We here describe a 49-year-old man who suffered repeated anaphylactic shock after systemic chemotherapy with vinorelbine for stage IV left lung adenocarcinoma (S1+2). He was treated using a combination of cisplatin and weekly irinotecan (CPT-11) as the first line; however, the regimen was changed to a combination of vinorelbine (VNR) and gemcitabine (GEM) because of his progressive disease. He was admitted to our hospital for examination of the unknown cause of hypotension and loss of consciousness. The second shock occurred after eating pistachios, and the third one at cancerous pain. After pain control, the shock no longer occurred. Anaphylactic shock may show two peaks and late symptoms. In patients with a history of anaphylactic shock, we should pay attention to foods, drugs, and various stresses which might cause anaphylaxis.

We report a case of recurrent carcinoma of the ampulla of Vater with multiple lung and abdominal lymph node metastases that well responded to S-1, an oral fluoropyrimidine. A 56-years-old woman underwent a pylorus-preserving pancreaticoduodenectomy for carcinoma of the ampulla of Vater in October 2003. Multiple lung metastases were detected by chest X-ray as a post operative screening a year after surgery. Computed tomography showed multiple abdominal lymph node metastases. The patient was treated with S-1 (80 mg/day, day 1-28, followed by 2 weeks rest) from November 2003. Anti-tumor efficacy was confirmed to be partial response by Response Evaluation Criteria in Solid Tumors (RECIST). Leukocytopenia, anemia, and mucositis were observed. Every toxicity was mild to moderate, and no other severe toxicities were noted. S-1 might be an effective and safe agent for carcinoma of the ampulla of Vater.

The purpose of this study was to evaluate the effectiveness and adverse events of combination chemotherapy with S-1 and docetaxel (DOC) as neo-adjuvant chemotherapy (NAC) for patients with oral squamous cell carcinomas. Fifteen patients were enrolled in this study (11 men and 4 women, with a mean age of 65.9 years). All patients given S-1 80 mg/body per day for 14 days and following were administered a dose of DOC 60 mg/m(2) by drip infusion for 120 minutes. The locoregional response was evaluated 3 weeks after the administration. As a result, the locoregional response rate was 60.0%, including 46.7% complete response. According to Oboshi and Shimosato's classification, histological evaluation of surgical specimens revealed that 3 cases were Grade I , 3 cases Grade IIa, 4 cases Grade IIb, 1 case Grade III, 3 cases Grade IVb, and 1 case Grade IVc. The severe side effect was neutropenia. The present study suggests that combination chemotherapy with S-1 and DOC is an effective and safe regimen in NAC for oral squamous cell carcinomas.