We must understand the conditions during the onset of allergic reactions induced by anticancer drugs in order to respond with an appropriate treatment. We have therefore conducted this study, focusing on allergic reactions induced by each anticancer drug used in outpatient chemotherapy. Allergic reactions occurred in a total of 3.9% (76 cases), most of which were induced by platinum and taxane anticancer drugs. The number of administrations at symptom onset and the times of onset for platinums and taxanes were 11. 7±1. 3 times and 43. 3±4. 8 minutes for platinum; and 2. 3±0. 5 times and 18. 1± 3. 6 minutes for taxanes, respectively. This demonstrated a significant difference between these two drugs(both were p< 0. 01). In terms of re-administration following the onset of allergic reactions, 21 cases(72. 4%)out of 29 cases(38. 2%) were able to continue the administration of suspected drugs. We studied various factors surrounding the possibility of continued administration to two groups which were or were not able to continue receiving treatment. No significant differences were observed between the groups. For continuous safe treatment, it is necessary to understand the characteristics of allergic reactions induced by each anticancer drug. It is also advisable to consider possible precautions(by introducing prevention regimens)and appropriate measures at the time of re-administration, following the onset of allergic reactions.

(Case 1) An 82-year-old man started immunotherapy with interferon because of lung metastasis 5 years after he had undergone radical nephrectomy. Three years later, he developed multiple metastases, and was started on sorafenib (400 mg/day) and nonsteroidal anti-inflammatory drug (NSAID) orally. As his cancer-related pain worsened with time, he was administered 30 Gy radiation therapy for bone metastasis of L4. He was then admitted to our hospital for pain control because of ineffective radiation therapy. One day, he suddenly had abdominal pain and vomiting, and was diagnosed as bowel perforation based on computed tomography. He was managed conservatively by nasogastric suction and antibiotic course. (Case 2) A 62-year-old man diagnosed as metastatic renal cell cancer began immunotherapy soon after undergoing radical nephrectomy in Dec., 2006. Although he was started on oral sorafenib (800 mg/day) in July, 2008, metastatic foci enlarged after 18 months. He was then changed to sunitinib (50 mg/day). Sunitinib had immediate and long-lasting effect on the cancer for about 10 months, but he was then admitted to our hospital for pleural effusion. While under treatment for thoracic cavity drainage, he experienced upper abdominal pain and was diagnosis as bowel perforation based on computed tomography. He underwent emergency laparotomy. Molecular target drugs such as sorafenib and sunitinib have serious adverse effects. Bowel perforation is rare, but among those adverse effects. It should be remembered that caution is required for long-term use or combined radiation therapy and NSAIDs with molecular target drug.

An 80-year-old man presented to our hospital with macroscopic hematuria. Before coming to our hospital, he was treated for multiple myeloma with cyclophosphamide. We detected diffuse dilation of capillary on urinary bladder mucosa on cystoscopy, and diagnosed the patient with cyclophosphamide-induced hemorrhagic cystitis. Macroscopic hematuria once resolved by indwelling urethral catheter, but recurred and bladder tamponade developed. We performed transurethral electric coagulation. Macroscopic hematuria temporarily disappeared, but again relapsed. Then we performed intravesical instillation of aluminum hydroxide gel, but without a clear effect and the patient developed hemorrhagic shock. Eventually, we performed bilateral ureterostomy because the disease was unresponsive to less invasive therapies. Vesical bleeding disappeared and the patient was discharged 32 days after surgery. The treatment for multiple myeloma has been continued without cyclophosphamide since surgery.

We report a case of a female in her 80s who was diagnosed with recurrent lung adenocarcinoma after primary surgery. She was treated with a systemic chemotherapy regimen consisting of carboplatin plus paclitaxel until the disease showed progression. On detection of epidermal growth factor receptor(EGFR)mutations, we administered gefitinib, an EGFR tyrosine kinase inhibitor, at a dosage of 250 mg daily. After 6 months of gefitinib therapy, laboratory findings revealed elevated serum aspartate aminotransferase(AST)and alanine aminotransferase(ALT)levels(grade 2), indicative of hepatotoxicity. Gefitinib was discontinued and erlotinib was initiated at a dosage of 50 mg daily. She continued the therapy for 3 years, during which her disease stabilized without any further complications or hepatotoxicity. Thus, low-dose erlotinib may be effective and well tolerated by patients with non-small cell lung cancer harboring EGFR mutations who are intolerant to gefitinib.

Recently, a new tyrosine kinase inhibitor, axitinib, was approved for the treatment of advanced renal cell carcinoma for when one prior systemic therapy fails. The approval was based on an international, randomized, open-label trial(AXIS trial) of patients with metastatic renal cell carcinoma who failed in one prior systemic regimen. The present manuscript summarizes this new drug and the AXIS trial.

Capecitabine, an oral prodrug of 5 -fluorouracil, is a promising treatment for colorectal, breast, and gastric cancers, but often causes hand-foot syndrome(HFS), which is the most common dose-limiting toxicity. The aim of this study was to evaluate of the efficacy of the pharmacist in providing support at ambulatory therapy centers, especially for HFS. The HFS is a higher-incidence adverse event that may develop during chemotherapy with capecitabine. Once developed, the symptoms significantly impair quality of life(QOL), leading to a reduction in the dosage or discontinuation of the treatment. Patient symptoms may therefore increase in severity. This study was performed to analyze the treatment adherence and adverse events resulting from capecitabine therapy provided by pharmacists to cancer outpatients. All patients were prescribed vitamin B6(pyridoxine), which can help to reduce or prevent HFS. A lesser or milder extent of HFS was detected in patients who had used a moisturizer at the same time as the introduction of capecitabine therapy. Adherence to this approach will benefit the patients' selfcare in maintaining moisture retention, which is an important countermeasure for HFS. Additionally, early introduction of effective countermeasures for skin care, dose reduction, and rest periods is important for HFS management; in addition, team care support is dispensable. Our support system may be useful for management strategies for HFS. We suggest that improved quality of lif e is needed in cancer outpatients being treated with chemotherapy.

A 69-year-old woman who had locally advanced pancreatic cancer underwent proton beam radiotherapy(67.5 GyE/25 Fr) concurrent with gemcitabine chemotherapy (GEM 800 mg/m2 day 1, 8) at Hyogo Ion Beam Medical Center, followed by GEM chemotherapy (1,000 mg/m2 day 1, 8, 15/28 day)at Kobe University Hospital. She visited our hospital because she was suffering from dyspnea 212 days after first administration of GEM. A chest computed tomography revealed that infiltrations were spreading in the bilateral lung fields. A bronchoscopy showed diffuse alveolar hemorrhage. We diagnosed GEM related interstitial lung disease with diffuse alveolar hemorrhage. We introduced steroid pulse therapy (methylprednisolone 1 g/day) for 3 days followed by oral prednisolone (40 mg/day), which was tapered gradually. She recovered and was discharged on the 24th day after admission.