Markhood1358

Our patient was a 41-year-old man with non-small cell lung cancer of grade cT3N2M0 and clinical Stage ⅢA. After induction chemoradiotherapy(weekly CBDCA plus PTX[5 courses]and concurrent radiation of 50 Gy, left upper lobectomy with lymph node dissection(ND2a-1)was performed. The postoperative pathological findings were large cell carcinoma, ypT2aN2M0, Stage ⅢA, with complete resection; the PD-L1 tumor proportion score was 50 to 74%. Consolidation chemotherapy( triweekly CBDCA plus PTX, 1 course)followed. Twelve months after surgery, he developed mediastinal lymph node recurrence(#4L), and pembrolizumab was administered every 3 weeks as a first-line treatment. Complete response was evident after 3 courses; thus, we continued this monotherapy. After 35 courses(24 months)of pembrolizumab, we discontinued the regimen. SM-164 IAP antagonist Twenty-two months later, the disease has not progressed. The patient is being followed-up in our outpatient department. We report a case of recurrent postoperative lung cancer with continuous tumor shrinkage after discontinuation of pembrolizumab.A man in his 70s was observed to have GIST recurrence 19 months after surgery. Chemotherapy was initiated with imatinib 400 mg/day orally. The dose was eventually reduced to 100 mg/day to avoid side effects. Tumor reduction was confirmed 3 months after treatment initiation. Currently, 84 months after the onset of GIST, the patient survives with continuous intake of the same dose of oral imatinib. We were able to observe long-term survival in a patient with recurrent GIST after the administration of a small dose of imatinib.A 68-year-old man diagnosed with gastric mixed neuroendocrine-non-neuroendocrine neoplasia(MiNEN)concomitant with liver metastasis received chemotherapy using ramucirumab and paclitaxel. A decrease in tumor marker levels and size of the metastatic liver lesions was observed after 3 courses of treatment. However, the patient developed progressive disease after 9 courses of chemotherapy; hence, nivolumab chemotherapy was initiated. Although liver metastases were reduced after 2 courses of nivolumab, the patient developed new liver lesions after 18 courses of treatment; irinotecan, S-1 and oxaliplatin, and trifluridine/tipiracil were then administered. Liver metastases progressed despite changing the regimen, and the patient died 25 months after the initiation of chemotherapy. Gastric MiNEN usually shows poor prognosis, and there is lack of consensus regarding optimal treatment. Ramucirumab and nivolumab are relatively well-tolerated and may be effective for chemotherapy.We performed a study on the ratio of anti-cancer drug purchase costs at municipal hospitals in Aichi using meeting materials from the 2020 Aichi Prefectural Public Hospital Pharmacy Directors' Association. The ratio of anti-cancer drug purchase costs to all drug purchase costs at 17 hospitals was 41.5%(average)and 37.1%(median). In addition, we confirmed a positive correlation between all drug purchase costs and the ratio of anti-cancer drug purchase costs for each hospital(r= 0.537, 95%CI 0.076-0.809, p=0.026). Furthermore, we conducted a univariate analysis on the background of hospitals where the ratio of anti-cancer drug purchase costs is ≥40%. As a result, we confirmed a significant difference(p less then 0.05)in the cases where there are more than 500 beds, with the approval of designated cancer hospitals, and with the department of hematology. This study clarified that hospitals with active anti-cancer drug treatment tended to increase drug purchase costs.

Several studies reported that skeletal muscle mass affects the clinical response and quality of life of cancer patients during chemotherapy. Here we examined the adverse events and effects of anticancer drugs on the skeletal muscle mass of patients with esophageal cancer who received biweekly docetaxel, cisplatin, and 5-fluorouracil(DCF)neoadjuvant chemotherapy in our department.

We retrospectively analyzed 105 patients with esophageal cancer who received biweekly-DCF neoadjuvant chemotherapy in 2009-2019. The cross-sectional area of the psoas muscle at the level of the third lumbar vertebra on computed tomography was assessed to calculate the psoas muscle index(PMI). Patients were divided into the high PMI group(high-group)and low PMI group(low-group)by cut-off value(male 6.36 cm2/m2; female 3.92 cm2/m2). Hematological toxicity, non-hematological toxicity, and therapeutic effect were retrospectively examined.

Male in the high-group had significantly less ≥Grade 3 hematological toxicity than those in the low-group. Univariate and multivariate analyses showed that PMI(odds ratio 1, p<0.05)was significantly related to decreased hematological toxicity.

In preoperative chemotherapy for esophageal cancer, the incidence of hematological toxicity was significantly higher in patients with low skeletal muscle mass. Thus, skeletal muscle mass may be a marker for determining optimal anticancer drug dosage.

In preoperative chemotherapy for esophageal cancer, the incidence of hematological toxicity was significantly higher in patients with low skeletal muscle mass. Thus, skeletal muscle mass may be a marker for determining optimal anticancer drug dosage.In the treatment of diverse elderly cancer patients, not only cancer progression and general condition but also social factors, comorbidities, and cognitive function have a great influence. Therefore chronological age and performance status(PS) alone, there is a possibility that under treatment that inappropriately lowers the treatment intensity and over treatment that performs the same treatment as young people without considering the risk of chemotherapy may be performed. Comprehensive geriatric assessment(CGA)evaluates individual health conditions such as physical function, comorbidities, cognitive function, psychological status, social support system, and nutritional status of the elderly from various aspects, and selects treatment. The goal is to be useful for treatment support. CGA results should be shared with other members of the medical team to intervene on issues. And it's important to do it over and over again. CGA may help optimize elderly cancer treatments and improve the quality of life of the limited elderly, not just prolonging their lives.There are 3 major problems in clinical trials for older cancer patients. First, the number of older patients enrolled in clinical trials is very small, given the proportion of older patients with cancer. Second, most clinical trials for enrolled patients have not been evaluates by geriatric assessments(GA). These issues make it difficult to extrapolate the results of clinical trials conducted to clinical practice, as the background differences between patients enrolled for clinical trials and requiring treatment in clinical practice are not apparent. Finally, for the implementation of safe and effective cancer chemotherapy, multifaceted GA and intervention based on GA results are important for the treatment of older patients but the results of clinical trials to verify the usefulness of functional evaluation are still insufficient. Especially in Japan, the penetration rate of GA evaluation in clinical practice is very low. In the future, it is expected that by establishing a clinical trial system for older patients and creating evidence, it will be possible to propose optimal treatment based on the results of GA rather than judging the treatment policy based only on the chronological age.Older patients with cancer are different physically, psycho-spirituality, and socio-economically, and when considering the indications for chemotherapy and other drug therapies for cancer, it is important to comprehensively assess their condition and risk using geriatric assessment(GA). Multidisciplinary team-based approach is essential to address impaired domains that are found by GA. The G8 screening is useful tool for screening the GA candidates. In recent years, there have been increasing opportunities that older patients with cancer who receive immunotherapy with immune checkpoint inhibitors. There is no consensus on the treatment and management of immune-related adverse events(irAEs)specific to older patients, and therefore it is important to adhere to an evidence-based approach.In Japan, the population aged 65 and over accounts for 29% of the total population, and the number of elderly cancer patients is increasing. Geriatric oncology is an academic area that considers the characteristics of the elderly and provides appropriate cancer care. The International Society of Geriatric Oncology considers education, medical care, research, and partnership formation as priority areas and has set them as policy goals. In Japan, the content related to"cancer in the elderly"has been added to the 3rd-term Basic Plan to Promote Cancer Control Programs, aiming to formulate cancer treatment guidelines for the elderly. So far, the"Guidelines for Cancer Chemotherapy for the Elderly"have been published. With the aging of the population, social security costs will increase significantly after 2022, when the baby boomer generation will be 75 years old. Currently, reforms of social security systems such as pensions, medical care, and long-term care are underway. In order to promote geriatric oncology, it is important to enhance cooperation between oncology and geriatrics and to support the cooperation system between families and medical staff. In Japan, where the working-age population and the total population have begun to decline, we are facing many challenges. The experience of Japan, a top runner in a super- aged society, has the potential to be shared on a global scale and should be addressed from a long-term perspective.Delirium is a condition in which the main symptom is a mild disturbance of consciousness caused by a physical abnormality or medication, and various symptoms such as cognitive dysfunction, hallucinations, delusions, and mood swings appear with any disease. Delirium is frequently observed in patients with cancer, especially in the terminal stage, and is observed in about 90% of patients just before death. Hypercalcemia due to bone metastases, brain metastases, and the use of opioids and steroids for symptom relief are direct factors in the development of delirium. Furthermore, there are many opportunities to encounter delirium at the end of life caused by conditions that are difficult to recover from, such as brain metastasis, liver failure, and hypoxic encephalopathy. In the management of delirium, "search for the cause(s)and its treatment"and"environmental adjustment"are the most important. Then, pharmacotherapy is considered to reduce the severity of delirium. Antipsychotics are the basic medication of choice. The route of administration, half-life, dosage form, adverse events of medication, as well as patient factors such as the presence or absence of diabetes and the subtype of delirium should be comprehensively considered when selecting a medication. The timing of medication discontinuation should also be kept in mind once medication therapy is initiated. On the other hand, when delirium is caused by factors that are difficult to recover from, the goal of treatment is to alleviate the painful symptoms caused by delirium, and it is important to take a holistic approach for patients and family members.