[Measures to Ensure Safety of Docetaxel plus Ramucirumab for Advanced Non-Small-Cell Lung Cancer as the Second- or Later-Line].

With the standpoint ofref ining the chemotherapy regimen, we retrospectively reviewed adverse events encountered by the initial 10 cases during the first course of docetaxel plus ramucirumab for non-small-cell lung cancer that progressed after platinum-based chemotherapy. Febrile neutropenia(FN)was observed in 40% ofcases, and a halfofall patients experienced oral mucositis, including 2 Grade 3 cases. These results were concordant with a previous randomized phaseⅡstudy on Japanese patients. We amended the treatment regimen by adding the prophylactic use ofpegf ilgrastim. Post-amendment, FN was not observed in all 10 cases. However, the frequency and severity of chemotherapy-induced oral mucositis were not affected; Therefore, some patients discontinued treatment due to this toxicity as well as diarrhea. In conclusion, prophylactic granulocyte-colony stimulating factor is considered effective for reducing the risk of FN. Further intervention by an oral care team is required to validate our findings.

[Management and maintenance of pemetrexed monotherapy regimen - initial experience of pretreated non-small cell lung cancer].

We aim to maintain the registered pemetrexed (PEM) monotherapy regimen from the standpoint of its frequency of use, patient adherence and compliance to treatment its toxicity and efficacy. With the development and expanded indication of PEM for non-small cell lung cancer (NSCLC), we registered the PEM monotherapy regimen for pretreated NSCLC. In order to investigate the validity of this approach, we retrospectively collected and analyzed data on the background, administration status, and toxicity of PEM from medical records of the initial consecutive 21 cases who received PEM monotherapy. Excluding only one case of grade 3 neutropenia (leucopenia), hematological toxicities were not significant. Common non-hematological toxicities were grade 1-2 nausea, fatigue, rash, and liver dysfunction, while grade 3 pneumonitis was observed in one case, and grade 3 hyponatremia was observed in two. Co-medication with non-steroidal anti-inflammatory drugs (NSAIDs) did not increase toxicity. PEM is tolerable for pretreated NSCLC, but continual problems with non-significant common toxicities may arise.

[Analysis of adverse events of amrubicin hydrochloride for pretreated lung cancer patients].

Although amrubicin hydrochloride (AMR) has promising activity against pretreated lung cancer, there are few reports on the adverse events of this agent in a clinical practice setting. We analyzed the adverse events experienced in 27 hospitalized patients who had received AMR monotherapy by collecting data from the pharmaceutical management records. Neutropenia was the main hematological toxicity, and 77.8% of patients developed grade 3/4 neutropenia. Neutrophil counts reached the nadir in 9 to 21 (median 14) days and recovered to normal in 14 to 27 (median 20) days. Seven cases experienced febrile neutropenia without any serious sequelae. Grade 2 or worse non-hematological toxicities were fatigue, constipation, nausea, vomiting, anorexia, and pneumonitis. In comparison with the data of pre-marketing clinical trials, constipation was more commonly observed, while nausea/vomiting was less frequent probably due to appropriate preventive antiemetics. Based on these findings, we have created a novel drug information chart for patients and utilized it in pharmaceutical care in our hospital.

[A case of adenocarcinoma of unknown primary site successfully treated with gemcitabine monotherapy].

A 68-year-old female diagnosed with adenocarcinoma of unknown primary site (ACUP) by biopsy of supraclavicular lymph node was admitted to our department because of progressive dyspnea with cough. The diagnosis of multiple lung metastases and malignant pleural effusion was made. Marked elevation of serum CA 19-9 and DUPAN-2 urged us to treat her as a case of pancreatic carcinoma. Gemcitabine monotherapy yielded resolution of symptoms, decline in the level of tumor markers, shrinkage of lung metastases, and disappearance of pleural effusion. After 10 cycles, the chemotherapy was terminated. However, clinical deterioration was observed two months later. The re-treatment with gemcitabine was started, and a good response was obtained again. Gemcitabine monotherapy can be one of the treatment options for ACUP.