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Background. Prior supplementation with folic acid and vitamin B 12 is required to reduce pemetrexed therapy toxicity; the recommended lead-in time is at least 7 days. On the basis of previous pharmacokinetic and clinical studies, we hypothesized that the lead-in time could be shortened to 24 hours, enabling earlier commencement of standard chemotherapy; thus, we planned the first prospective trial of this regimen. Methods. Patients with advanced nonsquamous non-small cell lung cancer who had not previously received cytotoxic chemotherapy were enrolled. After measurement of homocysteine concentrations, the patients received 1,000 mg of vitamin B 12 by intramuscular injection and began taking 350-500 mg of oral folic acid daily. Starting 24-48 hours after the vitamin B 12 injection, the patients received intravenous 500 mg/m 2 pemetrexed and 75 mg/m 2 cisplatin for 4 cycles at 3

Immuno-checkpoint inhibitor response and immune-related adverse events remain controversial issues. Managing pericardial effusion during programmed cell death 1 inhibitor treatment is challenging. Here, we report a case of successfully managed cardiac tamponade caused by nivolumab-induced pseudoprogression. A 62-year-old male diagnosed with advanced lung adenocarcinoma started on nivolumab. Seven days later, he experienced cardiac tamponade and required pericardiocentesis, and other lesions were larger on computed tomography. The patient's condition stabilized after pericardiocentesis. However, although the lesions other than pericardial effusion were reduced on chest CT, cardiac tamponade recurred after 6 weeks. We considered that the case involved cardiac tamponade induced by pseudoprogression and administered intrapericardial bleomycin after pericardiocentesis. Thereafter, the patient was administered nivolumab for 7 months until disease progression.

BackgroundMalignant pleural effusion (MPE) can occur during the progression of various cancers. However, factors, such as the incidence of MPE associated with different types of cancers and its potential for diagnosing previously undetected cancers, are unknown. Moreover, MPE may accompany potentially curable cancers or those with a favorable survival prognosis with adequate treatment. The present study determined the types of cancers accompanied by MPE at initial diagnosis and investigated appropriate related methods for diagnosing previously unknown cancers.MethodsWe retrospectively reviewed the medical records of 35 patients with MPE at initial cancer diagnosis between 2004 and 2012. We evaluated the patient characteristics, final diagnosis, and diagnostic processes.ResultsOf the 35 patients, 10 had lung cancer, seven ovarian or peritoneal cancer, four malignant pleural mesothelioma, one breast cancer, one lymphoma, one pancreatic cancer, and 11 had cancers of unknown origin. Diagnoses of the primary lesions were confirmed using the MPE cellblock method for seven of 11 patients (63.6%), by excisional biopsy or aspiration from other sites in four of nine patients, by exploratory laparotomy in two of three patients, and by peritoneal washing cytology in five patients.ConclusionLung cancer and cancer of unknown origin are major causes of MPE at initial presentation. However, these groups also contain cancers that are curable and those with good long‐term prognosis. The MPE cellblock method represents an accurate method for identifying cancer origin.

This study failed to meet its primary endpoint. We could not demonstrate the safety and efficacy of the 1-week vitamin B12 oral administration protocol as compared with intramuscular administration.

BACKGROUND: Some investigations have revealed an association between depression and physical measurements of COPD patients in North America and Europe, but few related studies have been performed in Asia. METHODS: In this cross-sectional study, 84 consecutive, stable outpatients with COPD (mean ؎ SD age 72.0 ؎ 9.0 y, percent-of-predicted FEV 1 46 ؎ 15%, 15 [17.9%] female) in a Japanese community hospital were recruited. "Probable depression" was defined as a score of > 6 on the short-form Geriatric Depression Scale (SF-GDS). Relationships among commonly used physical measurements, SF-GDS raw score, and probable depression were evaluated with the Spearman rank correlation test, multiple linear regression analysis, logistic regression analysis, and receiver operating characteristic curves. RESULTS: Thirty-two subjects (38.1%) had probable depression. Body mass index, obstruction, dyspnea, exercise capacity index, percent-ofpredicted FEV 1 , Modified Medical Research Council dyspnea score, 6-min walk distance, and S pO 2 had: simple correlations (r 0.42-0.60, P < .001 for all) with the SF-GDS raw score; partial correlations (r 0.25-0.51, P < .05 for all) with the SF-GDS raw score after adjusting for demographic and social factors; association with probable depression in the logistic regression analysis after adjusting for demographic and social factors (P < .05 for all); and areas under the receiver operating characteristic curve of 0.72؊0.84 (P < .001 for any) for probable depression. CONCLU-SIONS: Physical parameters were associated with depression in our Japanese COPD out-patients.