Successful paclitaxel-based chemotherapy for an alpha-fetoprotein-producing gastric cancer patient with multiple liver metastases

<p>Abstract</p> <p>Background</p> <p>Alpha-fetoprotein (AFP)-producing gastric cancer is known to frequently cause multiple liver metastases and to have an extremely poor prognosis.</p> <p>Case presentation</p> <p>A 64-year-old Japanese man admitted to our hospital was diagnosed with gastric cancer with liver metastases. He underwent a total gastrectomy with splenectomy, and pathological stage IV disease according to the classification proposed by the Japanese Gastric Cancer Association was assigned. The histological diagnosis was poorly differentiated adenocarcinoma, and tumor production of AFP was confirmed by immunohistochemical staining. Following surgery, the patient received combination chemotherapy consisting of TS-1 and paclitaxel. Initially, AFP levels decreased dramatically and computed tomography (CT) revealed regression of liver metastases. However, multiple new liver metastases appeared and serum AFP levels increased after 5 months. A regimen of 5-FU plus paclitaxel followed by paclitaxel monotherapy was used next. Serum AFP levels once again decreased and CT showed regression or disappearance of liver metastases. The patient currently has a very good quality of life, and is receiving weekly paclitaxel monotherapy as an outpatient. No progression of liver metastases has been observed to date.</p> <p>Conclusion</p> <p>We consider this rare case to have significant value with respect to treatment of AFP-producing gastric cancer with multiple liver metastases, and propose that combining surgery with chemotherapeutic agents such as paclitaxel may lead to a better prognosis in such cases.</p

Granulocyte-colony stimulating factor producing rectal cancer

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Strategies for gastric cancer in the modern era

Gastric cancer is one of the most common neoplasms in Japan, and it is also the second leading cause of cancer-related deaths worldwide. Nowadays, infection with Helicobacter pylori (H. pylori) is a known risk factor for the development of gastric cancer. Therefore, gastric cancer should be considered as an infectious disease, and in fact, prophylactic eradication of H. pylori may prevent the development of metachronous gastric carcinoma. Before the role of H. pylori was understood, a different approach was used. Recently even after the cancer has developed, some newer therapeutic approaches have been pursued. These newer treatments have been summarized as “minimally invasive therapies” and use endoscopic or laparoscopic techniques. In addition, robotic approaches are being developed that seem to hold a great potential to change the surgical approach. Since basic understanding and treatment of the disease have both changed significantly over the last decade, we present a review of current advances in gastric cancer research and therapy

Randomized phase II trial of first-line treatment with tailored irinotecan and S-1 therapy versus S-1 monotherapy for advanced or recurrent gastric carcinoma (JFMC31-0301)

Objective: The pharmacokinetics of irinotecan vary markedly between individuals. This study sought to compare tailored irinotecan and S-1 therapy with S-1 monotherapy for the treatment of patients with advanced/recurrent gastric cancer. Methods: Patients with advanced/recurrent gastric cancer were randomized to receive tailored irinotecan and S-1 (arm A) or S-1 alone (arm B). Arm A received S-1 (80-120 mg/m2/day) for 14 days, with irinotecan on days 1 and 15. The initial irinotecan dose of 75 mg/m2 (level 0) was adjusted for toxicity during the previous course. In arm B, S-1 (80-120 mg/day) was administered alone for 28 days, followed by 14 days without therapy. Results: Ninety-five patients were randomized (48 to arm A and 47 to arm B). The response rate of the primary tumor (Japanese criteria) was 25.0% in arm A (12/48) and 14.9% in arm B (7/47), whereas the response rates according to Response Evaluation Criteria In Solid Tumors (RECIST) were 27.8% (10/36) versus 21.9% (7/32). Hematological toxicity, anorexia, and diarrhea were significantly more common in arm A, but both arms had similar grade 3-4 toxicities. Conclusion: These findings suggest the usefulness of tailored irinotecan plus S-1 therapy for gastric cancer

TGF-β regulates invasive behavior of human pancreatic cancer cells by controlling Smad expression

Introduction: To investigate the role of Smads in tumor cell activation, we examined changes in Smad expression as well as changes in proliferative and invasive behaviors in transforming growth factor-β (TGF-β) – stimulated pancreatic cancer cells. Material and methods: Expression of TGF-β receptor type I (TβR-I) and type II (TβR-II) was determined using RT-PCR and Western blot analysis in the human pancreatic cancer cell lines BxPC-3, Capan-2, and PANC-1. TGF-β-mediated changes in Smad mRNA expression were examined using quantitative real-time RT-PCR. Proliferation of pancreatic cancer cells was monitored using an MTT assay and cell counting. Invasive behavior was examined using a Matrigel double-chamber assay. Results: TβR-I and TβR-II were expressed in all three cell lines studied here at the mRNA and protein level. Smad2/3 mRNA expression was decreased after TGF-β stimulation in all three cell lines, while Smad4 mRNA expression remained unchanged. Smad6/7 mRNA expression was also attenuated in all three cell lines. TGF-β enhanced the invasive capacity of all three cell lines, but had no effect on the proliferative behavior. Anti-TβR-II antibody inhibited this TGF-β-enhanced invasive potential in pancreatic cancer cells. Conclusions: The Smad pathway, particularly down-regulation of Smad2/3 and Smad6/7, may be responsible for TGF-β-induced invasion of human pancreatic cancer cells