腫瘍免疫賦活薬、ネオアジュバント

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/07/16 06:09:03」(JST)

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Neoadjuvant therapy is the administration of therapeutic agents before a main treatment. One example is neoadjuvant hormone therapy prior to radical radiotherapy for adenocarcinoma of the prostate. Neoadjuvant therapy aims to reduce the size or extent of the cancer before using radical treatment intervention, thus making procedures easier and more likely to succeed, and reducing the consequences of a more extensive treatment technique that would be required if the tumor wasn't reduced in size or extent.

Another related concept is that neoadjuvant therapy acts on micrometastatic disease. The downstaging is then a surrogate marker of efficacy on undetected dissemination, resulting in improved longtime survival compared to the surgery-alone strategy.^{[citation needed]}

This systemic therapy (chemotherapy, immunotherapy or hormone therapy) or radiation therapy is commonly used in cancers that are locally advanced - where clinicians plan an operation at a later stage. The use of such therapy can effectively reduce the difficulty and morbidity of more extensive procedures.

The use of therapy can turn a tumour from untreatable to treatable by shrinking the volume. Often it can be unclear which surrounding structures are directly involved in the disease and which are just showing signs of inflammation. By administering therapy a distinction can often be made. Some doctors give the therapy in the hope that a response will be seen so that they can then decide what is the best course of action. Unfortunately, not everyone is suitable for therapy in this way because it can be extremely toxic. Some patients react so severely that further treatments, especially surgery, are precluded because the patient is rendered unfit for anesthetic.^{[citation needed]}

Clinical Trials

A Phase 2 clinical trial,^[1]^[2] sponsored by Atossa Genetics, is being conducted by Dr. Sheldon Feldman, President of the The American Society of Breast Surgeons, at Columbia University Breast Center in New York City on the use of Fulvestrant administered through the microcatheter into the lactiferous duct as neoadjuvant treatment for ductal carcinoma in situ and invasive breast cancer.

References

^ "PK Study of Pre-Surgical Intramuscular and Intraductal Fulvestrant in Women With Invasive Breast Cancer or DCIS Undergoing Mastectomy". Clinicaltrials.gov. 28 August 2015.
^ "Dr. Sheldon M. Feldman Named President of the American Society of Breast Surgeons". Yahoo Finance. 18 April 2016.

Adjuvant and Neoadjuvant Therapy for Breast Cancer (as defined by the US National Institutes of Health (NIH)[1])

UpToDate Contents

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1. 乳癌に行う術前補助療法の一般原則 general principles of neoadjuvant therapy for breast cancer
2. ホルモン受容体陽性乳癌と新たに診断された患者への術前補助療法 neoadjuvant therapy for newly diagnosed hormone positive breast cancer
3. 直腸腺癌に対する術前補助化学放射線療法および放射線療法 neoadjuvant chemoradiotherapy and radiotherapy for rectal adenocarcinoma
4. 胃癌の補助化学療法および術前補助化学療法 adjuvant and neoadjuvant treatment of gastric cancer
5. 四肢の軟部組織肉腫に対する補助化学療法および術前補助化学療法 adjuvant and neoadjuvant chemotherapy for soft tissue sarcoma of the extremities

English Journal

Targeted scVEGF/(177)Lu radiopharmaceutical inhibits growth of metastases and can be effectively combined with chemotherapy.

Rusckowski M1, Wang Y, Blankenberg FG2, Levashova Z2,3, Backer MV4, Backer JM5.
EJNMMI research.EJNMMI Res.2016 Dec;6(1):4. doi: 10.1186/s13550-016-0163-1. Epub 2016 Jan 16.
BACKGROUND: scVEGF/(177)Lu is a novel radiopharmaceutical targeted by recombinant single-chain (sc) derivative of vascular endothelial growth factor (VEGF) that binds to and is internalized by vascular endothelial growth factor receptors (VEGFR). scVEGF/(177)Lu potential as adjuvant and neoadjuvant
PMID 26780081

Development of fistula between esophagogastric anastomotic site and cartilage portion of trachea after subtotal esophagectomy for cervical esophageal cancer: a case report.

Taniguchi D1, Saeki H2, Nakashima Y1, Tsutsumi R1, Nishimura S1, Kudou K1, Nakaji Y1, Tajiri H1, Tsutsumi S1, Yukaya T1, Nakanishi R1, Sugiyama M1, Sonoda H1, Ohgaki K1, Oki E1, Maehara Y1.
Surgical case reports.Surg Case Rep.2016 Dec;2(1):107. Epub 2016 Oct 6.
A 65-year-old man with cT3N2M0 stage III cervical esophageal cancer underwent subtotal esophagectomy and gastric tube reconstruction through the retrosternal route after neoadjuvant chemoradiotherapy. The anastomosis was located adjacent to the left side of the trachea, and a circular stapler was us
PMID 27714646

Pathological complete response after neoadjuvant chemotherapy for rectal cancer with synchronous multiple liver metastases: a report of an unusual case.

Arata R1, Itamoto T2,3, Ikeda S1, Nakahara H1, Oshita A1,4, Shinozaki K5, Nishisaka T6.
Surgical case reports.Surg Case Rep.2016 Dec;2(1):106. doi: 10.1186/s40792-016-0231-9. Epub 2016 Sep 30.
BACKGROUND: Systemic chemotherapy for stage IV colorectal cancer has advanced markedly in the recent years. We report an unusual case of 13 synchronous liver metastases for which a pathological complete response was achieved with neoadjuvant chemotherapy (NAC) consisting of a combination of 5-fluoro
PMID 27686666

Japanese Journal

診療非小細胞肺癌に対する術前導入化学放射線療法における画像診断の有用性 (胸部の最新画像情報 2013)

田中義浩,生島仁史,近藤和也
臨床放射線 58(1), 222-228, 2013-01
NAID 40019562587

Neoadjuvant or adjuvant therapy for resectable gastric cancer : a systematic review and practice guideline for North America

Knight Greg,Earle Craig C.,Cosby Roxanne
Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 16(1), 28-40, 2013
NAID 40019557180

症例報告術前化学療法により壁が菲薄化し組織学的寛解(pCR)となった巨大嚢胞内乳癌の1例

今田孝子,松岡順治,元木崇之
岡山医学会雑誌 124(3), 243-247, 2012-12
… The patient was administered neoadjuvant chemotherapy consisting of 12 cycles of weekly paclitaxel followed by 4 cycles of FEC (5FU, Epilubicin and cyclophosphamide). … We report a rare case of invasive ductal carcinoma presenting a multilobular phenotype which showed pCR by neoadjuvant chemotherapy despite no size reduction of the tumor. …
NAID 40019510273