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  • 1
    Language: Japanese
    In: 日本消化器病学会雑誌, 2018, Vol.115(6), pp.514-520
    Description: 〈p〉切除不能・再発胃癌の主たる治療法は化学療法である.本邦における一次治療は,HER2陰性例ではS-1+シスプラチン療法やS-1+オキサリプラチン療法が,HER2陽性例ではカペシタビン+シスプラチン+トラスツズマブ療法が標準的である.また二次治療の意義が明らかになり,ラムシルマブ+パクリタキセル療法が標準的に用いられる.さらに,三次治療としてニボルマブの有用性が明らかになった.抗PD-1抗体薬と殺細胞薬のコンビネーションも各ラインで検証されており,今後のさらなる展開が期待される.臨床腫瘍医は,切除不能進行・再発胃癌に対し有効な6剤すべてを使い切る戦略を考慮して治療にあたることが望ましい.〈/p〉
    Keywords: 切除不能・再発胃癌 ; 化学療法 ; 胃癌治療ガイドライン ; HER2 ; 免疫チェックポイント阻害薬
    ISSN: 0446-6586
    E-ISSN: 13497693
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  • 2
    Language: English
    In: Gastric Cancer, 2017, Vol.20(5), pp.757-763
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s10120-017-0702-0 Byline: Daisuke Takahari (1), Junki Mizusawa (2), Wasaburo Koizumi (3), Ichinosuke Hyodo (4), Narikazu Boku (5) Keywords: Prognostic index; Prognostic factor; Advanced gastric cancer; Chemotherapy Abstract: Background In a phase III study for advanced gastric cancer (AGC), the Japan Clinical Oncology Group (JCOG) 9912 trial, we previously identified the following four prognostic factors--performance status a[yen]1, number of metastatic sites a[yen]2, no prior gastrectomy, and abnormal serum alkaline phosphatase levels--and proposed a prognostic index (good risk with 0 or 1 factor, moderate risk with 2 or 3 factors, and poor risk with all 4 factors). To assess the generalizability of this index, we attempted an external validation study using an independent data set. Methods Individual patient data from the SPIRITS and G-SOX trials were applied to the JCOG prognostic index. The accuracy of the index for predicting survival was assessed by the Cox proportional hazards model. Results The available data were obtained from 936 (94.5%) of the 990 patients in these trials. The three risk groups categorized by the JCOG prognostic index demonstrated highly significant survival differences the hazard ratios (95% confidence interval) were 1.71 (1.46--2.01) between the good (n = 338) and moderate (n = 537) risk groups and 3.32 (2.47--4.46) between good and poor (n = 61) risk groups. The median overall survival times of the good, moderate, and poor risk groups were 17.2, 12.0, and 7.8 months, respectively. Conclusions The JCOG prognostic index was externally validated and can be widely utilized for clinical trials. Further studies are needed to apply this index to the Western population. Author Affiliation: (1) Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto ward, Tokyo, 135-8550, Japan (2) Biostatistics Division, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan (3) Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan (4) Division of Gastroenterology, University of Tsukuba, Tsukuba, Japan (5) Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan Article History: Registration Date: 06/02/2017 Received Date: 25/12/2016 Accepted Date: 05/02/2017 Online Date: 16/02/2017 Article note: Presented in part at the 2016 Annual Meeting of the American Society of Clinical Oncology, 3--7 June 2016, Chicago, IL, USA.
    Keywords: Prognostic index ; Prognostic factor ; Advanced gastric cancer ; Chemotherapy
    ISSN: 1436-3291
    E-ISSN: 1436-3305
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  • 3
    Language: English
    In: Journal of Clinical Oncology, 02/2016, Vol.34(4_suppl), pp.52-52
    ISSN: 0732-183X
    E-ISSN: 1527-7755
    Source: CrossRef
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  • 4
    Language: English
    In: Gastric Cancer, 2014, Vol.17(2), pp.383-386
    Description: Byline: Daisuke Takahari (1), Tetsuya Hamaguchi (2), Kenichi Yoshimura (3), Hitoshi Katai (4), Seiji Ito (5), Nozomu Fuse (6), Masaru Konishi (7), Hirofumi Yasui (8), Masanori Terashima (9), Masahiro Goto (10), Nobuhiko Tanigawa (11), Kuniaki Shirao (12), Takeshi Sano (13), Mitsuru Sasako (14) Keywords: Adjuvant chemotherapy; Gastric cancer; S-1; Cisplatin Abstract: Background We previously reported that S-1 plus cisplatin was feasible as adjuvant chemotherapy for stage III gastric cancer after D2 gastrectomy. Herein we evaluate the recurrence-free survival and overall survival rates as secondary endpoints based on updated follow-up data. Methods Patients with stage III gastric cancer who underwent D2 gastrectomy were enrolled. Treatment consisted of 3 cycles of S-1 (40 mg/m.sup.2 PO) twice daily on days 1--21 and cisplatin (60 mg/m.sup.2 IV) on day 8, and S-1 was given on days 1--28 every 6 weeks until 1 year after surgery. Results From August 2007 to September 2009, 63 patients were accrued. Overall, 34 and 25 patients had stage IIIA and IIIB disease, respectively. After a median follow-up of 3.9 years, 16 patients experienced recurrence and 11 patients died. The 3-year recurrence-free survival rate was 74.1 % (95 % CI: 60.8--83.5 %, IIIA 81.8 %, IIIB 64.0 %). The 3-year overall survival rate was 84.5 % (95 % CI: 72.3--91.6 %, IIIA 87.9 %, IIIB 80.0 %). Recurrence sites included the peritoneum (n = 8), hematogenous sites (n = 6), and lymph nodes (n = 4). Conclusion The present results indicate that adjuvant therapy with S-1 plus 3 cycles of cisplatin may provide a survival benefit to patients with stage III gastric cancer. Author Affiliation: (1) Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Aichi, Japan (2) Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan (3) Translational Research Center, Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan (4) Gastric Surgery Division, National Cancer Center Hospital, Kashiwa, Japan (5) Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Aichi, Japan (6) Division of Gastrointestinal Oncology and Digestive Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan (7) Division of Surgical Oncology, National Cancer Center Hospital East, Kashiwa, Japan (8) Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan (9) Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan (10) Cancer Chemotherapy Center, Osaka Medical College, Takatsuki, Japan (11) General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan (12) Department of Medical Oncology, Faculty of Medicine, Oita University, Yufu, Japan (13) Department of Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan (14) Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan Article History: Registration Date: 30/04/2013 Received Date: 04/12/2012 Accepted Date: 21/04/2013 Online Date: 30/05/2013
    Keywords: Adjuvant chemotherapy ; Gastric cancer ; S-1 ; Cisplatin
    ISSN: 1436-3291
    E-ISSN: 1436-3305
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  • 5
  • 6
    Language: English
    In: International Journal of Radiation Oncology, Biology, Physics, 01 November 2012, Vol.84(3), pp.786-792
    Description: The 7th edition of the American Joint Committee on Cancer staging system does not include lymph node size in the guidelines for staging patients with esophageal cancer. The objectives of this study were to determine the prognostic impact of the maximum metastatic lymph node diameter (ND) on survival and to develop and validate a new staging system for patients with esophageal squamous cell cancer who were treated with definitive chemoradiotherapy (CRT). Information on 402 patients with esophageal cancer undergoing CRT at two institutions was reviewed. Univariate and multivariate analyses of data from one institution were used to assess the impact of clinical factors on survival, and recursive partitioning analysis was performed to develop the new staging classification. To assess its clinical utility, the new classification was validated using data from the second institution. By multivariate analysis, gender, T, N, and ND stages were independently and significantly associated with survival ( 〈 0.05). The resulting new staging classification was based on the T and ND. The four new stages led to good separation of survival curves in both the developmental and validation datasets ( 〈 0.05). Our results showed that lymph node size is a strong independent prognostic factor and that the new staging system, which incorporated lymph node size, provided good prognostic power, and discriminated effectively for patients with esophageal cancer undergoing CRT.
    Keywords: Esophageal Cancer ; Chemoradiotherapy ; Tnm ; Recursive Partitioning Analysis ; Prognostic Factor ; Medicine
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 7
    Language: English
    In: International Journal of Radiation Oncology, Biology, Physics, 01 February 2012, Vol.82(2), pp.946-952
    Description: The new 7th edition of the American Joint Committee on Cancer TNM staging system is based on pathologic data from esophageal cancers treated by surgery alone. There is no information available on evaluation of the new staging system with regard to prognosis of patients treated with chemoradiotherapy (CRT). The objective of this study was to evaluate the prognostic impact of the new staging system on esophageal cancer patients treated with CRT. A retrospective review was performed on 301 consecutive esophageal squamous cell carcinoma patients treated with CRT. Comparisons were made of the prognostic impacts of the 6th and 7th staging systems and the prognostic impacts of stage and prognostic groups, which were newly defined in the 7th edition. There were significant differences between Stages I and III ( 〈 0.01) according to both editions. However, the 7th edition poorly distinguishes the prognoses of Stages III and IV (  = 0.36 by multivariate analysis) in comparison to the 6th edition (  = 0.08 by multivariate analysis), although these differences were not significant. For all patients, T, M, and gender were independent prognostic factors by multivariate analysis ( 〈 0.05). For the Stage I and II prognostic groups, survival curves showed a stepwise decrease with increase in stage, except for Stage IIA. However, there were no significant differences seen between each prognostic stage. Our study indicates there are several problems with the 7th TNM staging system regarding prognostic factors in patients undergoing CRT.
    Keywords: Esophageal Cancer ; Chemoradiotherapy ; American Joint Committee on Cancer ; Tnm ; Prognostic Factor ; Medicine
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 8
    Language: English
    In: Gastric Cancer, 2010, Vol.13(3), pp.186-190
    Description: Byline: Daisuke Takahari (1,2), Yasuhiro Shimada (1), Shigeyuki Takeshita (1), Hitoshi Nishitani (1), Atsuo Takashima (1), Natsuko Okita (1), Yoshinori Hirashima (1), Ken Kato (1), Tetsuya Hamaguchi (1), Yasuhide Yamada (1), Kuniaki Shirao (1) Keywords: Irinotecan; Cisplatin; Gastric cancer; Second-line chemotherapy; S-1 failure Abstract: Background For advanced gastric cancer (AGC), second-line chemotherapy after the failure of S-1 has not yet been established. The present study aimed to retrospectively evaluate the efficacy and safety of irinotecan plus cisplatin (IP) therapy after the failure of S-1 in patients with AGC. Methods The subjects included 87 patients with AGC who received IP therapy as second-line chemotherapy. Irinotecan (70 mg/m.sup.2) was administered by intravenous infusion followed by an intravenous infusion of cisplatin (80 mg/m.sup.2) on day 1. On day 15, irinotecan (70 mg/m.sup.2) alone was administered. The treatment was repeated every 4 weeks until disease progression, patient refusal, or severe adverse events. Results The median patient age was 62 years (range, 39--75 years), and the median number of treatment cycles was 3 (range, 1--9). Out of the 87 patients, 70 were assessable for clinical response. There were 2 complete responses and 18 partial responses. The overall response rate was 28.6% (95% confidence interval [CI], 18.4%--40.6%) and the disease control ratio was 70.0%. The median time to progression and median survival time from the first day of IP therapy were 4.3 months and 9.4 months, respectively. The 1-year survival rate was 34.6%. Severe (grade 3/4) leukopenia, neutropenia, anemia, and thrombocytopenia were observed in 34%, 40%, 28%, and 8% of patients, respectively. Grade 3/4 nonhematologic toxicities included anorexia (17%), febrile neutropenia (10%), diarrhea (6%), fatigue (5%), nausea (2%), and elevated creatinine (1%). Conclusions The combination of irinotecan plus cisplatin as second-line chemotherapy for AGC appears to be an effective and feasible treatment option after S-1 failure. Author Affiliation: (1) Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan (2) Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan Article History: Registration Date: 02/09/2010 Received Date: 07/12/2009 Accepted Date: 12/05/2010 Online Date: 05/09/2010
    Keywords: Irinotecan ; Cisplatin ; Gastric cancer ; Second-line chemotherapy ; S-1 failure
    ISSN: 1436-3291
    E-ISSN: 1436-3305
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  • 9
    Language: English
    In: Case Reports in Oncology, 21 July 2010, Vol.3(2), pp.262-267
    Description: Introduction: The prognosis of advanced gastric cancer patients, especially those with poor performance status (PS), is generally dismally poor. Patients with PS 3–4 are usually ineligible for participation in clinical studies and are managed with only best supportive care. Case Report: A 63-year-old male with advanced gastric cancer was admitted to our hospital. His PS was markedly impaired (Eastern Cooperative Oncology Group PS 4), with dyspnea secondary to lymphangitis, pleuritis and pericarditis). He also had bilateral leg paralysis due to multiple bone metastases. He was treated with chemotherapy using 5-fluorouracil and leucovorin for 14 days with pericardial drainage followed by intrapericardial infusion of cisplatin. He was also treated with radiotherapy for bone metastasis. The patient required 5 l/min oxygen therapy at the start of chemotherapy, but his dyspnea was improved by day 14 and he no longer required supplemental oxygen therapy. His leg paralysis also improved with the radiation therapy. His PS was significantly improved with this multimodal treatment modality, and he was ultimately discharged with chemotherapy with oral fluoropyrimidine. Conclusion: This case suggests that multimodal therapy including chemotherapy may be beneficial in advanced gastric cancer patients even in the setting of poor PS. Further study might be required to confirm the benefit of chemotherapy in this patient population.
    Keywords: Published: July 2010 ; Gastric Cancer ; Poor Performance Status ; Chemotherapy ; Medicine
    E-ISSN: 1662-6575
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  • 10
    Language: English
    In: Gastric Cancer, 2012, Vol.15(2), pp.137-143
    Description: Byline: Kohei Shitara (1), Junko Ikeda (1), Chihiro Kondo (1), Daisuke Takahari (1), Takashi Ura (1), Kei Muro (1), Keitaro Matsuo (2) Keywords: Chemotherapy; Gastric cancer; Prognostic factor; Randomized trial; Stratification Abstract: Background There is no consensus on which patient characteristics are the most suitable to report or to be used as stratification factors in clinical trials for advanced gastric cancer (AGC), to our knowledge. Methods We conducted a comprehensive review of published randomized trials for AGC to examine the patient characteristics that were reported. Results Among the 67 analyzed trials, age, gender, performance status, proportion of patients with measurable disease, and previous gastrectomy were frequently reported (〉69%). Histology, number of disease sites, and adjuvant treatment were reported in less than 50% of trials. Although the reporting of second-line chemotherapy has increased in recent trials, it remains at less than 50%. Notably, recent trials have tended to include patients with better performance status and less locally advanced disease, with Asian trials more frequently including patients with more diffuse histology and less locally advanced disease or liver metastasis than non-Asian trials. Stratification was conducted in approximately 60% of the trials, using quite variable stratifying factors. Conclusion Inconsistency exists in the reporting of patient characteristics, the characteristics themselves, and the use of stratification factors in clinical trials for AGC. A consensus set of important patient characteristics and strata may be necessary to conduct and interpret quality randomized studies. Author Affiliation: (1) Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan (2) Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan Article History: Registration Date: 25/07/2011 Received Date: 14/05/2011 Accepted Date: 24/07/2011 Online Date: 13/08/2011 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s10120-011-0083-8) contains supplementary material, which is available to authorized users.
    Keywords: Chemotherapy ; Gastric cancer ; Prognostic factor ; Randomized trial ; Stratification
    ISSN: 1436-3291
    E-ISSN: 1436-3305
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