Search

Original Article

Original Article

Original Article, Introduction: Immune-related adverse events (irAEs) have been reported to be a favorable prognostic factor in patients treated with immune checkpoint inhibitors. To identify the convenient biomarkers to predict irAEs, we analyzed the relationship between pretreatment laboratory data and irAEs in gastric cancer patients treated with nivolumab. Methods: A retrospective analysis was performed on 38 patients treated with nivolumab for unresectable or recurrent gastric cancer between September 2017 and December 2019. We evaluated the relationships between pretreatment laboratory data, adverse events, and prognosis. The significance of irAE predictors was evaluated via univariate and multivariate analyses. The prognostic significance of irAE predictors was also evaluated. This study was approved by the relevant ethics committee of Toho University Omori Medical Center (No. M21048, 20108, M20300). Results: In total, 14 irAEs were recorded in 13 of 38 patients (37%). The irAE (+) group showed favorable treatment response (P = 0.038) and prognosis (P = 0.093) in comparison with the irAE (-) group. The irAE (+) group showed low urea nitrogen, high sodium, and low white blood cell count (less than 5100/μl). Although low urea nitrogen and high sodium were identified to be not associated with good overall survival, the group with low white blood cell count was significantly associated with good overall survival (P = 0.022). Conclusions: A low white blood cell count at pretreatment may be a predictor of irAEs and favorable overall survival in gastric cancer patients treated with nivolumab. Gastric cancer patients with a low white blood cell count may be a good candidate for nivolumab treatment.

Original Article, Introduction: The effect of proton pump inhibitors on capecitabine- and S-1-based treatment for human epidermal growth factor receptor 2 (HER2)-positive gastric cancer is unknown. Therefore, we compared the effect of proton pump inhibitors between capecitabine- and S-1-based treatments for HER2-positive gastric cancer. Methods: In a multi-institutional study, we retrospectively analyzed the effect of proton pump inhibitors on 155 HER2-positive advanced or recurrent gastric cancer patients who were treated with oral 5-fluorouracil (capecitabine or S-1) and trastuzumab. Capecitabine- and S-1-based treatments were compared in terms of the response rate and time to treatment failure, and the negative effects of proton pump inhibitors on the treatment response were evaluated. In this study, the primary endpoint was the response rate, and the secondary endpoint was time to treatment failure. Results: There was no significant difference in the response rate between the capecitabine- and S-1-based treatments. However, in cases without proton pump inhibitor intake, the response rate significantly improved with capecitabine-based treatment rather than with S-1-based treatment (P = 0.046). Compared with the S-1-based treatment, the capecitabine-based treatment significantly prolonged the time to treatment failure (P = 0.044), including for patients with differentiated adenocarcinoma (P = 0.035). Conclusions: For HER2-positive and differentiated gastric cancer, capecitabine-based treatment may be better than S-1-based treatment. Proton pump inhibitors might decrease capecitabine's effects and should be avoided to increase the response rate to capecitabine-based treatment.

Case Report, A 58-year-old Japanese man was diagnosed with T4b (descending aorta) N2M1, stage IVB lower thoracic Barrett's esophageal adenocarcinoma. He was initially treated with definitive chemotherapy with cisplatin and 5-fluorouracil (FP therapy). After one course of FP therapy, he developed renal dysfunction complications. Computed tomography showed no remarkable change in the main tumor and metastatic lesion. Therefore, radical esophagectomy with resection of the invaded descending aorta and removal of the solitary metastatic lesion was performed. Superior mediastinal dissection, esophageal transection, and left adrenal gland removal were performed simultaneously. The patient underwent curative resection but died of multiple hematogenous metastases 116 days postoperatively. As aortic infiltrates were infected, artificial blood vessel replacement was selected. Although he underwent radical esophagectomy, hematogenous metastases have occurred in the early postoperative period.

Original Article, Introduction: The initial high systemic inflammatory index (SII), which is calculated as platelets × (neutrophils / lymphocytes), indicates a poor prognosis in patients with various malignant tumors, but its value after treatment in esophageal cancer is not well described. Methods: The prognostic value of the perioperative SII was evaluated in 103 esophageal cancer patients treated by radical esophagectomy. Fifty-nine of the patients received neoadjuvant chemotherapy (NAC); 44 received surgery only. The prognostic value of the SII was evaluated at each stage of the treatment. The impact of clinicopathological factors on the SII and prognosis was also evaluated after stratifying patients by treatment with surgery and NAC or surgery only. Results: Pre-treatment SII was not associated with prognosis, but pre-operative SII (p = 0.11), post-operative SII (p = 0.07), and post-NAC SII (p < 0.05) were associated with prognosis. A decrease in the SII during treatment was also associated with a good prognosis. A high SII before NAC was significantly associated with a decrease of SII during treatment (p < 0.05). Conclusions: A high or non-decreased SII after treatment of esophageal cancer was a poor prognostic indicator. The prognosis of patients with high SSIs might be improved by NAC.