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Our multicenter studies have repeatedly shown that disease severity and oral steroid dose are major independent factors negatively impacting health‐related quality of life (QOL) in patients with myasthenia gravis (MG). Even if pharmacological remission is achieved, QOL is low in patients taking oral prednisolone >10 mg/day. Disease severity tends to affect QOL by decreasing personal activities, whereas insufficiently reduced steroids affects QOL by decreasing social activities. MG patients often experience unemployment and decreased income, and many patients report reduced social positivity. More effort is required to reduce both the severity and dose of oral steroids. QOL in patients with minimal manifestations (MM) or better status who are treated with prednisolone at ≤5 mg/day (MM‐or‐better‐5 mg) is almost identical to that in patients achieving complete stable remission. Early achievement of MM‐or‐better‐5 mg is now recommended as a target for MG treatment in Japan. However, our studies suggested that the percentage of patients achieving MM‐or‐better‐5 mg was not high in 2010 and 2012 (<40% of generalized MG patients), and was not considered to be increased by physician skill in steroid dosing. In Japan, treatment strategies are now being reconsidered to further increase treatment success, placing a focus on helping MG patients resume a normal lifestyle by achieving the target as soon as possible. An initial attempt to achieve early MM‐or‐better‐5 mg for some period through aggressive use of non‐oral fast‐acting therapies can be more important for patient QOL, even if long‐term stability cannot be provided. [ABSTRACT FROM AUTHOR]

Introduction: In this study we sought to clarify the effects of early fast-acting treatment (EFT) strategies on the time course for achieving the treatment target in generalized myasthenia gravis (MG).Methods: This retrospective study of 923 consecutive MG patients analyzed 688 generalized MG patients who had received immunotherapy during the disease course. The time to first achieve minimal manifestations (MM) or better while receiving prednisolone at ≤5 mg/day for ≥6 months (MM-or-better-5mg) up to 120 months after starting immunotherapy was compared between EFT and non-EFT patients.Results: Achievement of MM-or-better-5mg was more frequent and earlier in the EFT group (P = 0.0004, Wilcoxon test; P = 0.0001, log-rank test). Multivariate Cox regression analysis calculated a hazard ratio of 1.98 (P < 0.0001) for utilization of EFT. Dosing regimens of oral steroids in EFT produced no differences in the time course.Conclusions: EFT strategies are advantageous for early achievement of MM-or-better-5mg. Muscle Nerve 55: 794-801, 2017. [ABSTRACT FROM AUTHOR]

Multiple myeloma is a cancer of plasma cells; the incidence rate of multiple myeloma is high among older adults. Although significant advances have been made in the clinical management of multiple myeloma driven by the introduction of novel drugs, such as proteasome inhibitors, immuno- modulators and antibodies, multiple myeloma remains incurable. Hence, the current therapeutic goal for multiple myeloma is to achieve long-term survival while maintaining a good quality of life. In this context, personalized treatment to balance the efficacy and safety of therapies is important, especially for older adults as they display diverse physical, cognitive or organ functioning. Furthermore, old age is also often associated with frailty. Several tools for evaluating frailty in older adults with multiple myeloma are now available, and frail patients defined by these tools have shown a poor prognosis and more treatment-related toxicities. In addition, it is important to evaluate other factors, such as the International Staging System, high-risk chromosomal abnormalities and treatment response, to predict the clinical course of patients. Further investigations are required to determine how these factors can optimize the treatment for multiple myeloma. In this review, we present a detailed account on the developments and issues related to the current treatment approaches for older adults with newly diagnosed multiple myeloma. We also discuss the ongoing phase III clinical study conducted by the lymphoma study group of the Japan Clinical Oncology Group, which targeted older adults with newly diagnosed multiple myeloma., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.)

The main methods of treatment for hepatocellular carcinoma (HCC) in Japan are hepatic resection, radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE). Meticulous follow up is then undertaken to check for recurrence, which is treated using repeated RFA or TACE. Hepatic arterial infusion chemotherapy has been introduced as treatment for advanced HCC, and the molecular-targeted drug sorafenib is also now available. Rigorous medical care using these treatment methods and early diagnosis mean that the prognosis for HCC in Japan is the best in the world. This paper reviews the treatment strategies for HCC in Japan. [ABSTRACT FROM AUTHOR]

Objectives This article reviews recent data on the biology, pathogenesis and pathophysiology of the different entity of epithelial ovarian cancer (EOC). Study design The present article reviews the English language literature for screening, epidemiology, clinical diagnosis, natural history, preclinical and clinical trials, and promising molecular targets on EOC, particularly for clear cell EOC (cEOC) based on the gene expression profiling studies. Results Prospective ovarian cancer screening trials in Japan showed that (1) serous-type EOC (sEOC) may exhibit a rapid progression possibly through de novo carcinogenesis, (2) the EOC risk was elevated significantly among patients with ovarian endometrioma (SIR = 8.95), (3) advancing age (>40 years) and the diameter of endometriomas (>9 cm) were independent predictors of development of EOC, (4) the benign-appearing ovarian masses are present several years before the EOC diagnosis in patients with endometriosis-associated EOC, and (5) the slightly elevated CA125 level is also typically present many years (>3 years) before the diagnosis in these patients. Upregulation of HNF-1beta and PLK-Emi1 genes were specifically detected in cEOC. In addition, the therapy currently used in renal cell carcinoma (RCC) should be considered as an attractive therapeutic option for cEOC. Conclusions Ovarian endometrioma could be viewed as a neoplastic process, particularly in perimenopausal women. Understanding the mechanisms of endometriosis development and elucidating its pathogenesis and pathophysiology are intrinsic to prevention and the search for effective therapies of endometriosis-associated EOC. [ABSTRACT FROM AUTHOR]