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Background We hypothesized that thermal damage accumulation during endoscopic submucosal dissection (ESD) causes the pathogenesis of post-ESD electrocoagulation syndrome (PECS). Aim To determine the association between Joule heat and the onset of PECS. Methods We performed a retrospective cohort study in patients who underwent colorectal ESD from May 2013 to March 2021 in Japan. We developed a novel device that measures swift coagulation time with a sensor adjacent to the electrosurgical coagulation unit foot switch, which enabled us to calculate total Joule heat. PECS was defined as localized abdominal pain (visual analogue scale ≥ 30 mm during hospitalization or increased by ≥ 20 mm from the baseline) and fever (temperature ≥ 37.5 degrees or white blood cell count ≥ 10000 µ/L). Patients exposed to more or less than the median Joule heat value were assigned to the high and low Joule heat groups, respectively. Statistical analyses included Mann-Whitney U and chi-square tests and logistic regression and receiver operating characteristic curve (ROC) analyses. Results We evaluated 151 patients. The PECS incidence was 10.6% (16/151 cases), and all patients were followed conservatively and discharged without severe complications. In multivariate analysis, high Joule heat was an independent PECS risk factor. The area under the ROC curve showing the correlation between PECS and total Joule heat was high [0.788 (95% confidence interval: 0.666-0.909)]. Conclusion Joule heat accumulation in the gastrointestinal wall is involved in the onset of PECS. ESD-related thermal damage to the peeled mucosal surface is probably a major component of the mechanism underlying PECS.

The standard chemotherapies for neuroendocrine tumors (NETs) are somatostatin analog (SSA) and targeted-agents for NET G1/G2 and platinum-based chemotherapy for neuroendocrine carcinoma (NEC), classified according to the WHO criteria of 2010. We report a case of NET, in which tumors were successfully treated with platinum-containing chemotherapy after remarkable progression with SSA. A 46-year-old man with multiple lymph nodes and liver metastases of unknown primary origin was diagnosed with NET G2 based on the examination of a biopsy specimen. His tumors were stable with SSA for a year, but rapidly became enlarged. A second biopsy revealed NEC. He received cisplatin plus etoposide, and his tumors showed a marked reduction in size.

Advanced liver cancers and biliary cancers represent diseases with dismal prognosis because of frequent local invasion and metastasis. Effective therapeutic agents for these cancers have not been established. Oncolytic viruses (OVs) constitute a novel class of promising, selective anticancer agents and recent studies have elucidated their unique features. Moreover, clinical trials are demonstrating promising results. Numerous OVs are being tested in preclinical models of hepatocellular carcinoma (HCC). The lead agent Pexa-Vec (pexastimogene devacirepvec, JX-594), a recombinant Wyeth strain vaccinia virus, has demonstrated preliminary evidence of safety and efficacy for HCC in clinical trials. Few other OVs have entered clinical testing. Relatively few preclinical studies and clinical trials exist for biliary cancers. In this review, we introduce various approaches using OVs to treat the intractable hepatobiliary cancers.

Combination chemotherapy of mFOLFOX6 (5-fluorouracil, leucovorin, and oxaliplatin) plus panitumumab, a fully human monoclonal antibody against epidermal growth factor receptor (EGFR), is one of the standard treatments for metastatic colorectal cancer (mCRC) without KRAS mutation. A few reports suggested no need of dose adjustment of cetuximab, a similar chimeric anti-EGFR antibody, in patients with renal impairment. However, panitumumab combined with cytotoxic drugs for hemodialysis patients has not been reported. We herein report a case of a hemodialysis mCRC patient successfully treated with mFOLFOX6 and panitumumab combination therapy.

Background Pulmonary metastases from colorectal cancer are resected due to the favourable 5-year overall survival rates of 30–60% reported in many studies. However, the efficacy of subsequent adjuvant chemotherapy remains unclear. Patient and methods We retrospectively collected clinical data of 1237 patients who underwent surgical resection of pulmonary metastasis from colorectal cancer at 46 Japanese institutions between 2004 and 2008. Patients with non-curative resection, pre-operative chemotherapy, extra-thoracic metastasis, complications after surgery, and inadequate data were excluded. Then, a 1:1 propensity score nearest-neighbour matching between patients with and without adjuvant chemotherapy was performed, considering relevant co-variables, and survival of patients between groups was compared. Results Data of 524 patients (surgery alone, 269 patients; surgery with adjuvant chemotherapy, 255 patients) were used for matching. From each group, 192 patients with similar background characteristics between groups were selected. Adjuvant chemotherapies included fluoropyrimidine alone (71%), an oxaliplatin-containing regimen (23%), or an irinotecan-containing regimen (6%). In the surgery alone and adjuvant chemotherapy groups, 5-year overall survival rates were 68% and 69%, and 5-year disease-free survival rates were 40% and 34%, respectively. There were no significant differences between the two groups in terms of overall survival (hazard ratio [HR]: 1.00, 95% confidence interval [CI]: 0.69–1.45, P = 1.00) and disease-free survival (HR: 1.07, 95% CI: 0.82–1.39, P = 0.62). Conclusions Adjuvant chemotherapy after curative resection of lung-limited metastasis from colorectal cancer did not show a survival benefit in the propensity score–matched analysis and should not be recommended without further clinical trials.

Background To develop a triplet regimen containinggemcitabine,cisplatin,andS-1(GPS),weassessedtherecom-mendeddoseforpatientswithuntreatedadvancedbiliarytractcancer in this phase I study.Methods Dose-limitingtoxicities(DLTs)wereevaluatedforthe following two dose levels: gemcitabine (1000mg/m 2 forlevel 1 and 1200mg/m 2 for level 2 on day 1), cisplatin(30mg/m 2 fixeddoseonday1),andS-1(40–60mg/dayfixeddose twice a day for 7days), every 2weeks until progression.DLTs for each level were evaluated in six or more patientsduring the first twocycles.Results A total of 18 patients were enrolled and 16 patientswere evaluated. DLTs at level 1 were observed in two of10 patients. At level 2, a DLT was observed in one of sixpatients. The main grade 3 or 4 treatment-related adverseevents were neutropenia and leukopenia, and a few non-hematological toxicities were observed. Among 14 patientswith measurable lesions, the best response rate was 50%.Conclusions GPS with a relative dose intensity correspond-ingto90%ofthestandardgemcitabinepluscisplatinregimencould be administered safely, and showed preliminary antitu-mor activity. Survival benefits will be studied subsequently.Keywords Biliary tract cancer · Cholangiocarcinoma ·Cisplatin · Gallbladder carcinoma · Gemcitabine · S-1IntroductionGemcitabine and fluoropyrimidine (FU) are used widely inpatients with advanced biliary tract cancer (ABTC). Re-cently, gemcitabine plus cisplatin (GP) combination che-motherapy has been recognized as a standard first-linechemotherapy based on the results of a phase III study(ABC-02), which compared GP to gemcitabine alone inpatients with ABTC [1]. Since then, FU-containingregimens have been used as second-line chemotherapyfor ABTC. S-1, which contains tegafur, gimeracil, andoteracil, has been approved for the treatment of varioussolid tumors including ABTC in Japan, and S-1 incombination with cisplatin has been approved for gastriccancer therapy in Europe [2]. It showed promisingactivity against ABTC in several studies [3–10] and ismainly used in gemcitabine-refractory patients in Japan.However, all patients do not receive second-line chemo-therapy. The proportion of patients who receivedsecond-line chemotherapy after the failure of first-linechemotherapy was reportedly 20 to 70% [1, 11, 12]. It was60% in our previous study, where we explored prognosticfactors for ABTC [13].This study aimed to develop a triplet regimen, GP plusS-1, using valid drugs in the upfront treatment of patientswith ABTC.

We performed a retrospective study on the use of cetuximab or panitumumab alone in patients with KRAS wild-type metastatic colorectal cancer between November 2008 and February 2012. Twenty-two patients were analyzed and classified as PS 0/1 (good PS group)and PS 2/3/4 (poor PS group)with 11 patients in each group. The response rate, disease control rate, median progression-free survival, and median overall survival were 9%, 73%, 5.1 months (95%confidence interval[CI]: 1.5-8.7), and 16 months (95% CI: 8.8-24), respectively, in the good PS group, and the corresponding values in the poor PS group were 0%, 18%, 0.7 months (95% CI: 0.3-1.0), and 1.5 months (95% CI: 0.7-2.4). Grade 3 or 4 adverse events were skin toxicities (2 patients with grade 3 toxicities), panitumumab-related interstitial lung disease (1 patient with grade 4 toxicity), and cetuximab infusion-related reaction (1 patient with grade 4 toxicity). No treatment-related deaths were observed. In conclusion, the efficacy and safety of cetuximab or panitumumab monotherapy in patients with a good PS in our study were similar to those reported in previous clinical trials, whereas patients with a poor PS showed poorer outcomes.

A 45-year-old man presented with severe abdominal distention with massive ascites due to a diffusely disseminated peritoneal tumor. A core needle biopsy specimen was obtained from the peritoneal lesion. Histological diagnosis was epithelioid type mesothelioma. He did not choose to receive chemotherapy. For 2.5 years, he went without medical intervention, and his disease gradually progressed, leading to a worsening of his symptoms. The patient then chose to be treated with combination chemotherapy of cisplatin and pemetrexed, followed by pemetrexed alone. There was remarkable tumor shrinkage and his symptoms improved. These effects have been sustained for two years after the initial chemotherapy. Chemotherapy appears to have contributed to survival prolongation for this patient. This case exemplifies the fact that malignant peritoneal mesothelioma may progress slowly when fits with some good prognostic factors, and it is important to consider the prognostic factors.