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Duk Joo Lee,
Tae Sung Sohn,
Do Hoon Lim,
Hee Kyung Ahn,
Se Hoon Park,
Jeeyun Lee,
Joon Oh Park,
Young Suk Park,
Ho Yeong Lim,
Dong Il Choi,
Kyoung Mee Kim,
Min Gew Choi,
Jae Hyung Noh,
Jae Moon Bae,
Sung Kim,
Byung Hoon Min,
Won Ki Kang
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ABSTRACT: The aim of this phase I study was to investigate the optimal dose of S-1 and oxaliplatin with concurrent radiotherapy in a preoperative setting for locally advanced gastric cancer.
Twelve patients with histologically confirmed clinical stage T2N+ or T3-T4 gastric adenocarcinoma received dose level -1 (oral S-1 at 60 mg/m(2)/day + oxaliplatin 40 mg/m(2) intravenously on days 1, 8, 15 and 22) or dose level 1 (S-1 80 mg/m(2)/day + oxaliplatin 40 mg/m(2)), with concurrent radiotherapy at daily fractions of 1.8 Gy 5 days per week, to a total dose of 41.4 Gy. Surgical resection, including D2 dissection, was performed within 4 weeks after the last day of chemotherapy.
Chemoradiotherapy was generally well tolerated, with the most common dose-related grade 1 or 2 adverse events being anemia, nausea, vomiting, anorexia and abdominal pain. Two DLTs (prolonged thrombocytopenia and stomach perforation) were observed at dose level 1 (n = 6) and resulted in dose de-escalation to level -1. The recommended dose for future study is dose level -1, at which 1 of 6 patients developed grade 3 vomiting and anorexia. R0 resection was possible in 11 patients. Pathologic down-staging was observed in 6 patients, including one complete response. No clinically relevant postoperative complications occurred.
The activity of preoperative concurrent chemoradiotherapy with S-1 (60 mg/m(2)/day for 28 consecutive days) and oxaliplatin (40 mg/m(2) on days 1, 8, 15 and 22) will be explored more extensively in a phase II study in patients with locally advanced GC.
Cancer Chemotherapy and Pharmacology 02/2012; 69(5):1333-8. · 2.83 Impact Factor
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Hee Kyung Ahn,
Ji Eun Uhm,
Jeeyun Lee,
Do Hoon Lim,
Sung Wook Seo,
Ki-Sun Sung,
Su Jin Lee, Duk Joo Lee,
Kyung Kee Baek,
Won-Seog Kim,
Joon Oh Park
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ABSTRACT: Pediatric-type sarcomas such as Ewing's sarcoma (EWS)/primitive neuroectodermal tumor family and rhabdomyosarcoma are relatively uncommon in adult patients. Optimal treatment strategies for this population and prognosis in adult patients compared with pediatric patients remain controversial.
We retrospectively reviewed pediatric-type sarcoma patients older than 15 years at a single institution.
A total of 84 consecutive patients between 1995 and 2009 were identified at the Samsung Medical Center, Seoul, Korea. Median age was 30 years with a range of 15-74 years. Forty-seven patients (56.0%) were diagnosed with Ewing's sarcoma/primitive neuroectodermal tumor family, 34 (40.5%) with rhabdomyosarcoma and 3 (3.6%) with desmoplastic round-cell tumor. Median follow-up duration was 5.9 years. Median overall survival for all patients was 33.1 months (95% CI 13.5-52.7) and median event-free survival for all patients was 14.4 months (95% CI 5.9-22.9 months). Multivariate analysis revealed that localized disease was a significant independent prognostic factor for longer overall survival (hazard ratio 0.30, 95% CI 0.14-0.66, p = 0.003), and favorable primary tumor sites were associated with longer event-free survival (hazard ratio 0.33, 95% CI 0.11-0.98, p = 0.045).
We identified the prognostic variables which may facilitate risk-adapted therapies for this rare adult sarcoma group, which should be further investigated.
Oncology 05/2011; 80(1-2):21-8. · 2.27 Impact Factor
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Taekyu Lim,
Jeeyun Lee, Duk Joo Lee,
Ha Yeon Lee,
Boram Han,
Kyung Kee Baek,
Hee Kyung Ahn,
Su Jin Lee,
Se Hoon Park,
Joon Oh Park,
Young Suk Park,
Ho Yeong Lim,
Kyoung-Mee Kim,
Won Ki Kang
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ABSTRACT: Everolimus is a novel inhibitor of the mammalian target of rapamycin pathway, which is aberrantly activated in cancer cell. We conducted a phase I study of capecitabine plus everolimus (RAD001) in refractory gastric cancer patients.
Patients with metastatic gastric cancer and progression after prior chemotherapy were eligible. Four dose levels were planned as follows: Level 1, 5 mg bid/day of everolimus (D1-D21) and 500 mg/m(2) bid/day of capecitabine (D1-14); Level 2, 5 mg bid/day of everolimus (D1-D21) and 750 mg/m(2) bid/day of capecitabine (D1-14); Level 3, 5 mg bid/day of everolimus (D1-D21) and 1000 mg/m(2) bid/day of capecitabine (D1-14); and Level 4, 10 mg bid/day of everolimus (D1-D21) and 1000 mg/m(2) bid/day of capecitabine (D1-14). Treatment was repeated every 3 weeks until disease progression, patient refusal, or any serious adverse event.
Fifteen patients were enrolled in this study between November 2009 and April 2010. Fifteen patients were enrolled (median age, 50 years; men, 9). Six patients had received two previous chemotherapy regimens; six patients had three previous chemotherapy regimens before the study treatment. Thus, the majority of patients were heavily pretreated. The dose-limiting toxicities were grade 3 infection, grade 3 mucositis, and grade 3 hyperglycemia and hyponatremia. After a median follow-up duration of 5.6 months (range, 2.3-8.1 months), median PFS was 1.8 months (95% CI, 0.8-2.8 months). The maximum best change observed was a 28.7% decrease in sum of longest diameters when compared with baseline.
The combination of capecitabine and everolimus showed satisfactory toxicity profile and modest clinical benefit in patients with refractory gastric cancer. The recommended dose of capecitabine and everolimus was 650 mg/m(2) twice daily and 5 mg twice daily, respectively.
Cancer Chemotherapy and Pharmacology 04/2011; 68(1):255-62. · 2.83 Impact Factor
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Taekyu Lim,
Seok Jin Kim,
Kihyun Kim,
Jung-Il Lee,
Do Hoon Lim, Duk Joo Lee,
Kyung Kee Baek,
Ha Yeon Lee,
Boram Han,
Ji Eun Uhm,
Young Hyeh Ko,
Won Seog Kim
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ABSTRACT: Diffuse large B-cell lymphoma (DLBCL) constitutes most primary central nervous system (CNS) lymphoma (PCNSL), whereas T-cell, low-grade and Burkitt's lymphomas (BL) are rarely encountered. Due to the paucity of cases, little is known about the clinical features and treatment outcomes of PCNSL other than DLBCL. The objective of this study was to describe the clinical characteristics and outcomes for patients with PCNSL other than DLBCL. Fifteen patients, newly diagnosed with PCNSLs other than DLBCL between 2000 and 2010, were included. The male to female ratio was 0.67:1 with a median age of diagnosis of 31 years (range 18-59). Pathologic distributions were as follows: peripheral T-cell lymphoma (PTCL; n=7), marginal zone B-cell lymphoma (MZBCL; n=1), lymphoplasmacytic lymphoma (LPL; n=2), Burkitt's lymphoma (n=1), other unspecified (T-cell lineage, n=2; B-cell lineage, n=2). Thirteen patients (87%) showed Eastern Cooperative Oncology Group performance score (ECOG PS) 1-2. The remaining two were one PTCL patient and one Burkitt's lymphoma patient. Of the nine patients with T-cell lymphoma, five (56%) had multifocal lesions, and one (20%) with LPL of the five patients with B-cell lymphoma showed a single lesion. Leptomeningeal lymphomatosis was identified in two patients (one with Burkitt's lymphoma and one with unspecified B-cell lymphoma). Two patients (22%) with T-cell lymphoma died 7.7 and 23.3 months later, respectively, due to disease progression, despite HD-MTX-based therapy. Six patients with T-cell lymphoma (6/9, 66.7%) and four patients with low-grade B-cell lymphoma (4/5, 80%) achieved complete response and have survived without relapse (Table 3). One patient with Burkitt's lymphoma showed poor clinical features with ECOG PS 3, deep structure, multifocal, and leptomeningeal lymphomatosis, and died 7.6 months after the initiation of treatment. In comparison with previously reported DLBCLs (median OS 6.4 years, 95% CI 3.7-9.1 years), T-cell lymphoma showed equivocal or favorable clinical outcomes and low-grade B-cell lymphomas, such as MZBCL and LPL, had a good prognosis. However, primary CNS Burkitt's lymphoma presented poor clinical outcomes and showed a comparatively aggressive clinical course. In conclusion, primary CNS lymphoma other than DLBCL occurred more in younger patients and showed a generally good prognosis, except for Burkitt's lymphoma. Further research on treatment strategies for Burkitt's lymphoma is needed.
Annals of Hematology 04/2011; 90(12):1391-8. · 2.62 Impact Factor
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Jun Ho Yi,
Yoon La Choi,
Su Jin Lee,
Hee Kyung Ahn,
Kyung Kee Baek,
Taekyu Lim, Duk Joo Lee,
Bo Ram Han,
Ha Yeon Lee,
Hyun Jung Jun,
Jeeyun Lee,
Yeon Hee Park
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ABSTRACT: A carcinoma of unknown primary (CUP) is a histologically confirmed metastatic cancer without a definitive primary site after performing a detailed medical examination. The purpose of the study was to classify unfavorable CUPs into more reliable disease entities, which reflect the clinical course. We reviewed the medical records of patients diagnosed with a CUP between January 1995 and March 2008. Patients were classified into a conventional favorable-risk group and a newly proposed unfavorable-risk group according to the clinicopathologic features. Five hundred eighty-six patients were diagnosed with CUPs. Fifty-six (9.6%) patients were classified in the conventional favorable-risk group, and 486 (82.9%) patients were classified in the unfavorable-risk group. We further classified the 486 patients into six subgroups with an unfavorable risk, while excluding 29 patients (5.0%) who were not classifiable. The overall survival of the conventional favorable-risk group was 47.0 months (95% CI, 11.1~82.9 months), which was significantly longer than that of any subgroup of the newly proposed unfavorable-risk group (P < 0.001). Patients with squamous cell carcinoma in the abdominopelvic cavity showed similar overall survival with unfavorable-risk group (P = 0.484). Women with non-papillary malignant ascites had a survival in between the favorable and unfavorable groups (P < 0.001). The newly proposed unfavorable-risk group may assist in classifying CUP patients with an unfavorable risk in a clinically more meaningful way. Squamous cell carcinoma in the abdominopelvic cavity should be considered in the unfavorable-risk group and women with non-papillary malignant ascites in an intermediate-risk group. Further studies with molecular profiling would help in classifying and treating patients with CUPs and an unfavorable risk.
Tumor Biology 02/2011; 32(1):45-51. · 1.94 Impact Factor
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Duk Joo Lee,
Jeeyun Lee,
Ha Yeon Lee,
Taekyu Lim,
Su Jin Lee,
Seong Yoon Yi,
Se Hoon Park,
Joon Oh Park,
Ho Yeong Lim,
Won Ki Kang,
Young Suk Park
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ABSTRACT: The purpose of the study was to evaluate the efficacy and tolerability of S-1 monotherapy in metastatic colorectal cancer (CRC) patients who have failed the standard oxaliplatin-based or irinotecan-based chemotherapy. From 2007 to 2010, metastatic CRC patients who received S-1 monotherapy as salvage treatment were identified from tumor registry at Samsung Medical Center. All patients received ≥ second-line treatment for CRC. S-1 was administered orally from day 1 to day 14, every 3 weeks. The dose of S-1 for each patient was determined according to body surface area (BSA) as follows: for BSA < 1.25 m(2), 80 mg/day; for 1.25 m(2) < BSA < 1.5 m(2), 100 mg/day; and for BSA > 1.5 m(2), 120 mg/day divided by 2 doses. The median age of the 19 patients was 59 years (range: 33-77). Fourteen (73.7%) of 19 patients received S-1 monotherapy as third-line treatment after failing oxaliplatin-based or irinotecan-based chemotherapy. Previous regimens prior to S-1 therapy were as follows: FOLFOX, XELOX, FOLFIRI, XELOX + avastin, and cetuximab + irinotecan. The median number of administered S-1 courses given in the entire studied population was 3 cycles (1-10 cycles). Three patients had confirmed partial response (PR) after 3 cycles of S-1 treatment. After a follow-up duration of 22.3 months (range: 6.7-32.6 months), median time to progression (TTP) was 2.1 (95% CI, 1.8-4.2) months. Median overall survival was 11.3 months (95% CI, 8.8-16.8) from the time of S-1 chemotherapy administration. Two patients had grade 1 hand-foot syndrome (HFS) after first and 2nd cycles of treatments, respectively, but treatments were continued without developing further adverse events. The salvage S-1 monotherapy in metastatic colorectal cancer patients who failed irinotecan-based or oxaliplatin-based chemotherapy was moderately effective and well tolerated.
Medical Oncology 11/2010; 28 Suppl 1:S291-4. · 2.14 Impact Factor
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ABSTRACT: The purpose of the study was to assess the efficacy and safety of biweekly oxaliplatin in combination with leucovorin (LV)-modulated bolus plus infusion of 5-fluorouracil (5-FU) in patients with relapsed or metastatic colorectal cancer (CRC) as a second line therapy.
Between November 2002 and October 2005, 26 patients with histologically confirmed relapsed or metastatic CRC were enrolled. All patients were previously treated with irinotecan-based combination chemotherapy. The chemotherapy regimen consisted of oxaliplatin 85 mg/m(2) on day 1; LV 200 mg/m(2) on days 1 and 2; and 5-FU 400 mg/m(2) bolus IV with 600 mg/m(2) with a 22-hour infusion on days 1 and 2 every 2 weeks.
The median age of the 26 patients was 50.5 years (range, 31 approximately 72). Their metastatic sites included: the liver (42.3%), peritoneum (26.9%), lung (23.1%) and ovary (7.7%). Twenty five patients were evaluated for their response. Four patients achieved partial responses and 15 patients had stable disease. The overall response rate was 16% (95% confidence interval; 1.7 approximately 30.3%). The median follow-up duration for the surviving patients was 7.4 months (range, 2.08 approximately 21.2). Median overall survival (OS) and 1-year OS rates were 16.7 months and 63.9%, respectively. The most common hematological toxicities were: NCI grade I/II leucopenia (49.3%), grade I/II neutropenia (41%) and grade I/II anemia (65.2%). The main non-hematological toxicities were: grade I/II peripheral neuropathy (16.1% and 21.5%, respectively) and nausea/vomiting (23.6%/18.5%). There was no life-threatening toxicity.
The oxaliplatin, 5-FU and LV combination chemotherapy, scheduled as a biweekly protocol, was effective and well tolerated in the treatment of relapsed or metastatic colorectal cancer patients as second line chemotherapy.
Cancer Research and Treatment 12/2006; 38(4):201-5.
