Phase I/II trial of a biweekly combination of S-1 plus docetaxel in patients with previously treated non-small cell lung cancer (KRSG-0601).

BACKGROUND: Combination of S-1, an oral fluorouracil derivative, plus docetaxel against non-small cell lung cancer (NSCLC) showed promising efficacy but clinically problematic emesis. A phase I/II study utilising a new schedule for this combination was conducted. METHODS: A biweekly regimen of docetaxel on day 1 with oral S-1 on days 1-7 was administered to previously treated NSCLC patients. Doses of docetaxel/S-1 were escalated to 30/80, 35/80, and 40/80 mg m(-2), respectively, and its efficacy was investigated at the recommended dose below maximum tolerated dose (MTD). RESULTS: In phase I study employing 13 patients, dose-limiting toxicities were febrile neutropenia and treatment delay, with the respective MTDs for docetaxel 40 mg m(-2)/S-1 80 mg m(-2). In the phase II study, 34 patients were treated with docetaxel 35 mg m(-2)/S-1 80 mg m(-2) for a median cycle of 6. The response and disease control rates were 34.3% (95% confidence interval (CI), 18.6-50.0%) and 62.9% (95% CI, 46.8-72.9%), respectively. Median progression-free survival was 150.5 days. Haematologic grade 4 toxicities were observed in neutropenia (11.8%) and thrombocytopenia (2.9%). Regarding non-haematologic toxicities, including emesis, there were no grade 3/4 side effects. CONCLUSION: Combination of 1-week administration of S-1 with biweekly docetaxel is safe and active for NSCLC.

Papillary adenocarcinoma arising in placentoid bullous lesion of the lung: report of a case with immunohistochemical study.

We report the case of a 52-year-old man with papillary adenocarcinoma arising in placentoid bullous lesion of the lung, which is a rare cystic lung disease. Macroscopically, the cyst contained a soft villous tumor closely resembling the placental chorionic villi of early gestation. Histologic examination revealed the tumor to be papillary adenocarcinoma with an abundant stromal core, which comprised vascular and lymphatic vessels, lymphocytes, fat cells, and smooth muscle. Immunohistochemically, adenocarcinoma cells were positive for CAM 5.2, epithelial membrane antigen, and PE10 (antisurfactant apoprotein A antibody). These results indicate that the adenocarcinoma was derived from the component epithelial cells of the cyst. Based on the tumor's macroscopic and microscopic appearance and on the results of the immunohistochemical studies, we conclude that the cystic tumor in our case arose in a placentoid bullous lesion of the lung.

[Successful treatment of hypereosinophilic syndrome with cyclosporin and steroids].

A 41-year-old man with severe hypereosinophilic syndrome was first given a high dose of steroids. His condition improved, and the dose of steroids was tapered. His condition then worsened, and administration of cyclosporin was begun. Disease activity decreased and eosinophil counts decreased to the normal range. Cyclosporin and steroids inhibit the interleukin-2 gene transcription factors NF-AT and AP-1. They also inhibit the interleukin-5 production by peripheral lymphocytes stimulated by interleukin-2. AP-1 is the primary target for steroid-mediated repression of IL-2 gene transcription, but NF-AT appears to be the main target of cyclosporin. In patients with the hypereosinophilic syndrome, cyclosporin can be effective and can minimize the adverse effects of long-lasting therapy with high doses of steroids.

[Pulmonary involvement in immunoblastic lymphadenopathy: case reports and review of literature published in Japan].

To investigate pulmonary involvement in immunoblastic lymphadenopathy (IBL), we report five cases of IBL and 21 other reports from the literature published in Japan. Three of the present patients had respiratory symptoms and showed hypoxemia on admission. Radiographic findings in the present cases showed bilateral mediastinal and hilar lymphadenopathy (LA: 4/5), pleural effusion (PE: 5/5), interstitial shadow (Int S: 1/5), alveolar shadow (A1S: 2/5), and atelectasis (1/5). In the present cases and those previously reported in Japan, the following radiographic findings were observed; LA (56%), PE (40%), Int S (52%), and A1S (24%). Atelectasis was reported only in the present cases. The nine patients with Int S consisted of four with interstitial pneumonia and five with bronchopneumonia. Four of five patients with bronchopneumonia had an opportunistic infection (three had pneumocystis carinii and one had cytomegalovirus). Among the five patients with A1S, two had interstitial pneumonia and the others had bronchopneumonia. Pulmonary involvement was frequently seen in patients with IBL, and may be an important determinant of the outcome of the disease.

[Legionella pneumonia diagnosed by urinary antigen detection].

A 63-year-old man with dyspnea and high fever was admitted to the hospital. A pneumonic shadow in the right lower lung field was observed. After administration of rifampicin and clarithromycin, his symptoms were gradually alleviated. Although Legionella pneumonia was highly suspected, Legionella pneumophila was not isolated from his sputum specimens and the serum level of indirect immunofluorescent antibody titer was not significantly elevated. However, we believe it is very likely that he had Legionella pneumonia, because we detected a high density of urinary Legionella pneumophila serogroup 1 antigen by antigen capture EIA.