Takeo Nishimori

Bullous pemphigoid as a dermadrome associated with spindle cell carcinoma of the gallbladder.

Skin disorders that appear in association with internal malignancies are called dermadromes. Bullous pemphigoid (BP), which is a major autoimmune disease of the skin, is considered to be a dermadrome, although there have been conflicting reports. We report a case of BP that preceded the diagnosis of an internal malignancy. Although we could not detect any malignancies on chest, abdominal or pelvic computer tomography on the first hospital admission, intensive screening on the third admission revealed a gallbladder malignancy. Laparoscopic cholecystectomy was performed. Histopathology showed a spindle cell carcinoma of the gallbladder. To the best of our knowledge, this is the first report of a spindle cell carcinoma of the gallbladder in a patient with BP.

ENDOSCOPIC PLACEMENT OF METALLIC STENT FOR COLONIC STRICTURE RESULTING FROM CARCINOMA LOCATED AT THE SPLENIC FLEXURE

A 67‐year‐old woman was admitted to Ikuwakai Memorial Hospital with sub‐ileus symptoms. Radiographic and endoscopic examination revealed that the patient had a colonic cancer approximately 15 cm in length from the descending colon to the distal transverse colon with severe stricture. The histopathological finding was mucinous adenocarcinoma. Abdominal computed tomography showed multiple liver metastases and intraperitoneal lymph‐node swelling. A per‐rectal decompression tube was inserted temporarily, and surgical colostomy was initially proposed. However, the patient rejected surgery, and stent therapy was considered as an alternative therapy. An ultraflex esophageal expandable metallic stent was installed. At day 4, tumor projection through the expandable metal‐stent mesh was observed and additional balloon dilatation was carried out under colonoscopic assistance. At day 7, ileus symptoms disappeared and the patient had been able to maintain oral feeding for 3 months until she died as a result of cachexia by systemic metastasis of colonic cancer.

Phase I study of nanoparticle albumin-bound paclitaxel, carboplatin and trastuzumab in women with human epidermal growth factor receptor 2-overexpressing breast cancer

Although the concurrent use of anthracycline-containing chemotherapy and taxane with trastuzumab are considered the treatment of choice for the primary systemic therapy of human epidermal growth factor receptor 2 (HER2)-overexpressing early breast cancer, non-anthracycline regimens, such as concurrent administration of docetaxel and carboplatin with trastuzumab, exhibited similar efficacies in a previous study. In addition, tri-weekly treatment with nanoparticle albumin-bound paclitaxel (nab-paclitaxel) resulted in significantly higher response rates and a favorable safety profile compared with standard paclitaxel for metastatic breast cancer patients in another phase III study. Based on these results, a phase I study of combination therapy with nab-paclitaxel, carboplatin and trastuzumab was planned, in order to estimate its efficacy and safety for HER2-overexpressing locally advanced breast cancer. The present study was designed to determine the dose-limiting toxicity (DLT), maximum tolerated dose and recommended dose of this combination treatment in women with HER2-overexpressing locally advanced breast cancer. The starting dose of nab-paclitaxel was 220 mg/m2 (level 1), and the dose was escalated to 260 mg/m2 (level 2). Nab-paclitaxel was administered with carboplatin (area under the curve, 6 mg/ml/min) and trastuzumab tri-weekly. A total of 6 patients were enrolled. Although no DLT was observed during the first cycle, 4 patients developed grade 4 thrombocytopenia, 2 had grade 4 neutropenia and 3 exhibited a grade 4 decrease in hemoglobin levels. In the present phase I study, although no patients experienced DLTs, this regimen was associated with severe hematological toxicities and it was not well tolerated. However, considering the high efficacy and lower risk of cardiotoxicity and secondary carcinogenesis with taxane, platinum and trastuzumab combination therapy, further evaluation of another regimen including weekly administration or a more accurate dose setting should be conducted.