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Background: Etoposide and irinotecan are key drugs in the treatment of small-cell lung cancer. We did this study to investigate whether combined chemotherapy with cisplatin, etoposide, and irinotecan was superior to topotecan monotherapy as second-line chemotherapy in patients with sensitive relapsed small-cell lung cancer.Methods: We did this open-label, multicentre, randomised phase 3 trial at 29 institutions in Japan. Patients with small-cell lung cancer that responded to first-line treatment but showed evidence of disease relapse or progression at least 90 days after completion of the first-line treatment were eligible to participate. Enrolled patients were randomly assigned (1:1) to receive combination chemotherapy with cisplatin plus etoposide plus irinotecan or topotecan alone. Randomisation was done via the minimisation method with biased-coin balancing for Eastern Cooperative Oncology Group performance status, disease stage at enrolment, and institution. Combination chemotherapy consisted of five 2-week courses of intravenous cisplatin 25 mg/m(2) on days 1 and 8, intravenous etoposide 60 mg/m(2) on days 1-3, and intravenous irinotecan 90 mg/m(2) on day 8, with granulocyte colony-stimulating factor given by hypodermic injection every day starting from day 9 of the first course (except on the days anticancer drugs were given). Topotecan therapy consisted of four courses of intravenous topotecan 1·0 mg/m(2) on days 1-5, every 3 weeks. The primary endpoint was overall survival in the intention-to-treat population, which was analysed with a one-sided α of 5%, and safety was assessed in all patients who received at least one dose of study drug. The trial is registered with University Hospital Medical Information Network Clinical Trials Registry, number UMIN000000828.Findings: Between Sept 20, 2007, and Nov 30, 2012, 180 patients were enrolled, with 90 assigned to each treatment group. The median follow-up for censored patients was 22·7 months (IQR 20·0-35·3). Overall survival was significantly longer in the combination chemotherapy group (median 18·2 months, 95% CI 15·7-20·6) than in the topotecan group (12·5 months, 10·8-14·9; hazard ratio 0·67, 90% CI 0·51-0·88; p=0·0079). The most common grade 3 or 4 adverse events were neutropenia (75 [83%] patients in the combination chemotherapy group vs 77 [86%] patients in the topotecan group), anaemia (76 [84%] vs 25 [28%]), and leucopenia (72 [80%] vs 46 [51%]). Grade 3 or 4 febrile neutropenia was more common in the combination chemotherapy group than in the topotecan group (28 [31%] vs six [7%]), as was grade 3 or 4 thrombocytopenia (37 [41%] vs 25 [28%]). Serious adverse events were reported in four (4%) patients in the topotecan group and nine (10%) in the combination chemotherapy group. Two treatment-related deaths (one each of pneumonitis and pulmonary infection) occurred in the topotecan group and one (febrile neutropenia with sepsis) occurred in the combination chemotherapy group.Interpretation: Combination chemotherapy with cisplatin plus etoposide plus irinotecan could be considered the standard second-line chemotherapy for selected patients with sensitive relapsed small-cell lung cancer.Funding: National Cancer Center and the Ministry of Health, Labour and Welfare of Japan. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor erlotinib is associated with survival benefits in patients with EGFR mutation-positive non-small-cell lung cancer (NSCLC). This phase II, single-arm study examined the efficacy and safety of first-line erlotinib in Japanese patients with EGFR mutation-positive NSCLC. Methods: Eligible patients received erlotinib 150mg/day until disease progression or unacceptable toxicity. The primary endpoints were progression-free survival (PFS) and safety. Results: A high degree of concordance was observed between different mutation testing methodologies, suggesting feasibility of early, rapid detection of EGFR mutations. Median PFS was 11.8 months (95% confidence interval [CI]: 9.7–15.3) at data cut-off (1 June 2012) (n =102). Exon 19 deletions seemed to be associated with longer PFS compared with L858R mutations; T790M mutations were tentatively linked with shorter PFS. The safety profile was as expected: rash (any grade; 83%) and diarrhea (any grade; 81%) were most common. Six interstitial lung disease (ILD)-like cases were reported, and 5 were confirmed as ILD-like events by the extramural committee. Two patients died of treatment-related pneumonitis (JAPIC Clinical Trials Information number: Japic CTI-101085). Conclusion: Erlotinib should be considered for first-line treatment in this subset of Japanese patients, with close monitoring for ILD-like events. [Copyright &y& Elsevier]

Abstract: The effect of body-weight loading onto the articular cartilage on the occurrence of chondrotoxicity was investigated in male juvenile Sprague–Dawley rats given ofloxacin (OFLX) orally once at 900mg/kg. Just after dosing of OFLX, hindlimb unloading was performed for 0, 2, 4, or 8h by a tail-suspension method. Animals were sacrificed at 8h post-dose, and then the distal femoral articular cartilage was subjected to a histological examination and an investigation for gene expression of tumor necrosis factor receptor superfamily, member 12a (Tnfrsf12a); prostaglandin-endoperoxide synthase 2 (Ptgs2); plasminogen activator, urokinase receptor (Plaur); and matrix metalloproteinase 3 (Mmp3) by qRT-PCR analysis. As a result, cartilage lesions and up-regulations of these 4 genes that were seen in rats without the tail suspension were not observed in rats with the 8-h tail suspension, and a tendency to decrease in the incidence of the cartilage lesions and the gene expression was noted in a tail-suspension time dependent manner. Our results clearly indicate that body-weight loading onto the cartilage is necessary to induce cartilage lesions and gene expression of Tnfrsf12a, Ptgs2, Plaur, and Mmp3 in juvenile rats treated with OFLX. [Copyright &y& Elsevier]

Abstract: Quinolone antibacterial agents are extensively utilized in antimicrobial chemotherapy. However, they have been reported to induce arthropathy in juvenile animals, and the mechanism has not been clarified. Recently, we have demonstrated that Dusp1, Tnfrsf12a, Ptgs2, Fos, Mt1a, Plaur, Mmp3, Sstr1 and Has2 genes change in the articular cartilage of juvenile rats with a single oral administration of ofloxacin (OFLX), suggesting that these genes are involved in the induction of OFLX-induced chondrotoxicity. In the present study, to compare the chondrotoxic potential between new synthesized quinolones DC-159a and DX-619, and OFLX, they were orally administered by gavage at a dose level of 300 or 900mg/kg/day to male juvenile Sprague–Dawley (SD) rats, 3 weeks of age, for 7 days. Then the distal humerus and femur were subjected to microscopic examination. Moreover, concentrations of these quinolones in the femoral articular cartilage were measured in male juvenile SD rats following a single oral administration at 100, 300 or 900mg/kg. Furthermore, gene expression of Dusp1, Tnfrsf12a, Ptgs2, Fos, Mt1a, Plaur, Mmp3, Sstr1 and Has2 was investigated in the articular cartilage of the distal femur in male juvenile SD rats treated with 900mg/kg of DC-159a or DX-619 by quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) analysis. In a microscopic examination, no changes in the articular cartilage were observed in any animal administered DC-159a or DX-619. On the contrary, cavity formation and chondrocyte cluster in the cartilage of distal humerus and femur were noted in animals receiving OFLX at 300mg/kg/day or more. In toxicokinetic analysis, the maximum concentration (C max) value in the articular cartilage (cartilage C max) of DC-159a or DX-619 at 900mg/kg was lower than that of OFLX at 300mg/kg. However, the area under the cartilage concentration–time curve (cartilage AUC)0–24h value of DC-159a or DX-619 at 900mg/kg was higher than that of OFLX at 300mg/kg. In qRT-PCR analysis, up-regulated Dusp1, Fos and Mt1a, and down-regulated Sstr1 and Has2 genes were seen in the femoral articular cartilage of rats given DX-619 or DC-159a at 900mg/kg. However, Tnfrsf12a, Ptgs2, Plaur and Mmp3 genes, which were up-regulated in the distal femoral articular cartilage exposed to OFLX, did not increase or slightly increased. In conclusion, the penetration of DC-159a or DX-619 into the cartilage was low compared with that of OFLX, and no obvious changes in Tnfrsf12a, Ptgs2, Plaur and Mmp3 genes were observed in the articular cartilage of juvenile rats treated with DC-159a or DX-619, which was likely to be responsible for non-chondrotoxic potentials of DC-159a and DX-619. [Copyright &y& Elsevier]

Summary: Background: In approximately the year 2000, the results of a number of important studies of non-small-cell lung cancer (NSCLC) were published. Methods: Between July 1992 and December 2003, 223 patients with NSCLC aged ≥70 years received chemotherapy alone as their initial treatment at the National Cancer Center Hospital East. These patients were divided into 2 groups: those that began treatment between 1992 and 1999 (group A) and between 2000 and 2003 (group B). The details of chemotherapy regimens and outcomes were compared. Results: In group A, 83% of patients received platinum-based chemotherapy, two-thirds of these regimens comprised platinum plus second-generation combination chemotherapy. In contrast, although 55% of patients received platinum-based chemotherapy in group B, 41% of patients received non-platinum-based chemotherapy. Among patients in group B, performance status was significantly associated with the selection of platinum-based or non-platinum-based chemotherapy; age was marginally associated with this selection. Median survival time (MST), 1-year survival rate, and 2-year survival rate were 6.7 months, 14%, and 7%, respectively, in group A, and 8.1 months, 35%, and 20% in group B (p =0.0109). Multivariate analysis revealed that clinical stage and administration of salvage chemotherapy were independent prognostic factors. Conclusions: In and after the year 2000, chemotherapy regimens changed greatly and survival of elderly patients significantly improved in our institute, and this improvement appears to be attributable mostly to the effect of salvage chemotherapy. These results suggest that even elderly patients should be offered salvage chemotherapy regardless of age, if possible. [Copyright &y& Elsevier]

Abstract: Quinolone antibacterial agents are extensively utilized in antimicrobial chemotherapy. However, they have been reported to induce arthropathy in juvenile animals, and the mechanism has not been clarified. In the present study, to investigate the molecular details of the chondrotoxicity of the quinolone ofloxacin (OFLX), it was orally administered by gavage at a dose level of 900mg/kg once to male juvenile Sprague–Dawley rats, 3 weeks of age. Then gene expression profiles in the articular cartilage of the distal femur were analyzed at 2, 4, 8 and 24h post-dose. In the GeneChip analysis, the expression of 134 gene probes in the OFLX-treated group showed statistically significant differences with at least 1.5-fold difference from the control. Among them, intracellular signaling cascade- and stress response-related genes changed at 2h post-dose; cell death- and inflammatory response-related genes at 4 and 8h post-dose; basic-leucine zipper transcription factor and stress response-related genes at 8 and 24h post-dose; stress response-, proteolysis- and glycoprotein-related genes at 24h post-dose. In a quantitative real-time reverse transcription-polymerase chain reaction analysis, up-regulated Dusp1 (intracellular signaling cascade-related gene), Tnfrsf12a (cell death-related gene), Ptgs2, Fos (inflammatory response-related genes), Mt1a, Plaur (stress response-related genes) and Mmp3 (proteolysis-related gene) and down-regulated Sstr1 and Has2 (glycoprotein-related genes) were observed with dose dependency in the articular cartilage of juvenile rats treated with OFLX at 100, 300 and 900mg/kg. The expression of Tnfrsf12a, Ptgs2, Plaur and Mmp3 was also noted in chondrocytes around the cartilage lesions by in situ hybridization. In conclusion, our results suggest that cytokines, chemokines and/or proteases produced by up-regulation of cell death-, inflammatory response-, stress response- and proteolysis-related genes play a important role in the onset of OFLX-induced chondrotoxicity in juvenile rats. [Copyright &y& Elsevier]

Abstract: Inhibitory effects of hybrid liposomes (HL) composed of l-α-dimyristoylphosphatidylcholine (DMPC) and polyoxyethylene(20) sorbitan monooleate (Tween 80) including polyunsaturated fatty acids on the growth of human tumor cells were examined in vitro. Remarkably high inhibitory effects of HL including docosahexaenoic acid (HL-DHA) on the growth of lung carcinoma (RERF-LC-OK), colon tumor (WiDr), and stomach tumor (MKN45) cells were obtained. The induction of apoptosis by HL-DHA was revealed on the basis of fluorescence microscopic and flow cytometric analyses. [Copyright &y& Elsevier]

Abstract: We examined the structure–phototoxicity relationship for fluoroquinolone antimicrobial agents (quinolones) using female albino Balb/c mice. First of all, to obtain an optimum dosage level for induction of phototoxicity, the prototype phototoxicant sparfloxacin was intravenously administered once at 10mg/kg, 30mg/kg or 100mg/kg to female mice, followed immediately by ultraviolet-A (UVA) irradiation for 4h (21.6J/cm2). The auricular thickness was measured at pre-dose (0h), 4, 24, 48, 72 and 96h post-dose, and then the histopathological examination of the auricle was performed. As results, the auricular thickness increased from 30mg/kg, in conjunction with edema, cellular infiltration, epidermal necrosis and focal loss of the auricle. On the basis of these information, ciprofloxacin, enoxacin, fleroxacin, gatifloxacin, lomefloxacin, norfloxacin and ofloxacin were given intravenously to mice at a fixed dose of 100mg/kg to compare their potential phototoxicities. Certain quinolones caused the auricular lesions in the following rank order (from lowest to highest): vehicle control (non-phototoxicity)=gatifloxacin=ofloxacin<ciprofloxacin=norfloxacin<enoxacin=fleroxacin<lomefloxacin=sparfloxacin. From the viewpoint of the structure–phototoxicity relationship, quinolones possessing the C-8 substituent with a fluorine or hydrogen and 1,8-naphthyridine derivative evoked phototoxicity in the mouse auricle. These results demonstrate that phototoxicity induced by quinolones would be related to the property of the eighth position. [Copyright &y& Elsevier]