Chemotherapy is effective for stage I gastric cancer in patients with synchronous esophageal cancer

Gastric Cancer - Diagnostic endoscopy occasionally shows synchronous early gastric cancer (EGC) and esophageal cancer (EC) in the same patient. The treatment plan for these comorbid cancers is...     

Chemotherapy for thyroid cancer

Twenty-nine patients with advanced thyroid cancer have been treated with sequential chemotherapy regimes using the single agents etoposide, carboplatin, cis-platinum or methotrexate, and the combination of adriamycin, bleomycin and vincristine (ABC). Indications for chemotherapy were progressive, symptomatic recurrent or metastatic disease unresponsive to conventional treatment, or advanced anaplastic carcinomas. In these 29 patients there were a total of 60 evaluable drug exposures: 4 out of 22 responded to etoposide, 2 out of 9 responded to carboplatin, 5 out of 13 responded to cis-platinum, 1 out of 3 responded to methotrexate and 5 out of 13 responded to ABC. There was only one complete response in this series, seen with etoposide. Patients under 65 years and those with medullary carcinoma had the highest response rates. Mean survival in these 29 patients was 11.9 months. Mean survival in responders was 19 months compared to 5.4 months in non-responders. Etoposide, carboplatin and cis-platinum used as single agents are active in thyroid carcinoma and useful symptom control and improved survival may be achieved in those patients responding to sequential exposure to these agents.     

Chemotherapy for colorectal cancer

With effective chemotherapy as adjuvant treatment, the survival benefit is clearly achieved for certain (stage III) colorectal cancer patients, though there still exist many unsettled issues including the controversies in the treatment of stage II disease. Advances in the development of a new generation of cytotoxic agents in the past several years have allowed us to move forward from the "fluorouracil-only era" in the treatment of advanced/metastatic colorectal cancer. It is still not very clear how best to minimize toxicity without compromising efficacy of the combination therapy with newer agents, or how to maximize the benefit of chemotherapy (concurrent versus sequential). There are many current ongoing clinical trials designed to address these issues. With better understanding of the signal transduction and molecular biology characteristics of colorectal cancer, and the development of biologic and molecular target agents, the outcomes of patients with colorectal cancer will be improved further. Future clinical trials should be focused on optimizing and individualizing therapy for patients based on their molecular profiles to achieve maximal clinical benefit.     

Chemotherapy for pancreatic cancer

Pancreatic cancer has one of the worst prognosis of any malignant disease. The National Registry of Japan Pancreas Society has reported that only 13% of patients achieve 5 years survival after surgical resection. The vast majority of patients present with metastatic or unresectable disease. Gemcitabine (GEM) has replaced 5-fluorouracil (5-FU)-based chemotherapy as the standard of care. GEM first generated improvements in symptom control and survival in advanced disease, spurring further research. For locally advanced disease, most recent studies have incorporated GEM into combined-modality therapy. However, subsequent trials have not demonstrated that combinations of other agents with GEM extend clinical benefits yet. Similarly, in surgically resectable disease, current trials are incorporating GEM into adjuvant therapy. According to several clinical trials it has been demonstrated that improvements in locoregional control and survival may be achieved when chemotherapy using 5-FU is added to radiation for locally advanced pancreatic cancer. The new regimen for locally advanced disease has demonstrated that the better outcome is expected by chemoradiation therapy with 5-FU followed by GEM treatment. Furthermore, one of the patients showed the significant regression of pancreas tumor, resulting in the successful surgical resection. In order to develop chemotherapy for pancreatic cancer, we are analyzing mRNA expression of pancreas cancer cell lines and examined their resistant against to GEM. One of the genes is demonstrated to be a responsible for drug sensitivity by clustering analysis.     

Chemotherapy for gastric cancer

5-FU has been a key chemotherapeutic agent in the treatment of advanced or recurrent gastric cancer. In order to enhance the effect of 5-FU, biochemical modulation or combined chemotherapy has been developed. Although several phase III studies have been reported in 1990's, a standard chemotherapeutic regimen has not been established worldwide. Recently, newly developed anticancer agents such as CPT-11, TS-1, Paclitaxel, or Docetaxel can be clinically used for advanced gastric cancer either single agent or in combination that may further improve the quality of life and prolong the survival of patients with gastric cancer. In Japan, postoperative adjuvant chemotherapy has been actively developed to enhance survival benefit of surgery for patients with gastric cancer. There were a few positive single randomized controlled study showing benefit of adjuvant chemotherapy with a high evidence level. However, all reports of meta-analysis of adjuvant chemotherapy for gastric cancer indicated the survival benefit of adjuvant chemotherapy. At present, a nation-wide randomized controlled study in the postoperative adjuvant setting for gastric cancer using TS-1 (ACTS-GC) is under way that may clarify the effect of postoperative adjuvant chemotherapy in gastric cancer.     

晚期胃癌的化学治疗

与最佳支持治疗对比,化疗对晚期胃癌有显著意义,但仍没有一个方案能明显优于其他方案而被广泛接受。新一代化疗药物如伊立替康、紫杉醇、多西紫杉醇、奥沙利铂、S-1、卡培他滨等的近期Ⅲ期临床研究显示进一步提高了疗效。分子靶向药物带来新的希望,是另一研究热点,它和细胞毒药物的联合应用也正在探索中。     

Chemotherapy for metastatic breast cancer

Cytotoxic chemotherapy is a mainstay of treatment for advanced breast cancer. Treatment of metastatic (also called stage IV, advanced, or recurrent) breast cancer is not considered curative. Rather, the goals of treatment with chemotherapy are to prolong survival, alleviate or prevent tumor-related symptoms or complications, and improve quality of life. While the purpose of chemotherapy is to prevent or alleviate symptoms, chemotherapy paradoxically carries considerable toxicities that cause substantial symptoms in patients, notoriously including fatigue, nausea, vomiting, diarrhea, hair loss, mucositis, neutropenia, and neuropathy. Balancing the benefits and the side effects of chemotherapy is further complicated by the natural history of advanced breast cancer, which can be quite prolonged and typically involves multiple lines of chemotherapy, especially in patients whose tumors respond to treatment.     

Chemoradiotherapy for esophageal cancer

Since mucosal (T1a) esophageal cancer is well controlled by endoscopic treatment, chemoradiotherapy (CRTx) is not indicated. However, for a submucosal (T1b, N0) esophageal cancer, CRTx may be the first line of treatment, since it can provide a good response rate, with an excellent survival rate comparable to that after esophagectomy. Definitive CRTx is also in the first line of treatment for a T4 esophageal cancer, because there was no difference in the survival rate between CRTx with surgery and CRTx without surgery in our trial. Esophagectomy is indicated only for non-responders or recurrence-salvage surgery. For patients with a potentially-resectable (T2-T3) esophageal cancer, esophagectomy offered a longer survival rate than CRTx did, in our series. However, there remains controversy over the efficacy of CRTx for a T2-T3 esophageal cancer. It has been reported by the National Cancer Center Hospital East Group that definitive CRTx provided the same survival rate as esophagectomy. A prospective trial comparing the survival rate after esophagectomy and that after CRTx for a T2-T3 esophageal cancer is needed.     

Chemotherapy for metastatic breast cancer

The treatment of metastatic breast cancer aims to relieve symptoms by controlling disease and prolonging survival with better QOL. The meta-analysis demonstrated the significant advantage for overall survival by chemotherapy with a longer period. It means that chemotherapy can prolong survival. The major chemotherapies contain anthracyclines or taxanes. For HER 2-overexpressing breast cancer, a standard treatment utilizes trastuzumab-containing chemotherapy. The other active agents include vinorelbine, capecitabine, S-1, mitomycin and gemcitabine. Bisphosphonates combined with chemotherapy or hormone therapy are able to alleviate pain or complications of osteolytic bone metastasis. Experimental agents, such as monoclonal antibody or small molecular kinase inhibitor, are investigated for clinical use. The treatments, either chemotherapy or hormone therapy, could be performed in sequence in order to minimize toxicities and maximize efficacy. In selecting the most appropriate treatment for metastatic breast cancer, it is recommended to consider patients' preference by providing the correct information on the status of disease, efficacy and toxicities of chemotherapy.     

晚期胰腺癌的化疗

单药吉西他滨是晚期胰腺癌的标准治疗,但疗效并不理想.吉西他滨已与多种细胞毒药物或生物靶向药物组成多个联合方案,但是在大多数Ⅲ期临床研究中这些联合方案对生存时间的延长并没有超过吉西他滨单药.有Ⅲ期临床研究结果显示埃罗替尼联合吉西他滨可延长晚期胰腺癌患者的生存时间.非吉西他滨的化疗方案也正在评估中,并已初步看到了希望.     

晚期胃癌的化学治疗

与最佳支持治疗对比,化疗对晚期胃癌有显著意义,但仍没有一个方案能明显优于其他方案而被广泛接受。新一代化疗药物如伊立替康、紫杉醇、多西紫杉醇、奥沙利铂、S-1、卡培他滨等的近期Ⅲ期临床研究显示进一步提高了疗效。分子靶向药物带来新的希望,是另一研究热点,它和细胞毒药物的联合应用也正在探索中。     

Chemotherapy for metastatic colorectal cancer

The past decade has seen a significant survival improvement for patients with metastatic colorectal cancer, fueled in large part by the arrival of active novel chemotherapeutic drugs and their incorporation into combination regimens. Several randomized trials have successfully integrated oxaliplatin and irinotecan into previously existing 5-fluorouracil (5-FU)-based regimens for advanced colorectal cancer, resulting in median survivals that have risen from 9 months to almost 2 years. Even as the ideal combinations and sequences of these regimens are elucidated, targeted therapies such as recently approved bevacizumab and cetuximab have been added to treatment protocols, with favorable consequences. We review the evolution of primary chemotherapy for advanced colorectal cancer, focusing on the trials that have led to the new standard first-line treatments. We also review the data on newer targeted therapies, especially in combination with cytotoxic therapy.     

Chemotherapy for metastatic bladder cancer

This paper reviews the current status of systemic chemotherapy in the management of advanced and metastatic urothelial cancer. The activity of a number of single agents and combination drug regimens is discussed, and the small number of randomised-controlled studies available is also considered. Prognostic factors for response and survival, particularly long-term survival after systemic chemotherapy, are also reviewed. Special consideration is given to the role of systemic chemotherapy as a precursor to surgery (or radiotherapy) in locally advanced disease that is initially considered incurable. Therapeutic options for patients unable to tolerate cisplatin owing to renal impairment or other comorbidities are explored. Future directions are explored, including the role of molecular phenotyping in providing prognostic information, indicators of the likely success of conventional therapeutic measures and the development of specific targeted therapies.