapy combining oral uracil and futrafur (UFT) with cisplatin (CDDP), but results showed recurrence of multiple abdominal lymph node metastases around the aorta. He therefore received various anticancer drug regimens (irinotecan [CPT-11]/CDDP; 1 M tegafur-0.4 M gimeracil-1 M oteracil potassium [TS-1], methotrexate (MTX)/5-fluorouracil); however, final results showed growth of lymph node metastasis and simultaneous worsening of his general condition. The patient then received combined administration of doxifluridine (5'-DFUR)/docetaxel (5'-DFUR, 1000 mg/body [666.7 mg/m(2)], given by consecutive daily administration, orally, for days 1-14; and docetaxel, 80 mg/body [60 mg/m(2)], on day 8, by venous drip, every 3 weeks). Three courses of this regimen resulted in approximately 90% reduction of the abdominal lymph node size, disappearance of the right cervical lymph node metastasis, reductions of the levels of two tumor markers (carcinoembryonic antigen [CEA] and carbohydrate antigen [CA]19-9), and improvement of his general condition. In total, seven courses of the regimen were carried out. The patient died on day 298 after starting this combined regimen and showed a response period of 126 days. The primary toxicity identified was neutropenia (grade 4), as well as other low-grade (grade 1, 2) hematological and nonhematological toxicities. In the field of gastric cancer treatment, especially for patients showing multiple resistance to anticancer drugs, an effective therapy is critically needed.

[Development of a Japanese version of the FLIE].

Nausea and vomiting induced by chemotherapy have an impact on cancer patients' quality of life (QOL). The Functional Living Index-Emesis (FLIE), which is designed to assess the change in QOL from the influence of nausea and vomiting is rarely used in Japan, regardless of its utility, because it is written in English. We investigated the use by cancer patients with the main object of designing a reliable and valid Japanese version of the FLIE. We also verified the validity of a Japanese translation and improved part to design a highly precise Japanese version FLIE. Consequently, we found a correlation between the FLIE Japanese version and the QOL questionnaire Quality of Life Assessment of Cancer Patients Receiving Chemotherapy (QOL-ACPRC), which was the external standard. Furthermore, we improved the questionnaire to raise the rate of patient response, and improve reliability and validity. We think that this FLIE Japanese version will become useful in assessing the change in patient QOL due to the influence of nausea and vomiting.

[Individuated molecular target chemotherapy].

Developing the technological innovation for genomic and molecular biology rapidly, the strategy of molecular target chemotherapy for cancer is recognized in the medical circles to be defined on the basic science and the ethical society. The novel strategy of the individuated anticancer chemotherapy is growing of geno-projects to be determined of more effective and harmless therapeutic methods for every cancer patients by the individual difference of pharmacogenetics and molecular biology. The new strategy is dependent on the general analysis for the personal life science from pharmacokinetics, pharmacodynamics, and oncogenomics. We summarized the problems and the possibility of the translational research for these strategies from the position of medical oncology.

Cellular sensitivity determinants to docetaxel in human gastrointestinal cancers.

beta-tubulin (beta-TUB), Bcl-XL, and additionally glutathione S-transferase pi (GSTpi) were found to participate in sensitivity to docetaxel (TXT) in 7 human gastrointestinal cancer cell lines. The gene expression level of beta-TUB, Bcl-XL, and GSTpi was closely correlated with the IC50 for TXT. beta-TUB amount related to TXT resistance, and GST activity was correlated with IC50 for TXT in the 30-min treatment setting. Bcl-XL transfection increased TXT resistance of COLO201 cells, whereas GST inhibition by ethacrynic acid enhanced TXT cytotoxicity. Continuous TXT treatment increased beta-TUB and GSTpi expression, but the increased GSTpi mRNA was observed in TXT-resistant HCC-48 cells alone.