Department of Thoracic Oncologyこのページを印刷する - Department of Thoracic Oncology

2014年11月1日掲載

Summary


Director.Shinji Atagi
Our department is conducting various clinical studies in patients with malignant thoracic tumors. In particular, we are participating in multicenter collaborative studies with groups such as the Japan Clinical Oncology Group (JCOG), the West Japan Oncology Group (WJOG), the Japan-Multinational Trial Organization (JMTO), and the National Hospital Organization (NHO) Network Study Group to develop novel treatments. Our research also includes investigation of mechanisms of drug resistance and analysis of pharmacokinetics on clinical specimens.

Research projects

・Treatment of elderly patients with lung cancer
Owing to the progressive increase in age of the Japanese population, the number of elderly patients with lung cancer is expected to further increase. Our medical center has a long-standing history in clinical trials to develop treatment approaches for elderly patients. In this regard, the results of a multicenter trial investigating carboplatin + pemetrexed followed by pemetrexed maintenance therapy in elderly patients with advanced non-small cell lung cancer (NSCLC) have been published. In addition, a Phase III trial comparing radiation therapy alone to a combination of radiation therapy and chemotherapy, as part of a trial sponsored by the JCOG trial, was carried out in elderly patients with unresectable Stage III NSCLC. A study (Study ID: UMIN000005036) is currently in progress to develop a treatment approach that is more appropriate for elderly patients.
In general, the high toxicity of standard cancer treatments limits their use in elderly patients. However, owing to the large differences in the performance status of elderly individuals, it is difficult to accurately predict whether standard treatment is feasible based only on age. Thus, we are currently conducting a multicenter study (Study ID: UMIN000010384) to establish an assessment system for elderly patients with lung cancer for chemotherapy based on risk stratification.

・Investigation of the optimal dose of molecular targeted agents and mechanisms of drug resistance
The introduction of epidermal growth factor receptor (EGFR) and anaplastic lymphoma receptor tyrosine kinase inhibitors has dramatically improved treatment outcomes. However, resistance to many of these inhibitors is often acquired, resulting in reduced efficacy. Since these inhibitors have toxicity profiles that are different from conventional chemotherapies, dose adjustments may be required. In this regard, we are currently conducting two studies (Study IDs: UMIN000014181, UMIN000014065) on the pharmacokinetics and molecular mechanisms of resistance in patients with NSCLC receiving afatinib and harboring an EGFR mutation. This will help to develop treatment approaches that have greater efficacy and less toxicity.

・Examination of asbestos exposure and serum HMGB1
Asbestos is known to cause mesothelioma and lung cancer. However, exposure to asbestos is not clinically evident in all patients. High-mobility group box 1 (HMGB1) is a major non-histone nuclear protein that is involved in septic shock and various inflammatory diseases. It has been reported that mesothelial cells damaged by asbestos release HMGB1, which may be associated with the development of mesothelioma by affecting macrophages and inducing various inflammatory cytokines. We are presently measuring the levels of serum HMGB1 to examine its potential correlation with various pulmonary diseases including mesothelioma and lung cancer with a particular focus on exposure to asbestos.