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We report three cases of methotrexate (MTX) -induced oral erosions and ulcers mimicking Stevens-Johnson syndrome (SJS) in older women with rheumatoid arthritis, although they did not had conjunctivitis. Furthermore, age, dehydration, and renal dysfunction could trigger adverse reactions of MTX, but one patient underwent dialysis, which is a contraindication for MTX. It is sometimes very difficult to differentiate the toxicity of MTX from SJS. Learning from the three cases, we propose that oral mucosal erosions without conjunctive mucosal inflammation, leukopenia, and thrombocytopenia differentiate MTX toxicity from SJS. Furthermore, our patients nearly recovered from myelosuppression within seven days and recovered from mucosal erosions characteristic of MTX toxicity within 14 days. These clinical courses could also be characteristic for MTX toxicity rather than SJS, although quick recovery does not happen in all cases. Therefore, physicians who prescribe MTX must accurately know MTX-induced adverse reactions to recognize them early. Furthermore, as seen in our patients, oral mucosal erosions occur often. Therefore, dermatologists or others who examine these symptoms should consider that mucosal erosions mimicking SJS could be an adverse reaction of MTX, regardless of whether or not SJS/toxic epidermal necrolysis is suspected.

Background: The lung cancer biopsy specimens obtained by endobronchial ultrasound-guide sheath (EBUS-GS) trans lung biopsy occasionally do not contain cancer cells. It is a problem that there is a possibility that they may not contain cancer cells. Aim of the study: To investigate the proportion of biopsy specimens containing cancer cells in total biopsy specimens. Materials & methods: Patients with lung cancer diagnosed by EBUS-GS were selected. The primary end point was the proportion of specimens containing tumors in the total specimens obtained by EBUS-GS. Results: Twenty-six patients were investigated. The percentage of specimens containing cancer cells in the total specimens was 79.0%. Conclusion: The proportion of biopsy specimens containing cancer cell to all biopsy specimens by EBUS-GS was high, but not 100%.

Pulmonary sarcomatoid carcinoma (SC) is an aggressive subtype of lung cancer that exhibits resistance to cytotoxic chemotherapy. Although programmed cell death 1 (PD‐1) inhibitors have been reported to show antitumor effects in patients with high programmed death‐ligand 1 (PD‐L1) expressing SC, the efficacy of combined therapy with PD‐1 inhibitor plus cytotoxic chemotherapy has not previously been clarified. We herein report a case of SC with low expression of PD‐L1 and few pre‐existing tumor‐infiltrating lymphocytes which showed a remarkable response to pembrolizumab plus cytotoxic chemotherapy as first‐line treatment. Our findings suggest that combined treatment might enhance the immunogenic response, even in immunologically ignored SCs., Pulmonary sarcomatoid carcinoma (SC) is an aggressive subtype of lung cancer that exhibits resistance to cytotoxic chemotherapy and the efficacy of combined therapy with PD‐1 inhibitor plus cytotoxic chemotherapy as first‐line treatment has not previously been clarified. Here we report a case of SC with low expression of PD‐L1 and few pre‐existing tumor‐infiltrating lymphocytes which showed a remarkable response to pembrolizumab plus cytotoxic chemotherapy. Our findings suggest that treatment might enhance the immunogenic response, even in immunologically ignored SCs.

Dabrafenib and trametinib therapy for BRAF V600E‐mutant non‐small cell lung cancer (NSCLC) has demonstrated strong antitumor effects in clinical trials and has been approved for use in clinical practice. However, the efficacy and safety of this combination therapy in elderly patients remain unclear. An 86‐year‐old male patient, who had been diagnosed with lung adenocarcinoma with the BRAF V600E mutation, received dabrafenib and trametinib combination chemotherapy. The tumor shrunk rapidly; however, therapy was discontinued after 40 days because adverse events (hypoalbuminemia, peripheral edema, and pneumonia) developed. Although this targeted combination therapy seemed to cause relatively severe adverse events compared with single‐agent targeted therapy in this “oldest old” elderly patient, the marked tumor shrinkage prolonged the patient's life and helped him to maintain a good general condition. Active targeted therapy may therefore be considered with appropriate drug dose reduction instead of conservative treatment, even if a patient is extremely old., An 86‐year‐old male patient, who had been diagnosed with lung adenocarcinoma with BRAF V600E mutation, received dabrafenib and trametinib combination chemotherapy. The tumor shrunk rapidly; however, therapy was discontinued after 40 days because adverse events (hypoalbuminemia, peripheral edema, and pneumonia) developed. Although this targeted combination therapy seemed to cause relatively severe adverse events compared with single‐agent targeted therapy in this “oldest old” elderly patient, the marked tumor shrinkage prolonged the patient's life and helped him to maintain a good general condition.

Background: Single-agent amrubicin chemotherapy is a key regimen, especially for small cell lung cancer (SCLC), however, it can cause severe myelosuppression. Purpose: The purpose of this study was to determine the real-world incidence of febrile neutropenia (FN) among patients treated with single-agent amrubicin chemotherapy for thoracic malignancies. Patients and methods: The medical records of consecutive patients with thoracic malignancies, including SCLC and non-small cell lung cancer (NSCLC), who were treated with single-agent amrubicin chemotherapy in cycle 1 between January 2010 and March 2020, were retrospectively analyzed. Results: One hundred and fifty-six patients from four institutions were enrolled. Their characteristics were as follows: median age (range): 68 (32–86), male/female: 126/30, performance status (0/1/2): 9/108/39, SCLC/NSCLC/others: 111/30/15, and prior treatment (0/1/2/3-): 1/96/31/28. One hundred and thirty-four (86%) and 97 (62%) patients experienced grade 3/4 and grade 4 neutropenia, respectively. One hundred and twelve patients (72%) required therapeutic G-CSF treatment, and 47 (30%) developed FN. Prophylactic PEG-G-CSF was not used in cycle 1 in any case. The median overall survival of the patients with FN was significantly shorter than that of the patients without FN (7.2 vs. 10.0 months, p = 0.025). Conclusions: The real-world incidence rate of FN among patients with thoracic malignancies that were treated with single-agent amrubicin chemotherapy was 30%. It is suggested that prophylactic G-CSF should be administered during the practical use of single-agent amrubicin chemotherapy for patients who have already received chemotherapy.