We investigated the effectiveness of using an ice pack for reducing the pain associated with goserelin acetate injection. In this study, 39 patients with prostate cancer and 1 patient with breast cancer receiving hormonal therapy with goserelin acetate were enrolled. All patients completed a questionnaire regarding the use of ice application. We used the numerical rating scale (NRS) to assess the pain associated with injection. The NRS scores indicated that the pain was significantly less with ice application than with the usual method (p < 0.001). Further, ice application could decrease the duration of pain sensation. Ice application at the injection site is safe and effective for reducing pain.

This study included patients who were prescribed pregabalin, vitamin B12, amitriptyline, clonazepam, or carbamazepine to improve oxaliplatin(L-OHP)- or paclitaxel(PTX)-induced peripheral neuropathy at Iwate Medical University Hospital between April 2011 and July 2012. The efficacy and safety of pregabalin was evaluated by comparing 27 patients with L-OHP-induced peripheral neuropathy and 28 with PTX-induced peripheral neuropathy prescribed pregabalin(pregabalin group) with 20 patients with L-OHP-induced peripheral neuropathy and 25 with PTX-induced peripheral neuropathy prescribed other drugs(non-pregabalin group). Response was defined as a decrease in neuropathy of at least 1 grade from baseline. The response rates were 40.7% and 10.0% for L-OHP-induced peripheral neuropathy patients and 28.6% and 12.0% for PTX-induced peripheral neuropathy patients in the pregabalin and non-pregabalin groups, respectively. The severity of peripheral neuropathy before and after the administration of pregabalin differed significantly[L-OHP, 1.33±0.48(mean±SD) vs. 1.00±0.78 and PTX, 1.46±0.69 vs. 1.21±0.88]. In 28-37% of patients, pregabalin was associated with adverse events, with drowsiness and dizziness being frequently observed. In conclusion, pregabalin was efficacious in reducing the severity of L-OHP- and PTX-induced peripheral neuropathy.

We surveyed the nutritional status of patients with colorectal cancer undergoing outpatient chemotherapy using the malnutrition universal screening tool(MUST)to examine its usefulness and association with adverse events.

Thirteen patients with metastatic colorectal cancer who suffered from oxaliplatin-induced sensory neuropathy were evaluated to determine the neuropathy Grade before and after the administration of pregabalin. All patients received oxaliplatin as adjuvant or first-line chemotherapy. The mFOLFOX6 and CapeOX groups included 3 and 10 cases, respectively, and the average treatment regimens were 8 and 5 doses, respectively. Before receiving pregabalin, sensory neuropathy was classified as Grade 3 in 2 patients, as Grade 2 in 8 patients, and as Grade 1 in 3 patient. The average amount of pregabalin administered to patients was 237 (range: 150-450) mg. After administering pregabalin, we observed improvements in 8 neuropathy cases (61. 5%)within approximately 2 weeks. All side effects were mild. In this study, pregabalin was shown to positively impact sensory neuropathy resulting from oxaliplatin treatment and to enable the long-term use of oxaliplatin-based chemotherapy.

We report a case of drug-induced pneumomediastinum by bleomycin in testicular cancer, which is extremely rare ; to our knowledge, only 3 cases have been reported. A 28-year-old man presented with a left testicular mass. He underwent radical left inguinal orchiectomy that demonstrated a seminoma, pT3N0M0. Ten months after surgery, para-aortic lymph node metastasis appeared, and he received three cycles of bleomycin, etoposide and cisplatin (BEP) chemotherapy. On day 13 of the fourth course of BEP, he complained of snowball crepitation of the neck and computed tomography revealed subcutaneous emphysema, extensive mediastinal air, and intraspinal air accumulation without pneumothorax. The pneumomediastinum and subcutaneous emphysema tended to deteriorate until 15 days after the onset of pneumomediastinum, but fortunately he had no signs or symptoms of infection. These findings resolved spontaneously after 1 month.

The patient was a 67-year-old male who had been treated for several years with 150 mg fluvoxamine maleate due to depression. He visited our hospital with primary symptoms of swelling of the right upper extremity and dyspnea in August, XXXX. As a result of examinations, he was diagnosed with stage IIIB extended small cell lung cancer(T4N3M0). One course of carboplatin/etoposide(CBDCA/VP-16)therapy was started on October 1. Since the tumor size was reduced, thoracic effusion disappeared, and superior vena cava syndrome was alleviated, the therapy was changed to cisplatin/irinotecan (CDDP/CPT-11)on October 23, and the 3rd course was initiated on November 22. Anxiety and tremor appeared on the 4th day of the 3rd course and because they were exacerbated, and myoclonus appeared, a diagnosis of serotonin syndrome was made on the 38th day, and the administration of fluvoxamine maleate was discontinued. The symptoms were alleviated after the discontinuation, and the 4th course could be implemented. In this patient, serotonin syndrome was considered to have been induced by serotonin secretion promoted by the CDDP administration, and by serotonin in the brain increasing abnormally due to the SSRI.

Chemotherapy for cancer has been reported to have many side effects. Dysgeusia or taste disorder is a common complaint among cancer patients undergoing ambulatory chemotherapy. The present study was undertaken to establish the importance of dysgeusia as a side effect of chemotherapy in these patients. The study included 356 patients who visted Shikoku Cancer Center to undergo outpatient cancer chemotherapy. Of these patients, 156(43.8%)experienced dysgeusia. Of the 156 patients, 34 were male and 122 were female. The incidence of dysgeusia was higher in patients receiving FOLFOX6(oxaliplatin+ 5-FU), docetaxel(DTX), paclitaxel(PTX), docetaxel+cyclophosphamide(TC)or epirubicin+cyclophosphamide(EC) than in those receiving other regimens. When the occurrence of dysgeusia was difficult to define, the changes in taste sensations were subtle for salty and umami taste. This disorder affected appetite: 87.2%of patients experienced loss of appetite. In addition, 66.7% of patients were distressed by this disorder. Dysgeusia may significantly reduce the quality of life of patients undergoing chemotherapy for cancer. Therefore, patient support is important for patients who experience dysgeusia.

Hiccups are often observed in patients treated with cisplatin(CDDP)-based chemotherapy. It has been reported that gender and specific dosages of CDDP and antiemetic drugs(e.g., dexamethasone and 5-HT3 receptor antagonist)using standard therapy are major risk factors in the onset of hiccups. Recently, aprepitant has been added to the antiemetic therapy in CDDP-based chemotherapy. However, it is not known how the onset of hiccups takes place in antiemetic therapy including aprepitant according to the guideline. In this study, we used cluster analysis to classify 229 patients treated with CDDP-based chemotherapy, to investigate the effect of antiemetic therapy on the onset of hiccups and chemotherapy-induced nausea and vomiting(CINV). Our analysis indicated that aprepitant was not a major risk factor for the onset of hiccups in the high CDDP dose group(≥70 mg/m(2)). However, an effect of antiemesis was confirmed in the standard therapy with aprepitant. In conclusion, we suggest that aprepitant is effective for CINV, without causing the onset of hiccups in patients treated with high-dose CDDP-based chemotherapy.

Paclitaxel therapy often causes musculoskeletal pain, and some clinical studies have indicated that this pain is due to nerve injury, rather than muscle or joint lesion. We report four clinical cases in which controlled-release oxycodone improved pain intensity in breast cancer patients with severe musculoskeletal pain caused by nab-paclitaxel therapy. In each case, oxycodone was well-tolerated and the symptoms of peripheral neuropathy were quite mild, indicating that oxycodone exhibited a preventive or therapeutic effect on peripheral neuropathy. Therefore, oxycodone may have favorable efficacy and tolerability against cancer therapy-related pain with a neuropathic element in breast cancer patients.

We present a case of vinorelbine (VNR)-induced acute tumor pain. Oral control-release oxycodone was administered for cancer pain by iliac bone metastasis. In chemotherapy by combined use of VNR and gemcitabine, severe pain in groin, thigh and hip occurred immediately after infusion of VNR. Oral rapid-release oxycodone was administered but the pain lasted half an hour and then resolved spontaneously. In the following course of chemotherapy by same regimen, pre-medication of rapid-release oxycodone did not prevent the pain.

Angiogenesis, the formation of new blood capillaries from preexisting blood vessels, is a vital process in growth of solid tumors and development to malignant stage. This makes angiogenesis a desirable target for cancer treatment. In this work, design and syntheses of structurally simplified analogues of cortistatin A (1), a novel antiangiogenic steroidal alkaloid from Indonesian marine sponge, and their biological activities were investigated. One of the analogues, in which the isoquinoline moiety was appended to the planar tetracyclic core structure, showed potent antiproliferative activity against human umbilical vein endothelial cells (HUVECs) together with high selectivity and also showed in vivo antiangiogenic activity and significant antitumor effect by oral administration.

Paclitaxel injection NK(NK)is a generic product containing the same amount of ingredients as a Taxol®Injection. We examined the safety of NK in clinical practice compared to the original drug. Our results suggested that for the cancer patient, most safety profiles between NK and the original drug are similar. However, patients who received Taxol®Injection had significantly more grade 2 neuropathy compared to those who received NK(p<0. 01).

A 64-year-old man received mFOLFOX6+bevacizumab chemotherapy for metastatic lung cancer after rectal cancer resection( Stage IV). After 28 courses, he had an abdominal pain with fever, and computed tomography showed pelvic abscess with stercolith of appendix. He was diagnosed as acute appendicitis with intra-abdominal abscess, and emergency appendectomy with drainage was performed. Two days after the operation, he was suspected to have a sutural leakage as was suggested from the properties of his drainage, therefore re-operation was performed. A small hole of the ileum, about 2mm in diameter, was observed. The margin of the hole showed neither inflammatory nor neoplastic change, and a suturing closure of the hole was performed. The post-operative course was uneventful. Histopathological findings of the resected appendix suggested that the perforation was caused by necrosis of metastatic cancer cells penetrating the appendiceal wall. This is a case of a bevacizumab-related metachronous perforation that occurred in different gastrointestinal origins within a very short term.

A recent foreign clinical trial showed albumin-bound paclitaxel(260mg/m2 tri-weekly)to have a better response for metastatic breast cancer(MBC)than did treatment with paclitaxel alone(175mg/m2 tri-weekly). It was sometimes difficult to control the occurrence of side effects, such as neutropenia and neuropathy, especially after many treatments. The effect of low-dose albumin-bound paclitaxel(180-220mg/m2 tri-weekly)was evaluated in 8 patients with MBC. The overall response rate was 62. 5%(CR 1, PR 4), and 2 cases had Grade 3/4 toxicity(Grade 3 neutropenia); however, all patients were manageable. In addition, there was a good response rate(50%, PR 3)among the patients previously treated with paclitaxel. Because patient's "care" is as important as the "cure" in the treatment of MBC, an effective and well-tolerated regimen is recommended for patients with this disease. Low-dose albumin-bound paclitaxel was effective with reduced side effects, even after PTX treatment. Therefore, albumin-bound paclitaxel may be an optional treatment for MBC after any treatment.

We have observed several cases of adverse reactions to paclitaxel, including visual impairment and lacrimation. Therefore, we conducted a survey of the current status of adverse reactions to paclitaxel and also performed a retrospective analysis of the initial symptoms and the times of their appearance. Of the 22 study patients, 8(36. 4%)presented with adverse ocular reactions, such as visual impairment and lacrimation, and for 3(13. 6%), an ophthalmologist confirmed that paclitaxel could not be ruled out as the direct cause of their adverse reactions. The group of patients who presented with adverse ocular reactions included significantly more patients with ocular complications and a previous history of ocular ailments, compared to the group showing no such reactions. The timing of reaction appearance did not show a consistent pattern. The results of this study suggest that the initial symptoms were mainly visual impairment and lacrimation, and that caution must be taken when administering paclitaxel to patients with a previous history of ocular ailments and ocular complications because of the risk of adverse ocular reactions. Thus, adverse ocular reactions to paclitaxel were indicated as a possible risk, in addition to other adverse events such as myelosuppression and peripheral neuropathy.

Hypomagnesemia is one of the well-known side effects in patients receiving cisplatin-containing chemotherapy. However, the relevance between hypomagnesemia and cisplatin-induced nephrotoxicity remain to be completely elucidated. Although patients with esophageal and hypopharyngeal cancer are susceptible to dehydration, there is no evidence yet that magnesium supplementation for these patients will prevent nephrotoxicity during cisplatin-containing chemotherapy. The aim of this study was to examine the effect of magnesium supplementation on the prevention of cisplatin-induced nephrotoxicity for patients with esophageal and hypopharyngeal cancer. Twenty-three patients with esophageal or hypopharyngeal cancer were studied over 2 weeks. Ten of them received magnesium supplementation and 13 did not. Magnesium sulphate(20 mEq) was administered before 5-fluorouracil(800mg/m2/24 h/day 1-5)and cisplatin(80mg/m2/day 1)(FP)treatment. The maximum serum creatinine concentration of magnesium-supplemented group demonstrated a significantly lower concentration compared to the non-magnesium-supplemented group(p=0. 018). As a result, magnesium supplementation successfully reduced the incidence rate of nephrotoxicity(p=0. 038). These results showed that magnesium supplementation before FP treatment may be quite beneficial for preventing nephrotoxicity in patients with esophageal and hypopharyngeal cancer, and it is therefore recommended that magnesium be routinely supplemented during FP treatment for esophageal or hypopharyngeal cancer.

The most serious adverse event in cancer patients who receive anti-neoplastic agents is febrile neutropenia(FN). The clinical guideline for the use of antimicrobial agents in managing patients with FN was published by the Infectious Diseases Society of America. However, the dosage and administration of antimicrobial agents are not completely adapted for Japanese insurance coverage. The Japanese Society of Medical Oncology therefore decided to develop a clinical guideline for the management of FN in Japanese patients. In this study, we provide a general description of the guideline. According to the guideline, fever is defined as a single axillary temperature of B37. 5°C(or an oral temperature of B38°C)and neutropenia is defined as a neutrophil count of <500/mL or <1, 000/mL if the count is expected to decrease to <500/mL within the next 48 h. In patients who develop FN, empirical anti-pseudomonal b-lactam agent monotherapy should be administered promptly at the onset of fever. Antibiotic therapy should continue until patients become afebrile and their neutrophil counts recover to B500/mL. If fever persists for 4-7 days under antibiotic therapy in high-risk patients, empirical antifungal therapy should be considered. Granulocyte colony-stimulating factor prophylaxis should be considered for high-risk patients with an anticipated risk of FN of B20%.

Chemotherapy-induced febrile neutropenia(FN)is a major risk factor for severe infections, with a dose-limiting toxicity that necessitates dose reductions and/or delays in scheduled chemotherapy sessions. Therefore, the use of granulocyte colony- stimulating factors(G-CSF)is recommended in cancer patients at a risk of chemotherapy-induced FN. Three types of GCSF, filgrastim, lenograstim, and nartograstim, have been available thus far. The differences in potency and efficacy among these G-CSF needs to be thoroughly understood. Prophylactic G-CSF is recommended in patients receiving a chemotherapy regimen associated with a high risk(>20%)of FN. A chemotherapy regimen associated with intermediate risk(10-20%)of FN, requires particular attention to the neutrophil count and observation of symptoms of infection after chemotherapy. Prophylactic G-CSF could be included in subsequent chemotherapy regimens, if needed.

Nausea and vomiting are among the most problematic symptoms experienced by patients with cancer who are receiving chemotherapy. 5-hydroxytryptamine 3(5-HT3)-receptor antagonists, NK1 receptor antagonists(aprepitant)and dexamethasone are now the standard therapies for preventing chemotherapy-induced nausea and vomiting(CINV)that follow highly emetogenic chemotherapy, such as cisplatin and anthracycline. However, since it is not cleared which 5-HT3-recepter antagonist is a proper treatment for combined use with aprepitant and dexamethasone, we conducted a questionnaire survey, which used the numerical rating scale(NRS), for comparing palonosetron with granisetron in the same patient. Palonosetron showed a significant improvement of nausea for both acute(within 24 hours)and delayed phase(24-120 hours later), regardless of the type of chemotherapy(cisplatin or anthracycline-based regimen). Furthermore, palonosetron had a tolerable safety profile. Our study suggests that palonosetron-based antiemetic treatment will be a preferred choice for preventing CINV following highly emetogenic chemotherapy.