A patient with esophageal cancer recurrence responding to S-1 combined with cisplatin (CDDP)

We administered a combination chemotherapy of S-1 plus cisplatin (CDDP) therapy to a patient with recurrenced cancer of esophagus in lymph node. S-1 (80 mg/m(2)/day), taken out of the capsule, was administered via the catheter for tube feeding on day 1 to day 21 and CDDP at 60 mg/m(2)/day by intravenous drip infusion on day 8 for 3 weeks followed by a drug-free 2 week period as the first course. After 2 courses, CT findings showed a complete regression of the lymph node for complete response (CR). He has been alive for 10 months without recurrence. Combined use of S-1 and CDDP is effective as chemotherapy for recurrenced esophageal cancer.     

A patient with gastric cancer complicated with multiple spinal bone metastases showing a complete remission to combination of S-1 and CDDP

The patient was a 66-year-old man. Total gastrectomy was performed due to Borrmann V type moderately differentiated adenocarcinoma of the middle part of the stomach. The final diagnosis was UM 7x6 cm, sT3, sN1, sH0, sP0, sM0, sCY0, sStage IIIA, PM (-), DM (-), D2+alpha, Cur B, ly2, v2. Because CEA had increased slowly from ten months after the operation, it was judged a possibly partial relapse. Twice-administered CDDP 80 mg/body and S-1 80 mg on the eighth day served to decrease CEA. He was hospitalized again due to fracture of the spine, though he left the hospital once. The patient was diagnosed by MRI inspection of the vertebrae thoracicae and the lumbar vertebra as multiple spinal bone metastases. After CDDP 60 mg/body of day 8 was administered twice at S-1 80 mg/day, CEA became normal. Osteolytic changes of the spinal bone disappeared. The 24 months from February 2004 to January 2006 passed without additional treatment. His CEA value tended to rise within the normal range in February 2006. After that, the CEA level increased with a 4-week cycle of 2 weeks of S-1 40-80 mg alternating with a two-week rest.     

A case of multiple bone metastases from gastric cancer treated with combination chemotherapy of S-1 and CDDP

We report a case of multiple bone metastases from gastric cancer treated with combination chemotherapy of S-1 and CDDP. A 54-year-old man underwent distal gastrectomy for gastric cancer (Stage II) in March 2003. Multiple bone metastases complicated with DIC were diagnosed in September 2005. The patient was treated with combination chemotherapy of S-1 and CDDP. S-1 (80 mg/m2/day) was administered for 21 days followed by 14 days rest as one course. CDDP (60 mg/m2) administration was begun 8 days after the start of S-1. After one course of the treatment, DIC was resolved. The abnormal uptake at the bone metastases was found to have decreased by bone scintigraphy. Bone metastases recurred in April 2006. Although combination chemotherapy of S-1 and DOC was administered, the patient died of DIC in August 2006. Combination chemotherapy of S-1 and CDDP is considered effective treatment for prolonging survival in cases of gastric cancer with bone metastases.     

Effective chemotherapy with S-1 alone in a patient with lung metastases of breast cancer

We report a 50-year-old female with pulmonary metastases from breast cancer who responded to S-1. In September 2003, she underwent surgery for breast cancer. Four years 8 months after the operation, lung relapse was detected. After the treatment failure of FEC60 (5-FU 500 mg/m2, epirubicin 60 mg/m2, cyclophosphamide 500 mg/m2) and taxane antitumor drugs, oral administration of S-1 80 mg/body/day was initiated. At the end of three courses, thoracic CT revealed the disappearance of the lung metastasis. Advanced reactions during the administration period were mild. After 14 courses of S-1 therapy (during 11 months), a complete response was clinically maintained. S-1 showed a good antitumor effect and tolerance, and it might be useful for treating metastatic and recurrent breast cancers.     

A case of advanced gastric cancer patient who died from meningitis carcinomatosa after S-1 + CDDP therapy with good response

A 68-year-old male who had undergone a distal gastrectomy for gastric cancer in 1996 visited our hospital. Gastroscopy revealed a type 2 tumor at upper corpus, and its biopsy showed poorly differentiated adenocarcinoma. Because enhanced CT showed lymph node swelling at para aorta, S-1 (100 mg/day) was administered for 14 days and CDDP (20 mg/day) was administered for 4 days as 1 course. After 2 courses, the main tumor and lymph node swelling reduced evidently. A total gastrectomy was performed and the pathology revealed no cancer cells in the stomach and dissected lymph nodes. Two months after the operation, speech disturbance and numbness of the left hand appeared. CT showed 3 metastatic brain tumors, and radiation therapy was administered. Four months after the operation, headache appeared and cerebrospinal fluid examination showed adenocarcinoma cells. Although MTX (10 mg) was administered intrathecally, he was died 5 months after the operation.     

Complete response in a case of advanced esophageal cancer treated by combined chemotherapy of TS-1 and CDDP with radiotherapy

A 70-year-old patient with advanced esophageal cancer with invasion to the aorta was treated by combined chemotherapy of TS-1 and CDDP with radiotherapy. TS-1 (80 mg/m2) was administered for 14 days followed by 14 days rest, CDDP (70 mg/m2) was administered by 24 h continuous intravenous infusion at day 8 after the start of TS-1. Radiotherapy (5 days/week) at 2 Gy/day was concurrently started from the beginning of chemotherapy for 3 weeks. After the end of the first course, leukocytopenia of grade 2 and thrombocytopenia of grade 2 were observed. The second course of chemoradiotherapy was suspended for 1 week. After recovery from the toxicity, the second course was started. After the 2 courses of chemoradiotherapy, endoscopic examination with biopsy revealed the disappearance of the esophageal cancer. Combined chemotherapy of TS-1 and CDDP was administered 2 times after chemoradiotherapy. After this therapy, endoscopy and a CT showed a complete clinical response. No severe adverse effects were observed during this therapy. Combined chemotherapy of TS-1 and CDDP with radiotherapy can be effective for advanced esophageal cancer.     

Combination therapy with S-1 and CDDP for head and neck cancer

The combination with cisplatin (CDDP) and 5-FU is considered the first choice chemotherapy for squamous cell carcinoma of the head and neck (HNSCC). S-1, a modulation of tegafur developed in Japan, is an active agent for HNSCC. Some clinical phase I/II studies about the combination with CDDP and S-1 have been reported. The combination showed a good response rate of 67.6% for advanced and recurrent HNSCC in our clinical phase I/II study. The regimens of S-1 combined with carboplatin or nedaplatin have also been reported. Regimens containing S-1 appear to have been effective for HNSCC. Multi-institutional phase II studies with a large sample size are needed in the future. The compliance for patients is better than a 5-FU injection because S-1 is orally administrated. The adverse effect, especially for bone mallow toxicity, is equal or upgraded compared with a 5-FU injection. The efficacy and adverse effects of CDDP plus S-1 should be studied in carefully designed phase II/III trials. S-1 will be one of the key drugs for HNSCC in the future.     

Long survival of advanced gastric cancer patient after total gastrectomy and postoperative treatment with S-1 despite S-1+CDDP+CPT-11 causing perforation

Here we report a rare case with perforation of gastric cancer responding to chemotherapy. The patient was a 74- year-old male who underwent abdominal ultrasonography and contrast CT because of body-weight lost and poor appetite in June, 2004 and whose lymph node(LN)swelling was seen in the level from the hepatic to the renal hilum. A gastric wall irregularity was also seen. We suspected gastric cancer with LN metastasis and carried out upper gastrointestinal endoscopy. Then it demonstrated type 2 advanced gastric cancer from the upper to the middle body. The pathological diagnosis of gastric tumor was poorly-differentiated adenocarcinoma containing por 2, tub 1, and pap. The patient was treated with S-1, CDDP and CPT-11 and remained ambulant. After completion of 1 course of chemotherapy, he complained of intense abdominal pain, so we carried out upper gastrointestinal endoscopy and found perforation in the stomach at the same location as the gastric cancer. Emergency total gastrectomy was performed at once. The histopathological finding showed disappearance of the cancer cell not only in the stomach but also accessory LN. Because the remnant LN metastasis was seen in the hepatic hilum at abdominal contrast CT after operation, S-1 was administered to the patient as 60 mg/m2/day in ambulant. Now, over 40 months after the operation, the patient has been alive with good performance status and disappearance of LN metastasis.     

Complete remission of bladder cancer with multiple pulmonary metastases obtained by combined chemotherapy with cis-platinum, adriamycin and cyclophosphamide

A 54-year old man with metastatic transitional cell carcinoma (grade 3) of the bladder has achieved complete remission as a result of combination chemotherapy. Plain chest X-P demonstrated multiple pulmonary metastases and computed tomography demonstrated a 35 X 40 mm-sized bladder tumor. The patient was treated with four courses of combination chemotherapy consisting of cis-platinum, adriamycin and cyclophosphamide, after which complete disappearance of the pulmonary metastases and bladder tumor was observed. The patient has been followed up, with no evidence of tumor nine months after the treatment.     

Erlotinib therapy in a patient with non-small-cell lung cancer and brain metastases

Brain metastases are a common occurrence and a major cause of mortality in non-small-cell lung cancer, with few systemic treatment options. Although targeting epidermal growth factor receptor-associated tyrosine kinase with erlotinib and gefitinib results in durable responses in some patients, the activity of these drugs against brain metastases has been poorly documented. In particular, few reports have so far reported the activity of erlotinib in this setting. Here we report the case of a male Italian smoker with an adeno-carcinoma of the lung whose lung cancer and brain metastases have both responded to erlotinib.     

A case of multiple pulmonary metastases from rectal cancer effectively treated by TS-1 and low-dose CDDP therapy

We report a patient with multiple pulmonary metastases from rectal cancer effectively treated with TS-1 and low-dose CDDP combination chemotherapy. The patient was a 61-year-old man with rectal cancer and multiple pulmonary metastases. He had undergone abdominoperineal excision of the rectum at another hospital before this hospitalization. After the operation, we treated the patient by the combination chemotherapy of TS-1 and low-dose CDDP during his hospital stay and in the outpatient clinic after hospital discharge. After the chemotherapy was started, tumor markers decreased, and finally were in the normal range. The pulmonary metastatic lesions were remarkably reduced on CT, and the effect of this therapy was PR. No severe side effect was observed throughout the treatment. This combination chemotherapy is considered to be an effective therapy for colorectal cancer with good QOL.     

A case of advanced gastric cancer with multiple bone metastases and distant lymph node metastases successfully treated by S-1/CDDP combination chemotherapy

We describe a 46-year-old man who presented with the chief complaint of lower back pain. The patient was diagnosed with advanced gastric cancer accompanied by multiple bone metastases, with compression fractures in the thoracolumbar vertebrae as well as distant lymph node metastases. He was administered eight courses of S-1/CDDP combination chemotherapy. Treatment results were as follows: primary lesion, non-CR/non-PD; lymph node metastases, CR; and bone metastases, non-CR/non-PD. As only the primary lesion showed a tendency toward progression after completion of eight courses, distal gastrectomy with D1 dissection was performed. Histopathological test results were ypT1b(SM1)and ypN1(2/22). The histological grade following treatment was grade 2 for both the primary lesion and the lymph nodes Following subsequent treatment with S-1 monotherapy and zoledronic acid, the disease did not progress, and at one year and four months since diagnosis and six months since surgery, CR and non-CR/non-PD have been maintained for the lymph node metastases and bone metastases, respectively.     

Complete response to CPT-11 and UFT/LV combination therapy in a case with simultaneous multiple lung metastases from colon cancer

We report the complete response for one year of a patient with simultaneous multiple lung metastases from colon cancer who was treated using a combination of irinotecan (CPT-11) and uracil/tegafur (UFT)/Leucovorin (LV) using a schedule reported overseas. A 61-year-old woman was admitted to our hospital and diagnosed with ascending colon cancer and simultaneous multiple lung metastases. The patient underwent a right hemicolectomy and was treated with CPT-11 (150 mg/m(2)) on day 1 and oral UFT and oral LV on days 1-14. This treatment cycle was repeated every 3 weeks. A CT examination after 4 cycles of chemotherapy revealed a partial response of multiple lung metastases, and the next examination after 6 cycles revealed a complete response. The adverse effects observed during this chemotherapy regimen were leucopenia (grade 1), neutropenia (grade 2), vomiting (grade 2) and hair loss (grade 1). The patient is now receiving her 22nd cycle of chemotherapy, and her multiple metastases have shown a complete response for one year. The CPT-11 and UFT/LV combination therapy was well tolerated and was covered by the national health insurance system in Japan. This treatment may enable prolonged survival and improve quality of life in patients with metastatic colorectal cancer.     

A case of postoperative multiple pulmonary metastases of non-small-cell lung cancer successfully treated with S-1

We report a case of postoperative multiple pulmonary metastases of NSCLC successfully treated with S-1. A 72-year-old man underwent rt. lower lobectomy + ND 2 a by VATS. The histopathological examination showed squamous cell carcinoma, pT4 (satellite nodules in same lobe) N0M0. Multiple pulmonary metastases appeared 3 months after operation. We started combination chemotherapy with S-1 and CBDCA. S-1 (100 mg/body) was administered on days 1-21. CBDCA (AUC=5.0) was administered on day 8. Multiple pulmonary metastases almost disappeared after 2 courses of combination chemotherapy. After 6 courses of combination chemotherapy with S-1 and CBDCA, we then converted to S-1 only. Every cycle was repeated every 5 weeks. One year later, there was no sign of disease progression. S-1 is considered to be effective and safely administered in patients with NSCLC.     

Complete response in an elderly patient with advanced gastric scirrhous cancer treated with combined chemotherapy of TS-1 and CDDP

A 79-year-old male was diagnosed as having a scirrhous cancer of the stomach. Carcinomatous peritonitis was suspected on abdominal CT examination and the CA19-9 showed a high level of 95 U/ml. The patient was treated with combined chemotherapy of TS-1 and CDDP. TS-1 (100 mg/day) was administered for 14 days followed by 14 days rest as one course. CDDP was administered in 24-h continuous intravenous infusion on day 8. This treatment was done every 4 weeks regularly. After 5 courses, X-ray and endoscopy examinations revealed disappearance of cancerous lesions in the stomach with an improvement in the extensibility. No cancer cell were confirmed by endoscopic biopsy, nor did a CT-scan detect carcinomatous peritonitis. The CA19-9 decreased within the normal limit. Ten months after chemotherapy was started, the patient was very healthy without a recurrence of cancer. This combined chemotherapy has administered in 8 courses, and during this period no high grade toxicities (WHO grade 3 or 4) occurred. This TS-1/CDDP chemotherapy was effective for scirrhous gastric cancer and might be administered safely even for aged patients.     

A case report of the combination therapy with S-1 plus CDDP intraperitoneal chemotherapy for CY positive cancer patient

A male patient in his 50s underwent distal gastrectomy for gastric cancer. In operation, there was no peritoneal dissemination. But peritoneal lavage cytology revealed positive peritoneal dissemination. Thus, we set an intraperitoneal infuser port to this patient. On specimen, a type-3 tumor was located in the gastric lesser of antrum to angle. Microscopic examination of specimens revealed a signet ring cell carcinoma and poorly differentiated adenocarcinoma under serosa, and positive of lymph node metastasis. The diagnosis was pT4N2M1P0CY1H0, Stage IV( Japanese classification of gastric carcinoma The 14 Edition). CDDP was administered through the infuser port (on day 7, a first dose of 60 mg/m2 and 30 mg/m2 for second) combined with oral administration of S-1 (100 mg/body) for two weeks, with one week of drug withdrawal. This chemotherapy was repeated for 11 courses. After that, peritoneal lavage cytology became negative. S-1 oral administration was continued for four years, and this patient has been well for five years and six months after the surgery. Therefore, it is suggested that intraperitoneal chemotherapy with cisplatin is an effective treatment for microscopical peritoneal dissemination.     

Complete response to treatment with low-dose FP therapy in a patient with stage IVB primary hepatocellular carcinoma with multiple lung and bone metastases

We report a case in which low-dose FP (5-fluorouracil/cisplatin, 5-FU/CDDP) therapy was remarkably effective for stage IVB advanced hepatocellular carcinoma (HCC) with lung and bone metastases. 5-FU of 250 mg/body/day was continuously infused over 24 hours and CDDP of 10 mg/body/day was infused over 30 minutes from day 1 to day 5 in a week. Administration was continued for 4 weeks as 1 cycle. An 81-year-old woman was diagnosed with HCC in S3 and underwent a transcatheter hepatic arterial embolization (TAE) for the tumor in December 2000. The patient complained of lumbago and hip pain in July 2001 and was admitted for dysbasia in September 2001. On admission, the level of serum AFP and PIVKA-II elevated to a remarkable 59,300 ng/ml and 25,700 AU/ml. Chest computed tomography (CT) showed multiple bilateral lung metastases and abdominal CT showed a tumor 12 x 11 x 10 cm in diameter in the right, iliac bone. No recurrent sign was found in the liver except for the accumulation of Lipiodol. Low-dose FP therapy of 2 cycles was performed. The levels of serum AFP and PIVKA-II decreased to 374 ng/ml from 59,300 and to 35 AU/ml from 25,700, respectively, after this therapy. The CT findings revealed that a complete response (CR) was obtained for lung metastases and a partial response (PR) was obtained for bone metastases after completion of course 2, and maintained thereafter. The oral UFT of 600 mg was administered after completion of course 2 in the outpatient setting. The level of AFP and PIVKA-II decreased to 13.2 ng/ml and to 26 AU/ml, respectively, in February 2002. No sign of recurrence was seen during the 13 months of follow-up after low-dose FP therapy. Toxic events consisted of only leukopenia (grade 1). Her quality of life (QOL) was fair during this therapy. Low-dose FP therapy is possibly useful for patients with stage IVB advanced HCC.     

A case of advanced gastric cancer with liver metastases successively treated with S-1/CDDP combination therapy followed by curative resection

The patient was a 67-year-old male with type-3 gastric cancer from the upper body of the stomach to the cardia. An abdominal computed tomography scan revealed liver metastases(S8)(T2N0M0H1, Stage IV). The patient received neoadjuvant combined chemotherapy with S-1 and CDDP. S-1(120mg/body/day)was orally administered for 3 weeks followed by 2 drug-free weeks as a course, and CDDP(60mg/m2)was administered by intravenous infusion on day 8. After the second course, significant tumor reduction and disappearance of liver metastases resulted. Total gastrectomy, splenectomy, cholecystectomy, and D2 nodal dissection were performed. The histological diagnosis revealed no metastases in all lymph nodes: Stage I B. The combined neoadjuvant chemotherapy with S-1 and CDDP can be considered an effective treatment for advanced gastric cancer.     

替吉奥联合奥沙利铂治疗晚期食管癌近期疗效观察

目的 观察替吉奥联合奥沙利铂治疗晚期食管癌的近期疗效及不良反应.方法 30例晚期食管癌均接受化疗,替吉奥80mg/(m2 ·d),分2次,餐后口服,dl-14;奥沙利铂130 mg/m2,dl,静脉滴注＞3小时,21天为1周期,2周期后行胸腹部CT及消化道钡餐造影或胃镜评价疗效,并评价不良反应.结果 30例患者均可评价疗效,完全缓解(CR)0例,部分缓解(PR) 12例,病情稳定(SD)8例,病情进展(PD) 10例,有效率(CR+ PR)为40.0％,临床获益率(CR+PR+SD)为66.7％.中位疾病进展时间5月,1年生存率63.3％.主要不良反应为血液学毒性、消化道反应、肝功能损伤、皮疹、神经毒性等.结论 替吉奥联合奥沙利铂治疗晚期食管癌疗效较好,不良反应可耐受.     

Complete response to S-1/CDDP combination in a patient with obstructive jaundice secondary to lymph node metastasis by gastric cancer - a case report

A 55-year-old woman was found to have a type-4 lesion centered on the greater curvature of the lower portion of her stomach during an upper gastrointestinal endoscopic examination.A diagnosis of inoperable advanced gastric carcinoma [type 4, tub 2/por, T3 (SE), N3, H0, P1, cStage IV], complicated by pyloric stenosis, liver dysfunction, and obstructive jaundice untreatable by bile drainage, was made.After obtaining the informed consent of the patient and her family and explain- ing that under the circumstances surgery was not indicated, chemotherapy [S-1 (granules) 80 mg/m2, CDDP 60 mg/m2] was selected. After starting treatment, an improvement in liver dysfunction and jaundice was observed, and at the start of the second course, the patient had become capable of oral feeding.The patient was discharged after completion of the second course. No choices associated with evidence exist for treatment of patients with inoperable advanced gastric cancer (complicated by obstructive jaundice), who are not elderly and have good performance status (PS).We report this case in which improvement of activity of daily living (ADL) was achieved relatively safely by treatment with S-1/CDDP, together with a brief discussion based on the literature.