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The application of systematic review (SR) has been increased rapidly in the field of cancer treatment. Complementary and alternative medicine (CAM) for cancer is no exception. The aim of this review is to evaluate and summarize systematic reviews on the CAM use in breast cancer patients. Search sources were Centre for Reviews and Dissemination (CRD), Cochrane Database of Systematic Reviews (CDSR), and PubMed. In addition, we assessed the quality of SR with the Assessing the Methodological Quality of Systematic Reviews (AMSTAR). This review did not consider control groups and outcomes. Thirty-four SRs met a set of criteria. According to interventions, there were twenty SRs which included yoga, acupuncture, and herbal medicines. Meta-analysis of 19 out of 34 reviews showed the followings: (1) acupuncture had a beneficial effect on the frequency of hot flushes, (2) yoga had a beneficial effect on depression and health-related QOL, (3) mindfulness-based stress reduction (MBSR) had a beneficial effect on anxiety and depression, (4) combination of herbal medicine and chemotherapy synergistically improved clinical outcomes, (5) acupuncture did not show significant effect on the severity of hot flushes and cancer-related pain, (6) yoga was unable to be confirmed as having an effect on cancer-related pain and physical well-being. Given the results of AMSTAR, 9 out of 34 reviews were of high quality and 3 reviews were deemed to be of low quality. In conclusion, since most SRs were at moderate or high quality levels, CAM could be helpful for treating specific symptoms related to breast cancer.

Here we report the case of an 88-year-old female with serious respiratory discomfort who exhibited significant heart enlargement and left pleural effusion in her chest X-ray. She developed cardiac tamponade with massive pericardial effusion, and the cytological analysis and diagnostic imaging revealed adenocarcinoma of an unknown primary site. Although supportive care was offered, due to her super-age and malignant pericardial effusion presenting cardiac tamponade, she and her family requested a detailed examination and active treatment. She was enrolled into our medical oncology department, and we immediately performed a cell block cytological examination procedure and drained the pleural effusion. The immunohistochemical and FISH analyses revealed anaplastic lymphoma kinase(ALK)-rearranged non-small cell lung cancer. An ALK tyrosine kinase inhibitor, alectinib, was administered and resulted in a prompt and effective improvement in clinical outcome. This case indicates that we should attempt to achieve an accurate diagnosis, even when patients are super-aged and exhibit serious progress disease conditions. The pleural effusion cell block analysis may be highly useful for the prompt and precise diagnosis of malignancies.

A 49-year-old man was referred to a neighboring hospital with a chief complaint of abdominal pain.He was diagnosed with locally advanced body-tail pancreatic cancer that had invaded the celiac artery and SMA.He came to our department after undergoing radiotherapy, 2.5 Gy×22 Fr, and chemotherapy with gemcitabine(GEM)and S-1.The same chemotherapy was continued for 15 months until DIC occurred.He was subsequently treated with GEM only and then S-1 only in sequence for 6 years.We decided to stop the chemotherapy because the original lesion had been stable for a long time.After 1 month, a hard nodule appeared in the subcutaneous layer of the navel.Although resection was performed and he received chemotherapy, he died after surviving a total of 7 years and 10 months.This case is important when considering whether to discontinue chemotherapy with a stable long-term pancreatic cancer patient.

We report a retrospective study on the efficacy, adverse events and the factors for continuous docetaxel (DOC) therapy for patients with castration-resistant prostate cancer (CRPC). Between April 2007 and April 2015, 37 CRPC patients were treated with DOC therapy at Kanazawa Medical University Hospital. DOC was administered every 3 weeks at 70 mg/m2. Prostatic specific antigen (PSA) level, adverse events, cycles of DOC therapy, survival time and clinical passage were examined. Fifteen patients showed a decrease in PSA level of 50% or more, 9 patients showed less than 50% decrease in PSA level and 13 patients showed no decrease in PSA level. Adverse effect of grade 3 consisted of neutropenia in 29.7% and leukocytopenia in 10.8%. The median number of treatment cycles was 11.7 courses. The patients were divided into two groups ; the first group comprised of 26 patients who received short-term DOC therapy (≤10 cycles) and the second group comprised of 11 patients who received long-term DOC therapy (≥11 cycles). The 1-year survival rate was 59 and 100% for the short-term and long-term groups, respectively. Long-term treatment was related to pretreatment PSA nadir, time to progression of CRPC and serum lactate dehydrogenase level.

In cancer chemotherapy, some molecular targeting drugs maintain their efficacy even during a non-dosing period. Nivolumab, an anti-PD-1antibody that has recently been receiving particular attention, often maintains its efficacy during a nondosing period, although it takes several weeks to take effect. The efficacy of ipilimumab, an anti-CTLA-4 antibody, lasts for more than 1year after only 4 administrations. However, how long to continue the anti-HER2 antibody trastuzumab, after HER2-positive breast cancer patients with advanced or recurrent disease show remarkable improvement in imaging examinations remains uncertain. The same is true for imatinib in the treatment of gastrointestinal stromal tumor and chronic myeloid leukemia. In addition, the use of bevacizumab, an anti-VEGF antibody, was reported to be associated with prolonged survival beyond progressive disease. As the use of molecular targeting drugs may provide prolonged beneficial effects, the continuation, suspension, or termination of therapy should be carefully determined to avoid any disadvantage to patients.

Solid tumors are generally more detected in male than female patients, except for sexual organs. However, females are dominant in biliary tract cancer, especially gallbladder cancer. Gender difference is not recognized in hematological malignancies. Selection of therapeutic agents is not influenced by gender, but nausea and vomiting as side effects of anti-cancer agents are more common in young females. Therefore, sufficient anti-emetic agents should be used especially at the first cycle of chemotherapy with highly emetic drugs such as cisplatin in order to prevent anticipatory nausea and vomiting. Furthermore, neutropenia due to the combination regimen of platinum plus gemcitabine or the monotherapy of gemcitabine or amrubicin is reported to be more frequent in females than males.

A 72-year-old man came to our hospital due to edema, malaise, and poor appetite in May 200X. He was diagnosed as cardiac tamponade, and open surgery revealed tumors in the right atrium and the left ventricule. Tumor tissue was revealed to be angiosarcoma by the pathological findings. Metastases to the brain, lungs, liver, and adrenal glands were found. The patient was treated with interleukin-2(IL-2)for 7 weeks. However, there was no anti-tumor effect, and the patient died in September, 200X. We reported a very rare case of cardiac angiosarcoma associated with cardiac tamponade, who was treated with IL-2 monotherapy.

In this symposium, we discussed the usefulness and feasibility of current chemotherapy protocols for urological cancers including renal cell carcinoma, urothelial cancer, prostate cancer and testicular cancer. (1) Renal cell carcinoma : Although molecular targeted therapy is now becoming a standard therapy for metastatic renal cell carcinoma, the current situation is somehow confusing due to unknown adverse effects and lack of guidelines for indication of each compound. (2) Urothelial cancer : gemcitabine and cisplatin (GC) therapy is taking over methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) therapy because of less toxicity. We focused on a novel biomarker, hENT1, to predict the anti tumor effect of GC therapy. (3)Prostate cancer : The survival benefit of docetaxel for castration resistant prostate cancer was proven by large clinical trials. We dealt with uracil and tegafur (UFT) therapy which has been widely used in Japan. (4)Testicular cancer : It is needles to say that BEP therapy was established as a standard induction therapy for metastatic testicular cancer. However, regarding salvage chemotherapy, it is still controversial whether vinblastine, ifosphamide and platinum (VIP), paclitaxel, ifosphamide and platinum (TIP) and high dose chemotherapy should be selected.

Docetaxel-based chemotherapy has been shown to be effective and well tolerated by Japanese patients with metastatic hormone-refractory prostate cancer (HRPC). This study was undertaken to assess the feasibility of docetaxel in combination with UFT (a combination of tegafur and uracil) in Japanese patients with HRPC. Ten patients aged 60-86 years with HRPC, who were pre-treated with hormonal therapy and expected to have more than 3 month survival and without major organ dysfunction, were included in this study. Treatment consisted of docetaxel 70 mg/m2 every 3 weeks plus UFT 260 mg/m2 /day. The primary end point was prostate-specific antigen (PSA) response, and the secondary end points included progression-free survival and toxicity. Nine patients were evaluable for efficacy and toxicity. The PSA response rate was 50% (1 CR and 4 PR). The most common non-hematological adverse events (of any grade) possibly related to treatment were neutropenia and anorexia. Grade 3/4 neutropenia and anorexia occurred in 50 and 20% of patients, respectively. The combination of docetaxel and UFT was feasible and active in Japanese patients with HRPC, with a manageable adverse-event profile similar to that observed in lung cancer chemotherapy.

A 73-year-old man diagnosed as having pancreatic body cancer with multiple liver metastases was referred to our hospital. Since the patient preferred oral agents, S-1 monotherapy (4-week administration followed by 2-week interval) was started. The initial dose of S-1 was 80 mg, and gradually increased to 150 mg/day. There were no significant adverse events. The liver metastases disappeared and the pancreatic tumor was markedly reduced in size at the completion of 4 courses. Distal pancreatectomy was carried out at 7 months since his first visit. Pathological diagnosis was non-functioning well-differentiated neuroendocrine carcinoma (pT4, pN0, pM0, Stage IVa). He is alive without relapse 6 months after operation. S-1 might be a candidate for chemotherapy for this neuroendocrine tumor.

We here describe a 49-year-old man who suffered repeated anaphylactic shock after systemic chemotherapy with vinorelbine for stage IV left lung adenocarcinoma (S1+2). He was treated using a combination of cisplatin and weekly irinotecan (CPT-11) as the first line; however, the regimen was changed to a combination of vinorelbine (VNR) and gemcitabine (GEM) because of his progressive disease. He was admitted to our hospital for examination of the unknown cause of hypotension and loss of consciousness. The second shock occurred after eating pistachios, and the third one at cancerous pain. After pain control, the shock no longer occurred. Anaphylactic shock may show two peaks and late symptoms. In patients with a history of anaphylactic shock, we should pay attention to foods, drugs, and various stresses which might cause anaphylaxis.

Each serum tumor marker has its own sensitivity and specificity. The sensitivity is the true positive rate in malignant cases, and the specificity is the true negative rate in benign cases. We should ascertain various benign diseases or triggers which tend to show false-positivity, especially in the measuring of CA19-9, CA125, and acute phase reactants, such as, IAP and TPA. Cancer-specificity is high in sialyl-stage-specific embryonic antigen-I, sialyl-Tn antigen, and NCC-ST-439, etc. Organ-specificity is considerably high in the case of some markers, such as, alpha-fetoprotein, elastase-I, and neuron-specific enolase, etc. On the other hand, the organ-specificity of carcinoembryonic antigen is low. Therefore, the combination of different categories of tumor markers is of great importance. Recently, molecular diagnosis of cancer is being developed. However, even K-ras oncogene mutations at codon 12 are not absolutely specific to pancreatic cancer from genetic analysis of pancreatic juice endoscopically aspirated from patients with pancreatic diseases. Improvement of sensitivity and specificity is still one of the most important issues in the research and development of tumor markers.

Most of the recently developed tumor antigens detected by monoclonal antibodies are sugar chains and frequently associated with blood group substance. By immunohistochemical studies, we evaluated mainly the clinical usefulness and significance of the serum assay of CA-50 classified as a type 1 sugar chain, sialyl SSEA-1 as a type 2 sugar chain, and ST-439 with an undetermined structure, as well as their clinicopathological significance. In addition, the value of measurement of CA19-9, ST-439, and SLX in pure pancreatic juice (PPJ) was investigated. Furthermore, the clinical usefulness of K-ras mutation at codon 12 (KRM) in PPJ was studied. The incidence of serum CA19-9 among tumor markers was highest in pancreatic cancer (81%), but relatively high in benign diseases. On the other hand, both serological and immunohistological studies showed that sialyl SSEA-1 and ST-439 were highly specific for the tumor, whereas they appeared in serum or tumor less frequently than CA19-9 or CA-50 carrying the type 1 sugar chain. The accuracy of the tumor markers (CA19-9, sialyl SSEA-1, and ST-439) for pancreatic cancer, was almost equal (77% to 80%) and higher than that of CEA (69%). However, a highly positive correlation between sialyl SSEA-1 and ST-439 was revealed as well as among type 1 sugar chains in malignant diseases. Therefore, we conclude that the combination assay with CA19-9 or a similar tumor marker, sialyl SSEA-1 or ST-439, and CEA would be appropriate for the screening of pancreatic cancer. When the cut off value was set as the M + 2SD of the controls, significantly elevated concentrations of CA19-9 in PPJ were found in the secretory phase in 90% of the patients with pancreatic cancer (PC) and 66% of the patients with chronic pancreatitis (CP). Although increased concentrations of CA19-9 in PPJ have no cancer specificity, measurement of CA19-9 in PPJ can be used as a sensitive marker for some pancreatic disorders. On the other hand, concentrations of ST-439 and SLX in PPJ were significantly increased only in PC, and their incidences were 50% and 40%, respectively. They have a high tumor-specificity, but their incidences were not as high as initially expected.(ABSTRACT TRUNCATED AT 400 WORDS)

A 66-year-old male with non-A, non-B liver cirrhosis underwent an operation for a partial resection of the S8 area. Intraoperative ultrasound (US) examination of the entire liver revealed 10 space-occupying lesions (SOLs), and a biopsy of 5 out of the 10 SOLs showed 3 hepatocellular carcinomas (HCCs), adenomatous hyperplasia (AH), and an atypical AH (AAH). In a resected specimen that including 4 SOLs that had been detected by operative US, 6 early HCCs, an HCC of the Edmondson grade I + II, and 2 AAHs were found. All tumors were less than 2 cm and were not encapsulated.

In order to evaluate the usefulness of sialyl SSEA-1 (SLX) as a tumor marker of digestive cancers, serum levels of the antigen were determined in 334 patients with malignancies and 196 patients with benign diseases. The results indicated that positivity of the antigen in sera from malignant patients was highest in pancreatic cancer (58%) and biliary tract cancer (56%). False positive incidence of SLX in sera from benign diseases was as low as 6%, revealing low false positivity. Comparison with other tumor markers such as CA19-9, CA-50, CEA and ST-439 showed that positivity of SLX was as high as that of CEA, whereas it was lower than that of CA19-9 or CA-50. On the other hand, false positivity of SLX as well as ST-439 was lowest, and accuracy of SLX was no less high than that of CA19-9 or CA-50. In sera of pancreatic and biliary tract cancer, positive incidences of CA19-9, CEA and ST-439 were 80%, 64% and 53%, respectively, and the diagnostic efficiency increased by combined assay of SLX with CA19-9 (88%), CEA (81%) and ST-439 (71%). SLX appears to be no less useful than the other recently developed carbohydrate antigens or CEA as serum tumor marker for pancreatico-biliary cancer.