Hepatitis C virus (HCV) is known as one of major causative agents of hepatocellular carcinoma (HCC) in the world. The pathogenesis of HCC associated with HCV, however, has not been fully elucidated yet, although the chronic inflammation induced by HCV infection is considered to contribute greatly to the HCC development. Some HCV gene products have been shown to possess transformation activities in cultured cells. Several oncogenic signal pathways in the cells were modulated by the exogenous expression of the HCV proteins. A few lines of the transgenic mice producing the core protein among those products was also reported to develop liver steatosis and HCC without apparent inflammation after rearing for a relatively long period. So, the functions of the core on the modulation of cellular events have been extensively examined and characterized. Here, I would summarize the progress of the research for the pathogenesis of HCC associated with HCV.

EGFR-TKI has been synthesized as a potential target for cancer therapy because EGFR is overexpressed and associated with poor prognosis of lung cancer. It was reported that EGFR mutations were more sensitive to EGFRTKI than those without the mutations among lung cancer patients. A subgroup of patients of Asian origin, female sex, adenocarcinoma, and no history of smoking were significantly associated with a high rate of EGFR mutations. These patients with EGFR mutations were not only favorable responders but also had a longer survival than without. In this article, we discuss the EGFR-TKI predictive factors by EGFR mutations.

Tailor-made medicine is a key concept in achieving a successful outcome for individual patients with malignant disease. Identifying the appropriate patient, i.e., "How to select patients", is the first concept of tailor-made medicine. In recent years, molecular target drugs have been developed rapidly and over a broad spectrum. The candidate patients for drugs are selected by particular biomarkers based on theoretical evidence. Moreover, conventional individualized methods such as TNM classification, pathological findings and patient background including performance status, and organ functions, are also important to correctly identify the patients. Identifying the appropriate therapy, i.e., "How to treat", is the next concept. Drug sensitivity tests and prediction models using DNA micro array are still under development and not available at bedside. Chemotherapy drug dosages are adjusted according to body surface area with a lack of scientific data. There have been some attempts to establish calculation formulas for modification of drugs. The Calvert formula is the best-known, however, it may not be used correctly in Japan because of the difference in the methods for estimating creatinine as well as ethnic differences. pharmacogenomics/pharmacogenetics is the front-line approach of modern chemotherapy that analyzes genomic information and pharmacokinetic/pharmacodynamic findings. This approach is achieving adaptable results for cancer treatment practice. Finally, for tailor-made medicine, we must develop genomic approach in both evaluating tumor characteristics and establishing adequate therapy, and have to combine all possible information including conventional TNM classification and pathological findings.

We performed a clinical analysis on 8 patients with primary follicular lymphoma in the duodenum taken from among 26 cases of primary gastrointestinal malignant lymphoma treated in our division. The median age was 60 years (range 48 to 82 yr). The ratio of males to females was 4:4. The chief complaints were no symptoms in 4 cases, heartburn in 2 cases, lower abdominal pain in 1 case, and back pain in 1 case. All patients were in clinical stage I EA. Gastroendoscopic findings showed multiple whitish granules around the ampulla of Vater in all patients. Involvement of the site in 6 cases was only located at the second portion; lesions in the other 2 cases were located at the second portion, and at the third portion or fourth portion, respectively. A histological study showed follicular lymphoma grade 1, and an immunohistological study demonstrated that the lymphoma cells were positive for CD79a, CD10, CD20, and bcl-2. Five patients were positive for the FISH analysis fusion signal of IgH/bcl-2 genes. Rituximab with CHOP therapy was performed for 7 patients. Seven patients are currently alive, and one died of uterine cancer. At the medium-term 39 month-follow-up, 7 patients were in complete remission, and 1 patient was in partial remission. Rituximab with CHOP (CVP) therapy is a possible treatment for primary follicular lymphoma in the duodenum. Further consideration of appropriate therapy for this disease might be necessary.