Administration of vitamin B12 and folic acid for 7 days prior to the administration of the first dose of pemetrexed is recommended. However, vitamin supplementation rarely is initiated less than 7 days prior to the first dose of pemetrexed. Therefore, we analyzed the safety of pemetrexed with vitamin supplementation for less than 7 days prior to the first dose of pemetrexed.

According to the literature, 40%of all oral complications associated with chemotherapy are due to oral mucositis. Moreover, such complications increase the difficulties associated with oral intake, leading to deterioration of the patient's nutritional condition and increasing the risk of systemic infection. Therefore, oral mucositis prevention and proper treatment are very important.

A drug use investigation of nanoparticle albumin-bound paclitaxel was conducted based on conditions for approval. A total of 963 patients were enrolled in this study from September 24, 2010 to February 14, 2011. Twenty-nine patients were excluded, and a total of 934 patients were evaluated for determining the safety of nanoparticle albumin-bound paclitaxel. Adverse drug reactions were observed in 92.8%of the patients, and major adverse drug reactions included myelosuppression and peripheral sensory neuropathy, both of which are characteristic adverse reactions of paclitaxel treatment. Both adverse drug reactions were observed at a high frequency after the second course of treatment, resulting in these reactions being primary causes for discontinuation. Increase in the rates of continuous drug administration may be accomplished by carrying out laboratory tests and noting the medical history in order to prevent myelosuppression from becoming serious and to perform earlier countermeasures for peripheral sensory neuropathy, leading to improved therapeutic effects.

Since there is accumulating evidence to indicate that introduction of early palliative care for cancer patients may improved their quality of life or survival rates, the number of patients receiving pain relief by narcotic analgesics in conjunction with chemotherapy is predicted to increase. Therefore to provide effective combination treatments it is important to evaluate basic evidence regarding drug-drug interactions between anti-cancer drugs and narcotics. We have focused on P-glycoprotein (P-gp), a drug efflux transporter, in small intestine where the absorption process of drugs administered via oral route is greatly limited. Then, we revealed that repeated oral treatment with etoposide (ETP) increases P-gp levels in the small intestinal membrane via RhoA/ROCK activation, leading to decrease in analgesia of morphine, a P-gp substrate drug, with alteration of its disposition after oral administration. Furthermore, we found that activation of ezrin/radixin/moesin (ERM), scaffold proteins that regulate plasma membrane localization or function of certain plasma membrane proteins such as P-gp, are involved in this mechanism. Of particular interest is that among ERM proteins, radixin may contribute, at least in part, to increased expression of P-gp in the small intestine under repeated oral treatment with ETP.

A 73-year-old woman had received 9 months of chemotherapy with nab-paclitaxel for locally advanced breast cancer. During the treatment, she was well and showed no major side effects except for alopecia and arthralgia. The tumor showed a tendency to reduction. However, chemotherapy was discontinued because of liver dysfunction. MRCP and ERCP demonstrated multiple stenoses of the hepatic ducts and the intrahepatic bile ducts. We diagnosed chemotherapy-induced sclerosing cholangitis caused by nab-paclitaxel. Treatment with ursodeoxycholic acid and steroid was ineffective. We added bezafibrate, which resulted in a gradual improvement in liver function. To the best of our knowledge, this is the first reported case of nab-paclitaxel-induced secondary sclerosing cholangitis.

Solid tumors are generally more detected in male than female patients, except for sexual organs. However, females are dominant in biliary tract cancer, especially gallbladder cancer. Gender difference is not recognized in hematological malignancies. Selection of therapeutic agents is not influenced by gender, but nausea and vomiting as side effects of anti-cancer agents are more common in young females. Therefore, sufficient anti-emetic agents should be used especially at the first cycle of chemotherapy with highly emetic drugs such as cisplatin in order to prevent anticipatory nausea and vomiting. Furthermore, neutropenia due to the combination regimen of platinum plus gemcitabine or the monotherapy of gemcitabine or amrubicin is reported to be more frequent in females than males.

We report a case of an 83-year-old woman who developed tumor lysis syndrome (TLS) 5 days after FOLFIRI+cetuximab (Cmab) therapy. A huge ascending colon cancer measuring 10 cm in diameter and with peritoneal dissemination was diagnosed. Following successful therapy with FOLFIRI alone, FOLFIRI+Cmab was administered. On day 5, TLS was diagnosed with hyperuricemia, hyperkalemia, hyperphosphatemia, and an increase in serum creatinine. Intravenous furosemide, volume loading, and glucose-insulin therapy resulted in improvement of laboratory data in 2 days. However, she died on the 34th day due to multiple organ failure caused by aspiration pneumonia following small intestine functional ileus. Although TLS is a rare complication in colon cancer, its onset must be taken into consideration. Also, risk assessment and preventive therapy for TLS should be performed before cancer treatment.