Publications by authors named "Okusaka T"
Background: JCOG1113 is a randomized phase III trial that showed non-inferiority of gemcitabine plus S-1 to gemcitabine plus cisplatin in patients with advanced biliary tract cancer. Assessment of inter-institutional heterogeneity in chemotherapy contributes to confirm generalizability and reliability of the study itself. However, there have been no studies conducted to assess the heterogeneity among participating centers in randomized phase III trials for biliary tract cancer.
View Article and Find Full Text PDFObjectives: This study aimed to investigate the diagnostic performance and safety of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for perivascular soft-tissue cuffing (PSTC).
Methods: This single-center, retrospective study evaluated patients in whom EUS-TA was performed for PSTC in pancreatic or bile duct cancer lesions between October 2017 and March 2024. PSTC was defined as a perivascular soft-tissue area contiguous with nearby blood vessels from the suspected primary tumor.
Background: Although activation of human epidermal growth factor receptor 3 (HER3) is linked to resistance to targeted therapies in several cancer types, the HER3 expression profile during pancreatic cancer treatment remains unknown.
Aims: We evaluated the HER3 expression status after chemotherapy for pancreatic cancer and its association with clinicopathological features and clinical outcomes.
Materials & Methods: We included patients with pancreatic cancer who underwent chemotherapy and whose post-treatment archival tissue specimens were collected.
Article Synopsis
- The study compares metal stents (MS) and plastic stents (PS) for treating malignant biliary obstruction during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS).
- The results showed that while MS led to a greater reduction in bilirubin levels within two weeks, PS had a better safety profile with fewer adverse events.
- Even though MS had longer stent patency after 100 days, PS was suggested to be an adequate option for palliative care in these cases.
Background: Nivolumab with modified FOLFIRINOX (mFOLFIRINOX) may have additive antitumour effects while minimising chemotherapy cytotoxicity. We assessed the efficacy and safety of nivolumab+mFOLFIRINOX in metastatic pancreatic cancer.
Methods: Thirty-one treatment-naïve patients aged ≥20 years with metastatic unresectable/recurrent pancreatic cancer (≥1 measurable lesion per Response Evaluation Criteria in Solid Tumours version 1.
Article Synopsis
- Major hepatectomy (MH) can lead to a higher risk of adverse events due to reduced liver function and surgical impact, prompting an analysis within the JCOG1113 trial focused on gemcitabine-based treatments for advanced biliary tract cancer.* -
- Among 354 patients, 76 were evaluated post-surgery for recurrence; results indicated that while platelet counts fell more in patients who underwent MH, anemia and white blood cell count decreases were less frequent compared to those who did not have MH.* -
- Overall survival rates were similar between MH and non-MH patients receiving gemcitabine with both S-1 and cisplatin, suggesting that gemcitabine-based chemotherapy maintains its safety and efficacy
Background: Although cisplatin plus gemcitabine and other combinations have improved the survival of advanced biliary tract cancer (BTC), high unmet medical needs remain. This study aimed to assess the efficacy and safety of nivolumab plus lenvatinib in the second-line treatment for advanced BTC.
Patients And Methods: Nivolumab (240 mg) was administered biweekly.
Article Synopsis
- The study aimed to assess the safety and effectiveness of propofol sedation in complex endoscopic procedures like endoscopic cholangiopancreatography, focusing on risk factors for excessive sedation.
- A review of 870 patient cases highlighted sedation-related issues, revealing rates of excessive sedation (7.8%), hypoxemia (6.0%), and hypotension (1.8%), with obesity and sleep apnea significantly linked to higher sedation risks.
- The findings suggest that sedation strategies for these patients should be personalized, especially for those with identified risk factors such as obesity and prolonged procedure times.
Tissue sampling in biliary tract cancer (BTC) is generally performed through transpapillary biopsy (TPB) or endoscopic ultrasound-guided tissue acquisition (EUS-TA). For the first time, we compared the suitability of specimens obtained using TPB and EUS-TA to determine the optimal tissue-sampling method for comprehensive genome profiling (CGP) analysis in patients with unresectable BTC (UR-BTC). Pathology precheck criteria for CGP analysis comprised the OncoGuide NCC Oncopanel System (NCCOP) and FoundationOne CDx (F1CDx).
View Article and Find Full Text PDFArticle Synopsis
- The PRIMATE study focuses on optimizing tissue collection methods through EUS-guided fine-needle aspiration (EUS-TA) for patients with unresectable pancreatic cancer to improve genomic profiling.
- The study compares success rates of tissue specimens from both primary and metastatic lesions to meet specific analysis criteria established by the OncoGuide NCC Oncopanel.
- Results will be shared in an international conference and peer-reviewed journal, and the study has been approved by the National Cancer Center Institutional Review Board (Research No. 2022-168).
Introduction: Lenvatinib (dosing for patients who weigh ≥60 kg was 12 mg/day; for patients who weigh <60 kg, the dose was 8 mg/day) plus pembrolizumab 200 mg once every 3 weeks demonstrated antitumor activity and a manageable safety profile in patients with first-line unresectable hepatocellular carcinoma (uHCC) in the open-label phase 1b Study 116/KEYNOTE-524 (primary analysis data cutoff date: October 31, 2019; median follow-up: 10.6 months). This analysis (updated data cutoff date: March 31, 2021) reports efficacy results from 17 months of additional follow-up time.
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- Patients with unresectable or recurrent biliary tract cancer (BTC) have limited treatment options after progressing on a gemcitabine regimen, and the role of HER2-targeting therapies is not well-understood.
- A phase II trial in Japan used trastuzumab deruxtecan (T-DXd) in patients with HER2-positive and HER2-low BTC, with the primary goal of achieving a minimum objective response rate (ORR) of 15%.
- Out of 32 patients, those with HER2-positive BTC showed a confirmed ORR of 36.4%, meeting the trial's endpoint, while safety concerns included anemia, neutropenia, and notable cases of interstitial lung disease requiring close monitoring.
Japanese classification of pancreatic carcinoma by the Japan Pancreas Society: Eighth edition.
J Hepatobiliary Pancreat Sci
November 2024
Article Synopsis
- The Japan Pancreas Society released the eighth edition of its classification for pancreatic carcinoma in 2023, highlighting several updates.
- The updated classification maintains a focus on local invasion factors for the T category, as opposed to tumor size, and introduces a redefined naming system for lymph nodes with added location-based definitions.
- Significant improvements include the incorporation of peritoneal cytology in the distant metastasis category and enhanced criteria for diagnosing tumors via endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB).
Article Synopsis
- Endoscopic ultrasound-guided hepaticogastrostomy with bridging shows a high technical success rate (90%) and minimal adverse events, making it a viable alternative to traditional drainage methods for malignant hilar biliary obstruction.
- In terms of stent patency, patients receiving this method experienced a significantly lower rate of recurrent biliary obstruction (17.6%) compared to those undergoing endoscopic transpapillary drainage-multi-stenting (58.5%).
- Results indicated that the endoscopic ultrasound-guided hepaticogastrostomy with bridging method provided longer median times to recurrent biliary obstruction, with strong potential for improved long-term outcomes, suggesting a need for further prospective studies.
Article Synopsis
- EUS tissue acquisition (EUS-TA) is an effective method for diagnosing small solid pancreatic lesions (≤10 mm), with a high technical success rate of 99.1% in a study of 109 patients.
- The study found strong diagnostic performance metrics, including a sensitivity of 90.1%, specificity of 97.3%, and overall accuracy of 92.6%.
- Important factors influencing diagnostic accuracy included the number of punctures and tumor type, while no instances of needle-tract seeding were reported.
Video 1A novel method of bilateral biliary decompression by EUS-guided hepaticogastrostomy with bridging stenting using the partial stent-in-stent method for reintervention of multiple metal stent failure.We report a case in which anterior and posterior drainage was performed using the partial stent-in-stent method via the transpapillary approach. The patient had a bismuth type IV biliary obstruction, but only the right hepatic lobe was drained due to obstruction of the left portal vein.
View Article and Find Full Text PDFBackground/aims: Advanced pancreatic and biliary tract cancers can invade the duodenum and cause duodenal hemorrhagic stenosis. This study aimed to evaluate the efficacy of covered self-expandable metal stents in the treatment of cancer-related duodenal hemorrhage with stenosis.
Methods: Between January 2014 and December 2016, metal stents were placed in 51 patients with duodenal stenosis.
Article Synopsis
- Endoscopic ultrasound-guided gastroenterostomy is a procedure to connect the stomach with an afferent loop affected by dilation, aimed at treating afferent loop syndrome; the study assesses its effectiveness and safety.
- The research found a 100% technical success rate and a 96% clinical success rate among 25 patients, with some serious early adverse events related to fluid leakage but no late complications.
- The procedure demonstrated a 32% rate of recurrent intestinal obstruction after a median of 6.5 months, but was highly successful in re-interventions, confirming its overall effectiveness and safety for this condition.
Article Synopsis
- Recent advancements in treatments for hepatocellular carcinoma (HCC) have improved patient survival, but these therapies are expensive, creating a financial burden on patients and society.
- A study analyzed first-line systemic treatments for advanced HCC in Japan, focusing on the number of patients receiving different treatments and their associated monthly costs from July 2021 to June 2022.
- The study found that 82.2% of patients received high-cost regimens, with atezolizumab plus bevacizumab being the most common and expensive treatment at 1,176,284 JPY per month.
Article Synopsis
- Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) is becoming a viable alternative for treating obstructive pancreatitis when traditional methods fail, but it has a concerning 20% rate of adverse events.
- A new plastic stent designed for EUS-PD was tested in a study involving 10 patients, where both technical and clinical success rates reached 100%, with only one experiencing a mild adverse event.
- Overall, the findings suggest that this novel stent appears to be a safe and effective option for EUS-PD, with a low recurrence rate of pancreatic duct obstruction.
Background: In the preplanned interim analysis of the TOPAZ-1 study, durvalumab plus gemcitabine-cisplatin significantly improved overall survival versus placebo plus gemcitabine-cisplatin in participants with advanced biliary tract cancer. We aimed to report updated overall survival and safety data from TOPAZ-1 with additional follow-up and data maturity beyond the interim analysis.
Methods: TOPAZ-1 was a phase 3, randomised, double-masked, placebo-controlled, global study done at 105 sites in 17 countries.
Introduction: Hepatic arterial infusion chemotherapy (HAIC) with cisplatin and lenvatinib exhibits strong antitumor effects against advanced hepatocellular carcinoma (HCC). Higher antitumor activity is expected for the combination treatment. The aim of this trial was to evaluate the efficacy and safety of lenvatinib in combination with HAIC using cisplatin in patients with advanced HCC.
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- The study focused on immune-related adverse event-sclerosing cholangitis, a rare condition linked to immune checkpoint inhibitor treatment, highlighting challenges in diagnosis and management.
- Researchers evaluated 10 patients, finding liver dysfunction primarily indicated by elevated biliary enzymes and various bile duct abnormalities observed through imaging techniques.
- Despite some therapeutic success with steroid treatment and other immunosuppressive agents, the prognosis for affected patients was poor, emphasizing the need for more extensive research and better treatment strategies.