title: [Successful downstaging by a low-dose, fractional administration of irinotecan hydrochloride (CPT-11) in combination with cisplatin in peritoneal lavage cytology positive, 5-fluorouracil refractory advanced gastric cancer patients].
abstract: A 46-year-old Japanese female with advanced gastric cancer with positive peritoneal cytology and who was refractory to methotrexate plus 5-FU sequential chemotherapy received low-dose, fractional irinotecan hydrochloride (CPT-11) in combination with cisplatin. This regimen could be repeated biweekly on an outpatient basis and was well tolerated. After 8 cycles of administration, a negative change in peritoneal cytology subsequently enabled a total gastrectomy, splenectomy, and cholecystectomy with a D3 lymph node dissection. The rationale for a low-dose, fractional administration of CPT-11 in combination with cisplatin is the synergistic antitumor activity obtained through the ability of SN-38 to potentiate cisplatin-induced cytotoxicity, as well as the increased therapeutic efficacy of a protracted CPT-11 administration over more intense treatment schedules. As far as we are aware, this case report demonstrates for the first time that a low-dose, fractional administration of CPT-11 with cisplatin can successfully produce a negative change in peritoneal lavage cytology, and potentiates a R0 resection in a 5-FU resistant advanced gastric cancer patient. This suggests that this combination could be an effective regimen for potentially disseminated, 5-FU resistant patients.
authors.affiliation: Dept. of Gastrointestinal Surgery, University of Tokyo.
authors.forename: Shouji
authors.initials: S
authors.lastname: Shimoyama
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Imamura
authors.forename: Atomu
authors.initials: A
authors.lastname: Katayama
authors.forename: Naoki
authors.initials: N
authors.lastname: Hiki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Shimizu
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Yamaguchi
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Mafune
authors.forename: Toru
authors.initials: T
authors.lastname: Motoi
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Oohashi
authors.forename: Michio
authors.initials: M
authors.lastname: Kaminishi
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy* / Q000601:surgery; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001202:Ascitic Fluid / Q000473:pathology; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018279:Carcinoma, Signet Ring Cell / Q000188:drug therapy* / Q000601:surgery; D002763:Cholecystectomy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005743:Gastrectomy; D006801:Humans; D000077146:Irinotecan; D008197:Lymph Node Excision; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000601:surgery
chemical_list: D000077146:Irinotecan; D002945:Cisplatin; D002166:Camptothecin