Readministration of gefitinib in a responder after treatment discontinuation due to gefinitib-related interstitial lung disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Gefitinib is a new molecular-targeted agent for the treatment of patients with advanced non-small cell lung cancer that fail to respond to conventional chemotherapy. Gefitinib is considered to be well tolerated and less toxic compared with conventional cytotoxic drugs. However, interstitial lung disease (ILD) has been reported as a serious adverse effect. The precise management of a gefitinib responder having severe adverse events remains unknown.</p> <p>Case Presentation</p> <p>We report the case of gefitinib readministration in a patient with lung adenocarcinoma who had once responded but in whom treatment had to be discontinued owing to gefinitib-related ILD. A dramatic response was achieved both at the time of initial treatment (250 mg/day) and at readministration of gefitinib (125 mg/day). The effectiveness of gefitinib therapy in our patient could be explained in part by the presence of an activating mutation of epidermal growth factor receptor (<it>EGFR</it>) gene, L858R in exon 21, which was identified in the primary tumor.</p> <p>Conclusion</p> <p>A reduced dose of gefitinib might be sufficient for patients having tumors with <it>EGFR </it>gene mutations, and that the currently approved dose may be excessively potent in some of these patients, thus resulting in the onset of adverse events.</p

Fat infiltration in the gluteus minimus muscle in older adults

Yuta Takano,1 Hiroto Kobayashi,2 Takuma Yuri,1 Saori Yoshida,2 Akira Naito,2 Yoshiro Kiyoshige1 1Graduate School of Health Science, Yamagata Prefectural University of Health Science, Yamagata, Japan; 2Department of Anatomy, Yamagata University Faculty of Medicine, Yamagata, Japan Purpose: Fat infiltration (FI) in the gluteus minimus muscle (GMin) has been reported as being restricted to the anterior part. The aim of this study was to verify whether FI is localized only to the anterior part of the GMin through the dissection of large number of elderly cadavers and to clarify the underlying mechanism of FI localized to a specific region. Materials and methods: Thirty-eight hips from 20 embalmed elder cadavers were dissected for verification of FI localization. The samples of three regions &ndash; the fat infiltrated region of the anterior part (FI), the region without FI (non-FI), and the posterior region &ndash; were harvested from nine hips for the histological fiber type assessment. Results: The FI area was distributed at 2.6&deg;&ndash;38&deg; from the anterior border within the anterior part, of which function is responsible for hip extension and internal rotation and is likely reduced by disuse following aging. The number of type I fibers was lowest in FI, followed by non-FI, while the number of type I fibers was highest in the posterior. Meanwhile, the number of type II fibers was equivalent across the three regions. Atrophic type II fibers were observed in overall samples of the three regions, and grouped atrophy, which is evidence of denervation, was observed in FI and non-FI samples. Type grouping, which suggests to be reinnervated, was found in the non-FI and posterior samples but very little in the FI samples. Conclusion: FI in the GMin in older adults restricted to deep within the anterior part is secondary to disuse and is strongly related to impaired denervation&ndash;reinnervation process. Keywords: gluteus minimus, fat infiltration, disuse, denervation, fiber typ