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Successful curative resection of gallbladder cancer following S-1 chemotherapy: A case report and review of the literature.

Einama T, Uchida K, Taniguchi M, Ota Y, Watanabe K, Imai K, Karasaki H, Chiba A, Oikawa K, Miyokawa N, Furukawa H - Oncol Lett (2014)

Bottom Line: The most effective treatment for GBC is surgical resection, however the majority of GBC cases are unresectable at the time of diagnosis.The surgical specimen exhibited high intratumoral DPD gene expression levels compared with those observed in previously reported non S-1 responsive cases of biliary tract cancer.Due to the results obtained in the current study, we hypothesize that CDHP enhanced the antitumor efficacy of 5-FU by inhibiting the excess DPD protein produced by the tumor.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan ; Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805, Japan.

ABSTRACT
The symptoms of gallbladder cancer (GBC) are vague and non-specific. Therefore, GBC is often detected at an advanced or metastatic stage. The most effective treatment for GBC is surgical resection, however the majority of GBC cases are unresectable at the time of diagnosis. Therefore, numerous GBC patients undergo chemotherapy. This study reports the case of a 60-year-old female with GBC who underwent successful surgical curative resection following a single dose of the chemotherapeutic agent, S-1, twice daily for 4 weeks followed by a 14-day rest period for 36 months. S-1 is a novel orally administered drug composed of a combination of the 5-fluorouracil (5-FU) prodrug, tegafur, 5-chloro-2,4-dihydroxypyridine (CDHP) and oteracil potassium in a 1:0.4:1 molar concentration ratio. The focus of the present study was the candidate factors that affect the therapeutic efficacy of S-1-based chemotherapy. In particular, the gene expression involved in the S-1 metabolic pathway was investigated by assessing the intratumoral dihydropyrimidine dehydrogenase (DPD), thymidylate synthase (TS) and orotate phosphoribosyltransferase gene expression. The surgical specimen exhibited high intratumoral DPD gene expression levels compared with those observed in previously reported non S-1 responsive cases of biliary tract cancer. Due to the results obtained in the current study, we hypothesize that CDHP enhanced the antitumor efficacy of 5-FU by inhibiting the excess DPD protein produced by the tumor.

No MeSH data available.


Related in: MedlinePlus

Changes in the patient CEA and CA19-9 levels (A) prior to chemotherapy and (B)six and (C) 27 months following chemotherapy, and computed tomography findings. (D) Clinical course of S-1 treatment. CEA, carcinoembryonic antigen; CA19-9, carbohydrate antigen 19-9; TS-1, thymidylate synthase; PTPE, percutaneous transhepatic portal embolization.
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f2-ol-08-06-2443: Changes in the patient CEA and CA19-9 levels (A) prior to chemotherapy and (B)six and (C) 27 months following chemotherapy, and computed tomography findings. (D) Clinical course of S-1 treatment. CEA, carcinoembryonic antigen; CA19-9, carbohydrate antigen 19-9; TS-1, thymidylate synthase; PTPE, percutaneous transhepatic portal embolization.

Mentions: The patient was followed up every six weeks for a total of 36 months. The tumor marker levels decreased after two months(Fig. 2), and a CT scan demonstrated a clear reduction in size in the regions of the liver that were invaded by the GBC, as well as those affected by lymph node metastasis and perineural invasion (Fig. 3). A partial response was maintained for over 30 months and, subsequently, surgical resection with curative intent was planned for 36 months following the initiation of treatment with S-1.


Successful curative resection of gallbladder cancer following S-1 chemotherapy: A case report and review of the literature.

Einama T, Uchida K, Taniguchi M, Ota Y, Watanabe K, Imai K, Karasaki H, Chiba A, Oikawa K, Miyokawa N, Furukawa H - Oncol Lett (2014)

Changes in the patient CEA and CA19-9 levels (A) prior to chemotherapy and (B)six and (C) 27 months following chemotherapy, and computed tomography findings. (D) Clinical course of S-1 treatment. CEA, carcinoembryonic antigen; CA19-9, carbohydrate antigen 19-9; TS-1, thymidylate synthase; PTPE, percutaneous transhepatic portal embolization.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214413&req=5

f2-ol-08-06-2443: Changes in the patient CEA and CA19-9 levels (A) prior to chemotherapy and (B)six and (C) 27 months following chemotherapy, and computed tomography findings. (D) Clinical course of S-1 treatment. CEA, carcinoembryonic antigen; CA19-9, carbohydrate antigen 19-9; TS-1, thymidylate synthase; PTPE, percutaneous transhepatic portal embolization.
Mentions: The patient was followed up every six weeks for a total of 36 months. The tumor marker levels decreased after two months(Fig. 2), and a CT scan demonstrated a clear reduction in size in the regions of the liver that were invaded by the GBC, as well as those affected by lymph node metastasis and perineural invasion (Fig. 3). A partial response was maintained for over 30 months and, subsequently, surgical resection with curative intent was planned for 36 months following the initiation of treatment with S-1.

Bottom Line: The most effective treatment for GBC is surgical resection, however the majority of GBC cases are unresectable at the time of diagnosis.The surgical specimen exhibited high intratumoral DPD gene expression levels compared with those observed in previously reported non S-1 responsive cases of biliary tract cancer.Due to the results obtained in the current study, we hypothesize that CDHP enhanced the antitumor efficacy of 5-FU by inhibiting the excess DPD protein produced by the tumor.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa, Hokkaido 078-8510, Japan ; Department of Surgery, Hokkaido Social Work Association Obihiro Hospital, Obihiro, Hokkaido 080-0805, Japan.

ABSTRACT
The symptoms of gallbladder cancer (GBC) are vague and non-specific. Therefore, GBC is often detected at an advanced or metastatic stage. The most effective treatment for GBC is surgical resection, however the majority of GBC cases are unresectable at the time of diagnosis. Therefore, numerous GBC patients undergo chemotherapy. This study reports the case of a 60-year-old female with GBC who underwent successful surgical curative resection following a single dose of the chemotherapeutic agent, S-1, twice daily for 4 weeks followed by a 14-day rest period for 36 months. S-1 is a novel orally administered drug composed of a combination of the 5-fluorouracil (5-FU) prodrug, tegafur, 5-chloro-2,4-dihydroxypyridine (CDHP) and oteracil potassium in a 1:0.4:1 molar concentration ratio. The focus of the present study was the candidate factors that affect the therapeutic efficacy of S-1-based chemotherapy. In particular, the gene expression involved in the S-1 metabolic pathway was investigated by assessing the intratumoral dihydropyrimidine dehydrogenase (DPD), thymidylate synthase (TS) and orotate phosphoribosyltransferase gene expression. The surgical specimen exhibited high intratumoral DPD gene expression levels compared with those observed in previously reported non S-1 responsive cases of biliary tract cancer. Due to the results obtained in the current study, we hypothesize that CDHP enhanced the antitumor efficacy of 5-FU by inhibiting the excess DPD protein produced by the tumor.

No MeSH data available.


Related in: MedlinePlus