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Lorlatinib, a third-generation ALK tyrosine kinase inhibitor, has been approved as a treatment for ALK-positive lung cancer. This review provides information regarding the pharmacology and clinical features of lorlatinib, including its efficacy and associated adverse events. Pivotal clinical trials are discussed along with the current status of lorlatinib as a treatment for ALK-positive lung cancer and future therapeutic challenges.Lorlatinib has been approved as a new standard treatment for lung cancer with gene alteration known as ALK fusion. This review provides information regarding the characteristics of lorlatinib, including its efficacy and the unexpected medical problems that occur during treatment. Today, treatment of ALK-positive lung cancer is more complicated because of the active development of drugs like lorlatinib. This review demonstrates the logic of including lorlatinib as part of the treatment plan and sheds light on the future of treatment for ALK-positive lung cancer.

Introduction The accelerated development of lung cancer treatments has resulted in a single global study that is sufficient for a new agent and indication to be approved. Not all new treatments predominate globally, and differences in standards of care may influence the efficacy of treatments in the real world. Methods The results from Japanese domestic trials and global trials that included a subset population of Japanese patients were evaluated for 18 genomic targeted agents and immune therapies approved after 2000. The results were collected from drug applications that were reviewed for treatment approval in Japan. Results Japan is one of the first countries to approve and fully reimburse new agents around the world. Alectinib and nivolumab, which were first developed by Japanese pharmaceutical companies, were evaluated in an independent domestic trial, which resulted in their early approval. For most other indications, 1.1–15.8% of the patients who participated in pivotal registration studies were Japanese, and their treatment results were comparable to those of the overall population. Overall survival was less likely to be improved by four agents for which the post-protocol therapy might have been different in Japan than in other countries. Conclusions Overall, a positive result in a global trial was emulated in Japanese patients and led to the approval of a new standard treatment in Japan. Early approvals were attained by either participating in the global registrational study or conducting a domestic phase II study. The higher efficacy of new agents may be an issue in the future, as Japanese patients had early access to the new agent and may receive better treatment after the trial.

PPM1D, a protein Ser/Thr phosphatase, is overexpressed in various cancers and functions as an oncogenic protein by inactivating the p53 pathway. Therefore, molecules that bind PPM1D are expected to be useful anti-cancer agents. In this study, we constructed a phage display library based on the antibody-like small molecule protein adnectin and screened for PPM1D-specific binding molecules. We identified two adnectins, PMDB-1 and PMD-24, that bind PPM1D specific B-loop and PPM1D430 as targets, respectively. Specificity analyses of these recombinant proteins using other Ser/Thr protein phosphatases showed that these molecules bind to only PPM1D. Expression of PMDB-1 in breast cancer-derived MCF-7 cells overexpressing endogenous PPM1D stabilized p53, indicating that PMDB-1 functions as an inhibitor of PPM1D. Furthermore, MTT assay exhibited that MCF-7 cells expressing PMDB-1 showed inhibition of cell proliferation. These data suggest that the adnectin PMDB-1 identified in this study can be used as a lead compound for anti-cancer drugs targeting intracellular PPM1D.

Pembrolizumab has become the standard first-line treatment for non-small cell lung cancer (NSCLC) patients with high PD-L1expression. MET exon 14 skipping is a rare mutation typically found in older, female, and non-smoking patients with NSCLC. Herein, we report the case of a 71-year-old non-smoking woman who was diagnosed with NSCLC in the left lung. EGFR mutation and ALK fusion were not detected. Because the biopsy specimen showed high PD-L1 expression with a tumor proportion score of 95%, pembrolizumab was introduced as first-line therapy, but resulted in no clinical benefit. The patient was subsequently administered chemotherapy with carboplatin and pemetrexed, leading to remarkable tumor shrinkage. A next-generation sequencing panel analysis revealed a MET exon 14 skipping mutation. Thus, pembrolizumab might not be effective for NSCLC patients with MET exon 14 skipping mutations, even if PD-L1 expression is high.

A de novo single-nucleotide mutation in the EGFR gene can cause the development of lung cancer. EGFR tyrosine kinase inhibitors (EGFR-TKIs) are used for clinical treatment of such lung cancers, but acquired resistance often mitigates their efficacy. Accordingly, monitoring of de novo and acquired nucleotide mutations is essential for clinical treatment of lung cancers with EGFR-TKIs. Previously, we reported that oligoribonucleotide interference-PCR (ORNi-PCR) can accurately and cost-effectively detect single-nucleotide mutations. In this study, we applied ORNi-PCR to simultaneous detection of the de novo L858R and acquired T790M mutations in the EGFR gene in lung cancer cells. First, we established optimal experimental conditions for ORNi-PCR to simultaneously detect the two single-nucleotide mutations in genomic DNA from lung cancer cells. The conditions we established could also be used for ORNi-PCR using complementary DNA reverse-transcribed from extracted RNA. We found that ORNi-PCR could detect lung cancer cells possessing both single-nucleotide mutations among a large number of cells harboring wild-type sequences, even when the cancer cells constituted less than ~0.2% of all cells. Our findings demonstrate that ORNi-PCR can simultaneously detect multiple single-nucleotide mutations in a gene of interest and might therefore be useful for simultaneous detection of EGFR mutations in clinical examinations.

Afatinib, a second-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) for mutant non-small cell lung cancer (NSCLC), was approved in Japan in 2014. This study evaluated clinical outcomes of afatinib in real-world practice. Medical records of patients who received afatinib for advanced EGFR-mutant NSCLC were retrospectively reviewed. In total, 128 patients were analyzed. Seventy-six patients received afatinib as the first-line setting and 52 as the re-challenge setting (i.e., after failure of prior first-generation TKI). There was no difference in patient characteristics, such as age, sex, and PS, between the first-line and the re-challenge settings. In the first-line setting, the median progression-free survival (PFS) was 17.8 months (95% confidence interval [CI] 13.7-21.5 months). The overall survival (OS) was 39.5 months (95% CI 34.4- not reached). The response rate (RR) was 64.4%. Subset analysis indicated that patients with dose reduction showed longer PFS than those without dose reduction (18.5 months versus 7.9 months) (P = 0.016). In the re-challenge setting, the median PFS was 8.0 months (95% CI 4.9-9.5 months). The RR was 25%. Most common adverse events leading to dose modification or treatment discontinuation included diarrhea, paronychia, and oral mucositis in both settings. Interstitial lung disease occurred in 5.4% (7/128). In the real-world practice in Japan, afatinib showed comparable or better efficacy compared with that shown in previous clinical trials in both the first-line and the re-challenge settings.

The present retrospective study was conducted to evaluate the efficacy of immune checkpoint inhibitors (ICIs) in patients with advanced non-small cell lung cancer (NSCLC) harboring driver mutations. Patients with NSCLC harboring driver mutations who received ICIs (nivolumab or pembrolizumab) were reviewed in Hirosaki University and Aomori Prefectural Central Hospital. There were 139 patients who received molecular targeted drugs, including 24 patients treated with ICIs. Patient characteristics were as follows: Male/female, 5/19; median age 68 (range 39–82); smoking/non-smoking, 6/18; PS 0–1/2, 20/4; driver mutation status, EGFR/ALK/RET/ROS1: 21/1/1/1. The overall response rate was 16.7% [95% confidence interval (CI), 7.0–37.1%] and the disease control rate was 33.4% (95% CI, 18.9–55.1%). The median progression-free survival (PFS) time was 62 days (95% CI 52–81 days). In the patients who had been treated by the preceding tyrosine kinase inhibitor (TKI) for >1 year, the PFS time was 110 days. On the other hand, in the patients who had received a TKI for less than a year, the PFS time was 56 days, which was significantly shorter (P=0.012). To conclude, some of the patients with NSCLC harboring driver mutation could benefit from ICIs, and the duration of previous TKI treatment may be associated with the efficacy.

This phase I trial was conducted to determine the maximum tolerated dose (MTD) and recommended dose of afatinib for phase II trial in elderly patients with advanced non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. The study used a standard 3 + 3 dose escalation design. Patients aged 75 years or older with advanced NSCLC harboring EGFR mutations were enrolled. The doses of afatinib, which were given once daily, were planned as follows: level 1, 20 mg/day; level 2, 30 mg/day; level 3, 40 mg/day. Dose-limiting toxicity (DLT) was defined as grade 4 hematologic, persistent grade > 2 diarrhea for > 2 days despite concomitant medications or grade 3 non-hematologic toxicity. DLT was evaluated during day 1-28. Fifteen patients were enrolled. Patient characteristics were: male/female 3/12; median age 79 (range 75-87); PS 0/1, 2/13. Six patients have been treated at levels 1 and 3, and three patients at level 2. At level 1, one of six patients experienced grade 3 rush, grade 3 anorexia, and grade 3 infection as DLTs. At level 2, none of three patients experienced a DLT. At level 3, two patients developed grade 3 diarrhea, one of whom also experienced grade 3 anorexia. Most frequent adverse events of any grade were diarrhea, paronychia, rush, and nausea. Most patients at level 2 and 3 required dose reduction in 3 months. MTD was defined as 40 mg/day, and recommended dose for phase II study in elderly patients was 30 mg/day.

Vertically aligned carbon nanosheets (CNSs) with bi- and trilayer graphene have been achieved on various metal substrates from solid carbon sources by irradiation with H2 and Ar plasma. The resulting graphene structures have fewer layers, bigger sizes, and higher graphitization compared to previous reports obtained from gas sources, as confirmed by scanning and transmission electron microscopes, Raman and X-ray photoelectron spectroscopes. The results suggest that the interaction between the plasma (of H2 and Ar) and carbon sources favors the formation of bigger and thinner nucleation cites in the initial stage and atomic H etching dominates during the whole thinner CNS growth. The vertically aligned graphene film can be directly transferred on as-patterned SiO2/Si to form a heterojunction photovoltaic cell with a power conversion efficiency of 0.9%.

In Japan, earthquake resistance improvement (earthquake proofing) of drinking water infrastructure is not as developed as for other types of infrastructure such as gas and electricity. To facilitate earthquake proofing, it is important for water utilities to encourage customers to better understand its importance and effectiveness. So that water consumers could instinctively understand the effectiveness of earthquake proofing, we applied the concept of ‘recovery time expectancy’ as an indicator of earthquake resistance of water treatment plants. In this study, we performed a recovery simulation of a medium-scale water treatment plant based on the system reliability theory, and then evaluated the effectiveness of earthquake proofing using recovery time expectancy as an indicator. The simulation was performed with five cases: the present condition of the facility and four hypothetical cases with different levels of earthquake proofing. As a result, the effectiveness of earthquake proofing was able to be expressed by a recovery curve showing the reduction of recovery time expectancy, and the priority became clear for seismically proofing each component of the plant according to the earthquake scale. Finally, the optimum capital investment was determined by comparing total costs (damage cost plus investment cost) of the five cases, which were computed according to recovery time expectancy after earthquake proofing.

e21173Background: Afatinib is the second generation epidermal growth factor receptor (EGFR) - tyrosine kinase inhibitor (TKI) for mutant non-small cell lung cancer (NSCLC), and approved in Japan in...

Asian populations have changed from traditional to Westernized diets, with increased red meat intake. They are suggested to be particularly susceptible to the adverse effects of red meat on the development of colorectal cancers, however, few prospective studies of this putative link have been conducted. We examined associations between the consumption of red and processed meat and the risk of subsite-specific colorectal cancer by gender in a large Japanese cohort. During 1995-1998, a validated food frequency questionnaire was administered to 80,658 men and women aged 45-74 years. During 758,116 person-years of follow-up until the end of 2006, 1,145 cases of colorectal cancer were identified. Higher consumption of red meat was significantly associated with a higher risk of colon cancer among women [multivariate hazard ratios (95%CIs) for the highest versus lowest quintiles (HR): 1.48 (1.01, 2.17; trend p=0.03)], as was higher consumption of total meat among men [HR=1.44 (1.06, 1.98; trend p=0.07)]. By site, these positive associations were found for the risk of proximal colon cancer among women and for distal colon cancer among men. No association was found between the consumption of processed meat and risk of either colon or rectal cancer. In conclusion, red meat intake may modestly increase the risk of colon cancer in middle-aged Japanese, although the highest quintile of red meat consumption could be considered moderate by Western standards.

In order to elucidate the mechanism involved in the toxification of trumpet shell, Charonia sauliae, with tetrodotoxin (TTX), nontoxic trumpet shells were fed with toxic specimens of a starfish, Astropecten polyacanthus, for one to four weeks. All the digestive glands of the trumpet shells became toxic after one week of feeding. The accumulation/administration value (percent) of TTX was 33% on average, and the total amount of accumulated toxin tended to increase with the amount administered.It was found by feeding of the toxified trumpet shells with nontoxic mackerel meat that the accumulated toxin is not readily metabolized in and/or excreted from the trumpet shell.

A total of 691 specimens of a trumpet shell Charonia sauliae were collected from several locations in Shizuoka Prefecture, and assayed for toxicity of the digestive gland by the official method for tetrodotoxin determination.1) The frequency of toxic specimens ranged from 30% at Ito to 93% at Shimizu, the average frequency being 66%.2) The average toxicity of all the specimens assayed was 151MU/g digestive gland. The toxicity score was clearly higher at Shimizu (226MU/g) or Numazu (277MU/g) than at other places.3) The highest toxicity scores recorded at Shimizu and Numazu were 1, 950 and 2, 580MU/g digestive gland, respectively. At other places, however, fairly toxic specimens (400-500MU/g digestive gland) were found sporadically.4) The toxicity of trumpet shells in the Shimizu area has tended to decrease in recent years.5) At Numazu, the toxicity of trumpet shells was higher in spring and summer than in other seasons. Shimizu specimens did not show such a seasonal variation.