Objectives Most testicular cancer (TC) survivors have long‐term survival. However, the association between financial toxicity (FT), which is an economic side effect of cancer treatment, and the quality of life (QOL) of TC survivors is still unclear. Thus, the impact of FT on the QOL of TC survivors was examined in a multi‐institutional cross‐sectional study. Methods We recruited TC survivors from eight high‐volume institutions in Japan between January 2018 and March 2019. A total of 562 participants completed the EORTC QLQ‐C30, EORTC QLQ‐TC26 and the questionnaires on demographics, including annual income. Financial difficulty in the EORTC QLQ‐C30 and low income were used to assess financial distress (FD) and financial burden (FB), respectively. FT was defined as FD and FB. The QOL scores were compared, and a multivariate logistic regression analysis for FT was performed. Results With severe FD, TC survivors had more treatment side effects, physical limitations, and anxiety concerning employment and future. The TC survivors who reported low income were worried about their jobs and the future. The QOL of the survivors with FT exhibited high impairment, except for sexual activity. In particular, the TC survivors with FT were physically limited and anxious concerning the future. The multivariate logistic regression analysis revealed that four or more chemotherapy cycles were substantial risk factors for FT (4 cycles, odds ratio (OR) = 4.17; ≥5 cycles, OR = 6.96). Conclusions TC survivors who received multi‐cycle chemotherapy were prone to experience FT, resulting in a decline in their health‐related QOL.

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Introduction Atypical femoral fractures are atraumatic or minimally traumatic fractures and rare side effects of bone resorption inhibitors. Bone resorption inhibitors are frequently used in the treatment of prostate cancer. Case presentation A 62‐year‐old man complained of difficulty in walking and left lower limb pain. Androgen deprivation and denosumab therapy for prostate cancer‐induced bone metastasis was initiated 27 months ago. Even though the prostate‐specific antigen level did not increase, imaging studies indicated the possibility of bone metastasis. The patient underwent bone biopsy; however, no malignancy was detected. Afterward, he had a fall, causing a complete fracture in his left femur. Conclusion Atypical femoral fractures occasionally mimic typical imaging findings and outcomes of bone metastasis. This case is important for recognizing such cases.

Background: A spontaneous iliopsoas muscle hematoma is relatively rare and often associated with abnormal coagulation. Nafamostat mesilate is an anticoagulant agent that is sometimes used to treat hemodialysis patients at high risk of bleeding. Although severe drug allergy caused by nafamostat mesilate was previously reported, spontaneous iliopsoas muscle hematoma secondary to disseminated intravascular coagulation caused by nafamostat mesilate allergy has not yet been reported. Case presentation: Severe nafamostat mesilate allergy occurred in a 78-year-old male patient with a 2-year history of hemodialysis. During hospitalization, disseminated intravascular coagulation occurred followed by a progressive iliopsoas muscle hematoma a few days later. Emergent transarterial lumbar artery embolization was successfully performed. Conclusion: For dialysis patients, a detailed medical history including repeated nafamostat mesilate use and considering an allergy to nafamostat mesilate in differential diagnosis are critical. In addition to early diagnosis, when an iliopsoas hematoma occurs, early intravascular treatment is important.

Abbreviations & Acronyms AE1/3 = cytokeratin AE1/AE3 CDX2 = caudal type homeobox 2 CEA = carcinoembryonic antigen CK = cytokeratin EGFR = epidermal growth factor receptor EMT = epithelialmesenchymal transition FOLFIRI = folinic acid, 5fluorouracil and irinotecan MRI = magnetic resonance imaging PSA = prostate-specific antigen

Introduction Bladder pleomorphic giant cell carcinoma is a rare and aggressive malignancy with a poor prognosis. There are no reports of immune checkpoint inhibitors for bladder pleomorphic giant cell carcinoma to date. Case presentation A 72‐year‐old man presented with gross hematuria due to multiple bladder cancers. Despite transurethral bladder resection and intravesical injection of Bacillus Calmette–Guérin, bladder cancer recurred. Nineteen months later, he underwent total cystectomy. Pathological examination revealed bladder giant cell carcinoma. Twenty‐eight months later, pembrolizumab was administered due to para‐aortic lymph node metastasis. Forty‐four months later, the lymph node metastasis disappeared, and pembrolizumab administration was terminated. Fifty‐eight months later, the patient has remained in remission at the time of writing. Conclusion Immune checkpoint inhibitors manifest a therapeutic potential in bladder pleomorphic giant cell carcinoma.

Abstract. Molecular-targeted therapy was recommended for the systemic therapy of renal cell cancer (RCC) in the RCC guidelines, but these guidelines do not address the order of administration of the multiple presently available agents. There are several aspects that remain unknown regarding the optimal administration order and combination of molecular-targeted drugs. Until the optimal treatment sequence is determined by clinical trials, treatment individualization is required for each patient based on patient and disease characteristics. We herein investigate 12 cases of RCC patients who received axitinib. Axitinib was used as the first-line drug in 4 cases, second-line in 5 cases, third-line in 1 case and as a fourth-line drug in 2 cases. Partial response (PR) was observed in 4 cases (30%) and stable disease in 4 cases (30%) during axitinib treatment, with an overall response rate of 60%. The duration of PR ranged from 6 to 19 months. Based on our cases, axitinib exhibited reasonable therapeutic efficacy as first-as well as second-line treatment. However, more cases are required to draw firm conclusions. IntroductionMolecular-targeted therapy was recommended for the systemic therapy of renal cell cancer (RCC) in the 2011 Japanese Urological Association RCC guidelines (1,2); however, these guidelines do not address the order of administration of presently available multiple agents. The European Association of Urology guidelines recommend either sunitinib or everolimus as first-line therapy, and sorafenib or everolimus as second-line therapy, although there are several aspects that remain unknown regarding the optimal administration order and combination of the multiple molecular-targeted drugs (3). At the 2015 ASCO annual meeting, the results of a comparison test of sunitinib→everolimus vs. everolimus→sunitinib were reported, indicating that the median survival rates were 29.5 and 22.2 months, respectively, concluding that sunitinib→everolimus was more effective (4,5).Until clinical trials determine the optimal treatment sequence, treatment individualization is required for each patient based on patient and disease characteristics. In this study, we investigated 12 cases of renal cancer in which axitinib had been administered. Patients and methodsCase series. A total of 12 patients who were diagnosed with RCC between 2005 and 2011 were reviewed (Table I). Approval was obtained from the Ethics Committee of our institution at the commencement of the study. The patients included 9 men and 3 women, with a mean age of 66 years (range, 58-79 years). Axitinib was used as a first-line drug in 4 cases, second-line in 5 cases, third-line in 1 case and as a fourth-line drug in 2 cases. Partial response (PR) was observed in 4 cases (30%) and stable disease in 4 cases (30%) during axitinib treatment, with an overall response rate of 60%. The duration of PR ranged from 6 to 19 months.Of the 4 PR cases, the case 1 patient had received axitinib as first-line therapy, and he had not received any other molecular-targeted drugs; i...

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