The aim of this study was to analyze the risk factors for grade 3 to 4 hematological toxicity after primary chemotherapy (Tegafur, gimeracil, oteracil potassium (S-1)/irinotecan hydrochloride (CPT-11)) in 87 (56 male, 31 female; median age 66.1 years) patients with unresectable or recurrent colonic cancer between April 2005 and May 2009, and to prepare a risk classes (low-risk, intermediate-risk or high-risk groups). The rate of grade 3 to 4 hematological toxicity was 16.1%. At multivariate analysis, risk factors for grade 3 to 4 hematological toxicity were baseline WBC, Cr, female (p<0.05). The toxicity index (TI) consisted of risk factors and regression coefficient. We were stratified patients into three groups according to TI that was calculated for each patient. The group with high value was found to include patients with grade 3 to 4 hematological toxicity with a significantly higher frequency than the group with low value (4.2% vs 57.1%, p=0.004). This risk classes could be useful to identify patients at high risk for chemotherapy-induced grade 3 to 4 hematological toxicity.

Decrease in white blood cell (WBC), neutrophil or platelet (PLT) count due to treatment with gemcitabine (GEM) is a dose-limited factor (DLF). Even for cases that satisfy the standard criteria for initiation of GEM therapy, the scheduled therapy is reportedly occasionally discontinued because of decreased PLT or WBC count. Here, a retrospective study was made to predict the factor causing discontinuation of GEM treatment before its first administration. The results showed that PLT count immediately before the first administration was significantly less in the unfinished administration group than in the finished group. It was also demonstrated that a PLT count less than 16×10/4 mL before the first administration of GEM was the significant risk factor leading to discontinuation of GEM treatment. Thus, it was suggested that this result would be available as the dose reduction standard to determine the first dose of GEM treatment.

Fifty-six patients treated with oxaliplatin were examined in order to clarify the factors that influence the appearance of allergic reactions by oxaliplatin at Kyoto City Hospital between January 2009 and December 2009, retrospectively. The number of patients in allergic and non-allergic group was 10 and 46, respectively. Patients' characteristics, the presence of hepatic metastasis, hepatic failure and kidney failure, albumin and white blood cell counts were compared in both groups. In the allergic group, the rate of hepatic metastasis was significantly higher than that in the non-allergic group (p=0.011). In conclusion, hepatic metastasis was suggested to be a factor that causes allergic reactions after administration of oxaliplatin.

The adverse effects of combination chemotherapy of ifosfamide, cisplatin, and etoposide (ICE) were evaluated in the treatment of various intracranial brain tumors.

An 81-year-old male with hormone refractory prostate cancer, received chemotherapy of Docetaxel, Estramustine and dexamethasone as an outpatient. After 4 courses of chemotherapy, he was admitted to our hospital in December 2007 because of general fatigue, appetite loss and erythema of the back of hands and face. He was diagnosed with pellagra. Nicotinic acid was administered and the symptoms disappeared. An 80-year-old male with hormone refractory prostate cancer, received chemotherapy of Docetaxel, Estramustine and dexamethasone without admission. After 8 courses of the chemotherapy, appetite loss appeared. In January 2008, medical examinations revealed nails peeling off, facial erythema and erosion of the back of his hands. He was diagnosed with pellagra. Nicotinic acid was administered and the symptoms disappeared. Pellagra, a nicotinic acid deficiency disease, is rarely observed clinically nowadays. However, it may occur in the patients, undergoing chemotherapy without admission.

The standard therapy for young patients with advanced non-small cell lung cancer (NSCLC) is platinum doublet therapy, whereas that for elderly patients with NSCLC is single-agent therapy. However, there is limited information about the platinum-based treatment for elderly patients.

At Komaki City Hospital, the drug cost in connection with cancer chemotherapy was re-examined as part of improved management along with the introduction of DPC in July 2008. With due attention to the 5-HT3 receptor antagonists, both the change from injections to oral drugs and the change from brand-name drugs to generic drugs were tried between July 2008 and June 2009. After that, in order to examine the economic impact of these changes, we investigated and analyzed the number of medications, the cost of medicine purchased, and the average drug cost per medication of the 5-HT3 receptor antagonists between April 2008 and September 2009. As a result, the cost of 5-HT3 receptor antagonists purchased decreased greatly, and the impact of the improvement was mainly due to the change to oral drugs, and partially to the change to generic drugs. Therefore, from the viewpoint of hospital economic improvement in DPC, it was thought that the change to oral drugs(5-HT3 receptor antagonists)is given top priority.

It has been thought that there is a possibility that infusion speed generally affects the manifested frequency of infusion reaction and its strength. The infusion prescription time of trastuzumab should be over 90 minutes according to the package insert. In the infusion US, is possible over 30 minutes after the second time. We sought to evaluate the safety and tolerability of trastuzumab administered as a 30-minute infusion.

A 63-year-old man with Stage IVa pancreas tail cancer was admitted for a distal pancreatectomy and splenectomy; adjuvant chemotherapy with gemcitabine was also administered. The chemotherapy was terminated after 16 courses due to hemolytic anemia, thrombocytopenia and renal dysfunction. Plasma exchange was performed; however the patient's renal function was diminished, requiring chronic hemodialysis. Physicians should be cautious of hemolytic uremic syndrome as a possible adverse reaction to gemcitabine and be aware that tests are needed for its early detection.

The recent guidelines of the Japanese Society of Hospital Pharmacists on the antitumor drug preparation have recommended the use of closed systems such as the PhaSeal® system for preventing cytotoxicity in health care workers involved in the preparation of these drugs. The PhaSeal® system and Clave® Oncology system were evaluated using a practical training kit for the preparation of antitumor drugs. The two systems were compared in terms of handling time, satisfaction as to availability, leakage of drugs from the connections in the system and area of drug spillage because improvements in convenience or lower cost system were available. With the closed systems, the average handling time increased by 10∼20%. The area of drug spillage did not significantly decrease. Leakage of drugs from the system was detected for all samples prepared with the Clave® Oncology system, and for some samples prepared with the PhaSeal® system. In terms of availability, the PhaSeal® system was better than the Clave® Oncology system. In conclusion, to decrease the exposure of health care workers to antitumor drugs during their preparation in a closed system, it is important to evaluate the handling time, operability, robustness with regard to drug leakage and spillage, and proficiency in handling of the closed system.

Anticancer drug-associated dermatopathy tends to be disregarded because of its small systemic influence. However, it may affect daily living activities, and mental distress due to its appearance may interfere with the continuation of therapy. In this study, we surveyed the state of skin care, and found that patients had anxiety over vomiting and depilation rather than dermatopathy. Patients who developed dermatopathy performed skin care, but none performed preventive skin care. For patients to perform skin care to prevent adverse effects, we provided information on appropriate self-skin care methods based on pharmaceutical management/instruction and instruction in an outpatient chemotherapy room using documents. On conducting the second questionnaire survey after providing information, 74.3% of patients answered that information provided by pharmacists was useful. Since skin care is a form of self-care, it is necessary to continuously provide information to support patients.

Although there are some sporadic reports about the ocular side effects (see below-named ocular disorders) of anticancer drugs, extremely few well-organized reports have been published. We report have eye disorders caused by anticancer drugs on the ocular surface (eyelids, conjunctiva, cornea), retina, optic nerve, and sites of the lacrymal ducts. For disorders of the anterior ocular segment, we use gefitinib (Iressa®) and erlotinib (Tarceba®), cetuximab (Arbitax®) for trichomegaly while for lacrymal duct disorders and retinas with corneal problems revolt biochemistry, S-1 (TS-1®), erlotinib, docetaxel, paclitaxel and tamoxifen, paclitaxel, tamoxifen, optic neuropathy with 5-fluorouracil (5-FU), S-1 and docetaxel have been reported. Eye disorders can be relieved by discontinuation of the anticancer drug, but one may cause irreversible change, and early diagnosis and treatment are required. In future, there is a need for examinations for large-scale eye disorders due to anticancer drugs and their prevention (about S-1 in particular) including the provision of information to ophthalmologists.

A 67-year-old man was diagnosed with multiple myeloma IgA-lambda type, Durie-Salmon classification stage IIIA in October 2001. He received five courses of induction chemotherapy consisting of vincristine, doxorubicin and dexamethasone and then underwent high dose chemotherapy followed by autologous stem cell transplantation in March 2003. He achieved partial response, but then relapsed after treatment with thalidomide and was admitted to our hospital in June 2007. The patient was complicated by tumor lysis syndrome (TLS) after receiving bortezomib therapy twice. Computed tomography after bortezomib therapy showed the rapid appearance of tumors in the right upper lobe of the lung, tail of the pancreas and the spleen. Though he was treated with antifungal agents, micafungin and voriconazole, he died eighty-five days after admission. Autopsy specimen showed fungal clumps and hemorrhagic infarction in the lung and spleen, and vegetation at the mitral valve was the same fungus as found in the lung. We diagnosed disseminated zygomycosis based on the pathological fungal morphology. This case suggested that metabolic acidosis was caused by TLS, while poorly controlled diabetes, secondary hemochromatosis due to transfusion, and breakthrough zygomycosis during antifungal therapy were thought to be factors contributing to the development of zygomycosis.