The role of the pharmacist to an inpatient in order to switch from inpatient treatment to a home-based care of an outpatient--the usefulness of a patient record notebook in cancer chemotherapy

We have been successfully using a patient's record notebook in home-based outpatient cancer chemotherapy since 2003. Many of the patients expressed their satisfaction carrying a patient record notebook through our questionnaires designed to illicit details of their side effects during the chemotherapy. There are so many tasks the patient has to do by his own once he leaves the hospital and to become an outpatient. One of the important tasks the patient has to do is how to take care of the side effect by himself. In fact, some of the patients had a difficulty in evaluating their own side effect symptoms. In evaluating the side effect of patients by a pharmacist, he should not rely on the patient record notebook alone, but careful attention has to be paid to a patient's general condition by our medical team members consisting of inpatient pharmacists, surgeons, chemotherapists, palliative care physicians, nurses, social workers and others. In order to proceed with the safety of chemotherapy, it is critical to have a consensus based on medical policies concerning the reduction of side effects and to support the fight against cancer with the medical team members. The results also suggest that the patient record notebook is more useful for pharmacists in controlling of side effects and to adopt a prudent policy for chemotherapy.     

鞘内化疗相关的脊髓病1例并文献复习

目的:探讨鞘内化疗相关脊髓病的临床表现、诊断与治疗,以提高临床医生对鞘内化疗相关脊髓病的认识.方法:总结1例男性急性髓系白血病患者,在多次鞘内化疗后继发脊髓病,表现为脊髓损害平面以下感觉异常、下肢无力及大小便困难等,给予抗神经毒治疗后,观察其病情演变及转归,并复习相关文献.结果:在营养神经、物理及针灸等治疗后患者脊髓病的相关症状逐渐减轻.结论:脊髓病是鞘内化疗的一种少见却严重的神经系统并发症,无特效治疗方案,预后不一,临床应加以重视.     

A case report of severe hypo-phosphatemia due to paraneoplastic syndrome followed by severe hyper-phosphatemia due to tumor lysis syndrome after CHOP chemotherapy

A 51-year-old man who underwent umbilical cord blood transplantation for acute lymphoblastic leukemia with a Philadelphia chromosome in April 2006 achieved complete remission. In June 2008, progressive renal dysfunction and melena emerged and the patient was diagnosed with B-cell-type malignant lymphoma. He presented with severe hypo-phosphate- mia(0. 1m g/dL)due to paraneoplastic syndrome, simultaneously. Because the development of tumor lysis syndrome followed by hyper-phophatemia was feared to occur after CHOP chemotherapy, we discontinued the adjustment of serum phosphorus. The serum phosphorus level was elevated to 11.6mg/dL after 3 days and decreased to 3. 8mg/dL after 5 days. We must be careful regarding hyper-phosphatemia and phosphorus adjustment even in patients with severe hypo-phosphatemia that is due to paraneoplastic syndrome.     

Age-related longitudinal changes in depressive symptoms following breast cancer diagnosis and treatment

Younger women being treated for breast cancer consistently show greater depression shortly after diagnosis than older women. In this longitudinal study, we examine whether these age differences persist over the first 26 months following diagnosis and identify factors related to change in depressive symptoms. A total of 653 women within 8 months of a first time breast cancer diagnosis completed questionnaires at baseline and three additional timepoints (6, 12, and 18 months after baseline) on contextual/patient characteristics, symptoms, and psychosocial variables. Chart reviews provided cancer and treatment-related data. The primary outcome was depressive symptomatology assessed by the Beck Depression Inventory. Among women younger than age 65, depressive symptoms were highest soon after diagnosis and significantly decreased over time. Depressive symptoms remained stable and low for women aged 65 and older. Age was no longer significantly related to depressive symptoms in multivariable analyses controlling for a wide range of covariates. The primary factors related to levels of and declines in depressive symptomatology were the ability to pay for basics; completing chemotherapy with doxorubicin; and decreases in pain, vasomotor symptoms, illness intrusiveness, and passive coping. Increased sense of meaning/peace and social support were related to decreased depression. Interventions to reduce symptoms and illness intrusiveness, improve a sense of meaning and peace, and increase social support, may help reduce depression and such interventions may be especially relevant for younger women.     

A case of lung resection after chemotherapy due to lung metastases derived from esophageal cancer resection

We report a rare case of esophageal cancer resection in which lung metastases was resected after chemotherapy with paclitaxel. A 59-year-old man with epigastralgia as a chief concern was referred to our hospital and was diagnosed with esophageal cancer by gastrointestinal fiber. In June 2007, the cancer was resected and followed by 3 courses of weekly chemotherapy with paclitaxel. In January 2009, chest computed tomography showed lung nodules (Rt-S1 and Rt-S5), and positron emission tomography (PET) showed uptake (Rt-S1); a final diagnosis of multiple lung metastases was made. Thereafter, the patient underwent 8 courses of weekly chemotherapy with paclitaxel. In December 2009, the growing Rt-S1 nodule was detected but no other lesion. The patient underwent a resection of lung metastases followed by 5 courses of weekly chemotherapy with paclitaxel. As of June 2011, the patient was alive and disease free. In conclusion, the resection of solitary lung metastases derived from esophageal cancer should be considered because it may improve survival.     

Remission due to CYVADIC chemotherapy of primary leiomyosarcoma derived from mesentelium of the sigmoid colon: a case report]

We report a case of leiomyosarcoma of mesenthelium origin, which was successfully treated with a combination of cyclophosphamide, vincristine, adriamycin and dacarbazine (CYVADIC). A 56-year-old woman received three courses of adjuvant CYVADIC chemotherapy after initial surgery consisting of tumorectomy, sigmoidectomy, descending colostomy, cystectomy and ureterostomy. A six-month disease-free period was attained obtained. A recurrent tumor showed remarkable reduction after three courses of CYVADIC chemotherapy. This case may be the first report of successful chemotherapy against a leiomyosarcoma of mesenthelium origin in Japan.     

Drug rash with eosinophilia and systemic symptoms syndrome following cholestatic hepatitis A: a case report

Hepatitis A virus (HAV) infections occur predominantly in children, and are usually self-limiting. However, 75-95% of the infections in adults are symptomatic (mostly with jaundice), with the illness symptoms usually persisting for a few weeks. Atypical manifestations include relapsing hepatitis, prolonged cholestasis, and complications involving renal injury. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, drug-induced hypersensitivity reaction characterized by skin rash, fever, lymph-node enlargement, and internal organ involvement. We describe a 22-year-old male who presented with acute kidney injury and was diagnosed with prolonged cholestatic hepatitis A. The patient also developed DRESS syndrome due to antibiotic and/or antiviral treatment. To our knowledge, this is the first report of histopathologically confirmed DRESS syndrome due to antibiotic and/or antiviral treatment following HAV infection with cholestatic features and renal injury.     

The experience of fatigue and other symptoms in patients receiving chemotherapy

Fatigue has been recognized as the most frequently reported symptom of cancer and cancer therapy. There is a lack of research on such aspects as the pattern of fatigue which accompanies treatment, its exacerbating and relieving factors, the different mechanisms of fatigue and its relationship with the factors purported to be related to the fatigue experience. It has been suggested that cancer patients may be those best placed to reveal the likely causes of fatigue. As part of a larger study examining the pattern of fatigue in cancer patients who were undergoing a course of chemotherapy treatment, patients’perceptions of fatigue and tiredness and the nature, pattern and causes of fatigue in relation to cancer and its treatment were obtained. In addition to a diary, interviews were conducted at two time points, at the beginning and end of a cycle of chemotherapy, with over 100 cancer patients. Just under 90% of the sample reported fatigue at some point during a cycle of chemotherapy. The majority of the sample did not consider tiredness and fatigue to constitute the same feelings. Subjects attributed their fatigue to a combination of factors but most frequently mentioned treatment, changes in sleep patterns and other symptoms. Implications for practice and research are outlined.     

Reactivation of chronic hepatitis B infection following intensive chemotherapy and successful treatment with lamivudine: A case report and review of the literature

Background:Hepatitis B virus reactivation has been reported incancer patients following administration of chemotherapy or immunosuppressivetherapy and may result in liver damage of varying degrees of severity.Although treatment is supportive in nature, lamivudine, a nucleoside analoguehas been found to suppress HBV replication as evidenced by reports of 13 casesin the medical literature. Patients and methods:We report a patient who achieved asuccessful outcome with lamivudine following reactivation of HBV duringcombination chemotherapy for non-Hodgkins lymphoma, and provide a briefoverview of the literature including the 13 published case reports. Results:Lamivudine therapy resulted in clinical improvement aswell as in normalization of liver function tests and coagulation profile. Conclusions:Lamivudine has been found to suppress HBV replicationmanifested both by histology and serum HBV-DNA levels in chronic carriers ofHBV who developed reactivation of hepatic disease following chemotherapy.Physicians caring for such patients should be able to recognize this clinicalchallenge, and lamivudine should be considered.     

Intestinal perforation due to metastasis of breast carcinoma, with special reference to chemotherapy: a case report

We report a case of small-bowel perforation due to metastatic carcinoma of the breast during chemotherapy. Partial resection of the small intestine and primary anastomosis were performed. Although the patient made a good recovery from panperitonitis, she died of the disease on the 55th postoperative day. Since perforation during chemotherapy results in an extremely poor prognosis, special caution during chemotherapy is needed for patients with possible gastrointestinal involvement with tumor.     

A case report of unresectable colon cancer that disappeared following pharmacokinetic modulation chemotherapy (PMC)

We encountered a case of unresectable colon cancer that disappeared following pharmacokinetic modulating chemotherapy (PMC). A 41-year-old male underwent ileotransverse anastomosis following a diagnosis of ileus due to unresectable colon cancer with peritoneal dissemination and multiple liver metastases. He was treated weekly with an intravenous infusion of 5-FU, 1,000 mg/body/24 hours and an oral administration of UFT 400 mg/day (PMC). After 6 months of weekly treatment of PMC, colon tumor disappeared and metastatic liver tumors decreased in size. PMC can be administered to outpatients without serious side effects; thus, this therapy improves the prognosis and the patient's quality of life.     

A case report of brain metastasis due to an advanced gastric cancer

In April 1984, a 49-year-old male underwent a partial gastrectomy for advanced gastric cancer. At that time, many metastatic foci were found, for example, in the rib, the lumbar vertebrae, the cervical vertebrae, and in the abdominal lymph nodes. Approximately one year later, he suddenly became disturbed and lost consciousness. A metastatic brain tumor was diagnosed. To destroy this tumor the patient received a course of irradiation therapy with a total dose of 45 gys directed toward head. Several months later, however, recurrence of the tumor was detected at the same intracranial region. Thus, a course of therapy, employing a combination of FT-207 and ACNU, was initiated against the recurrent tumor. Though the tumor was not eliminated, the patient manifested few of the prior symptoms. This state has continued for several months, with the patient having survived for three years after his gastrectomy. The following report will present the details of this case.     

Pericardial effusion due to pembrolizumab-induced immunotoxicity: A case report and literature review

The advent of immune checkpoint inhibitors has revolutionized cancer treatment. These novel agents have provided promising treatment options in patients with different types of cancers. One of these agents is pembrolizumab, which works by blocking the binding of T-lymphocytes to programmed cell death ligand 1 receptors on tumor cells, thus enabling immune activation of T-lymphocytes against tumor cells. Pembrolizumab is commonly used in metastatic nonsmall cell lung cancer and melanoma. However, despite the remarkable efficacy this agent has achieved, multiple immune-related adverse events have been reported including hepatitis, colitis, thyroid dysfunction, and pneumonitis. Only 2 other cases of pericardial effusion as a side effect of pembrolizumab have been cited in the literature; however, its incidence may be on the rise. Despite the rarity of this side effect, its complications are potentially life threatening and no clear platform currently exists to help guide healthcare professionals in the management of these adverse events. Herein we present the case of a 66-year-old female who developed pericardial effusion as a side effect of pembrolizumab and review the data currently available to assist in the management of this life-threatening condition.     

Osteosarcoma following radiation treatment for meningioma: Report of a case and effective treatment with chemotherapy

A case of effective chemotherapy in postirradiation sarcoma is reported. A 30-year-old woman underwent a subtotal resection of a benign mixed meningioma followed by a course of radiotherapy. Five years later she developed a skull tumor which was resected. Histological study showed sarcomatous change corresponding most likely to a postirradiation osteosarcoma. Adjuvant chemotherapy (methotrexate, carboplatin, and VP16) was given. A progression occurred 8 months later and the patient was treated unsuccessfully with tamoxifen, LHRH, and later with high dose methotrexate and carboplatin. Six months later a lung metastasis was discovered and she received four cycles of IVP (ifosfamide, vepeside, cisplatin) alternating with IVA (ifosfamide, vepeside, adriamycin). Within 4 months the primary and lung tumours had decreased substantially without evidence of progression at follow-up 5 months later. We conclude that IVP/IVA regimen is a potentially useful therapy when an osteosarcoma of the skull is in progression.     

The role of chemotherapy in intracranial germinoma: A case report

Background: The case of a 29-year-old man with histologically proven simultaneous germinoma (seminoma) of the pineal gland and a stage I embryonal carcinoma of the testis is reported. An intradural metastatic lesion from the pineal germinoma was diagnosed at the level of the first thoracic vertebra. Treatment, after inguinal orchiectomy, was chemotherapy only, rather than conventional radiotherapy for the pineal germinoma.Methods: Therapy consisted of bleomycin (B), etoposide (E) and cisplatin (P). MRI was used to assess the effectiveness of BEP chemotherapy.Results: A complete remission of the pineal gland germinoma and the epidural metastasis was documented after two cycles of BEP chemotherapy and after 15 months of follow-up the patient remains free of relapse.Discussion: The pathogenesis of simultaneously occurring germinoma of the pineal gland and embryonal cell carcinoma of the testis is discussed.The choice of therapy in these circumstances is a matter of debate and the good result of chemotherapy alone in this patient suggest that primary chemotherapy may be the therapy of choice in patients with pineal germinomas.     

A case report of primary duodenal adenocarcinoma responding to chemotherapy with S-1 and irinotecan

A 5 3-year-old woman was admitted to our hospital because of vomiting. CT scan and gastroduodenoscopy showed severe stenosis of the duodenal 3rd portion. There was no evidence of malignancy. We diagnosed a stricture due to a duodenal ulcer and laparotomy was performed. By means of biopsy of No.14d lymph node in the operation, adenocarcinoma of the duodenum was pointed out and we performed a pancreatoduodenectomy. Although adjuvant chemotherapy with S-1/paclitaxel (S-1 80 mg/body, po, day 1-14 and paclitaxel 120 mg/body iv day 1, 8)was administered after operation, the patient's serum CEA was elevated and metastic lymph nodes around the supra mesenteric artery were pointed out. The patient was started on combined chemotherapy with S-1/CPT-11(S-1 80 mg/body, po, day 1-14 and CPT-11 120 mg/body iv day 1), serum CEA levels returned to normal range, and marked reduction of lymph node size was observed on CT. The patient is still alive and free of disease three years after the operation. S-1/CPT-11 could therefore be a treatment option for patients with duodenal carcinoma.     

Resection of solitary metachronous lymph node metastasis from hepatocellular carcinoma following transarterial chemotherapy with cisplatin: a case report

A 74-year-old female was found to have a 40-mm liver tumor (in segment VIII) by ultrasonography and was diagnosed with hepatocellular carcinoma (HCC). She underwent liver resection and was stably treated without recurrence for 19 months. A 45-mm extrahepatic tumor was then found during follow-up with enhanced computed tomography and was diagnosed as being a metachronous lymph node (LN) metastasis. Angiography revealed that the metastasis LN was fed by both the right and left gastric arteries. Transarterial chemotherapy with cisplatin was scheduled to control LN metastasis and to prevent intrahepatic metastasis, simultaneously. Blood alteration using coil embolization was performed to isolate the feeding arteries before transarterial chemotherapy with cisplatin powder. The patient was stably treated for 6 months (3 times) and no new intra- or extrahepatic metastatic lesions appeared during the chemotherapy. The patient subsequently underwent systematic LN dissection of the porta hepatis. She was successfully treated, and has remained recurrence-free for almost 5 years.     

A case of bleeding tendency due to warfarin in a patient treated with chemotherapy by S-1

A 82-year-old male patient had suffered from a cancer of the papilla of Vater. After the operation, he received 4 courses of gemcitabine(GEM)adjuvant chemotherapy and warfarin(WF)administration because of thrombosis in the left internal jugular vein. Since the tumors re-grew, GEM was discontinued, and chemotherapy including S-1 and GEM was examined. However, the chemotherapy could not be continued because of edema in both lower legs and tassel midway in the 2nd course. Because of a bleeding tendency(non-measurable INR(international normalized ratio of prothrombin time)), WF administration was discontinued on the 11th day after S-1/GEM combined therapy was suspended. On the following day, although the INR value recovered to 1.7, it gradually worsened and the symptoms of pulmonary embolism developed on the 13th day. Then, INR was controlled by continuous infusion of heparin. Since the INR level decreased after that, in addition to heparin, re-medication of WF was performed. We tried to analyze the genotype of a patient, who had a tendency to bleed by coadministration of WF with S-1, in terms of hepatic cytochrome P-450(CYP)2C9 and vitamin K epoxide reductase complex subunit 1(VKORC1). We also measured the plasma concentration of S-and R-WF by HPLC after obtaining informed consent from the patient. We found that he is homozygous for CYP2C9 1/1 and for A/A of VKORC1(-1639G>A). The obtained data did not show the abnormalities of blood coagulation. Because the genotype of a patient with a tendency to bleed was a major type in a Japanese population, fine monitoring of INR is required in order to prevent side effects of blood coagulation by S-1 and WF coadministration, regardless of patient genotypes.