Toshimi Takano

Bio: Toshimi Takano is an academic researcher from Japanese Foundation for Cancer Research. The author has contributed to research in topics: Quality of life & Troponin I. The author has an hindex of 1, co-authored 6 publications receiving 745 citations. Previous affiliations of Toshimi Takano include Tokyo Medical and Dental University.

Effectiveness of self-help workbook intervention on quality of life in cancer patients receiving chemotherapy: results of a randomized controlled trial

Abstract: A self-help workbook is expected to support cancer patients to cope with physical and psychosocial distress, to facilitate communication with medical staff, and to improve quality of life (QOL). We conducted a randomized controlled trial to evaluate the effectiveness of a self-help workbook intervention on QOL and survival. From June 2014 to March 2015, patients with breast, colorectal, gastric, and lung cancer receiving outpatient chemotherapy were randomized into an intervention group (n = 100) or control group (n = 100). Intervention group participants received workbooks originally made for this study, read advice on how to cope with distress, and filled out questionnaires on the workbooks periodically. EORTC QLQ-C30 was evaluated at baseline, at 12 weeks, and at 24 weeks. The primary endpoint was Global Health Status / QOL scale (GQOL). No significant interaction was observed between the intervention and time in terms of GQOL or any of the functional scales. Among the 69 patients who continued cytotoxic chemotherapy at 24 weeks, the intervention was significantly associated with improved emotional functioning scores (P = 0.0007). Overall survival was not significantly different between the two groups. Self-help workbook intervention was feasible in cancer patients receiving chemotherapy. Although the effect of the intervention was limited, a post-hoc subset analysis suggested that the intervention may improve emotional functioning among patients who receive long-term cytotoxic chemotherapy. UMIN Clinical Trials Registry, UMIN000012842 . Registered 14 January 2014.

Myocardial dysfunction caused by abemaciclib: a case report

Abstract: A 68-year-old female patient with metastatic breast cancer presented 12 weeks after starting chemotherapy with abemaciclib and fulvestrant with breathlessness, peripheral edema, and weight gain. Brain natriuretic peptide (BNP) and troponin I levels were raised above normal, and chest radiography revealed an increase in the cardiothoracic ratio from 47% before chemotherapy to 55%. The transthoracic echocardiogram showed a reduction in left ventricular ejection fraction from 76% before chemotherapy to 68%. Contrast-enhanced cardiac magnetic resonance imaging (MRI) revealed delayed accumulation in the interventricular septum. Under the diagnosis of abemaciclib-induced myocardial dysfunction and heart failure, abemaciclib was discontinued, and enalapril and furosemide were started. Two months later, imaging revealed a cardiothoracic ratio of 47% with a left ventricular ejection fraction of 73%. A cardiac MRI after three months was normal. This case report demonstrates that cardiac dysfunction caused by abemaciclib is reversible if detected early and treated appropriately.

The era of meta-analyses-based recommendations: how were the Japanese Breast Cancer Society Clinical Practice Guidelines for Systemic Treatment of Breast Cancer established?

Abstract: The “Clinical Practice Guidelines for Breast Cancer” were established by the Japanese Breast Cancer Society (JBCS) in 2004, following the publication of the first edition of “Clinical Practice Guidelines for Systemic Treatment of Breast Cancer”. Evidence-based guidelines for systemic treatment, surgery, radiation therapy, “screening and diagnosis”, and “epidemiology and prevention” are periodically published since 2004. The JBCS Clinical Practice Guidelines for Systemic Treatment of Breast Cancer were updated in 2007, 2010, 2011, 2013, 2015, and 2018. Although evidence-based data were used for all editions of these guidelines, the review processes were not necessarily standardized and could not be considered valid “systematic reviews” until the publication of the 2015 edition. The 2018 edition of “The JBCS Clinical Practice Guidelines for Systemic Treatment of Breast Cancer” [1] was significantly revised and strictly conformed to the Medical Information Network Distribution Service (MINDS) Handbook for Clinical Practice Guideline Development 2014 [2], the MINDS Manual for Guideline Development 2017 [3] and, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach [4]. MINDS is an information service established by the Japan Council for Quality Health Care and is financially supported by the Ministry of Health, Labor and Welfare of Japan as a consignment project. MINDS published a handbook for guideline development in 2014 [2], which is equivalent to the GRADE approach. The GRADE working group was launched in 2000 and has developed a common, sensible, and transparent approach to grading the quality of evidence and strength of recommendations. The GRADE approach is now considered the standard in guideline development. A “Systemic Treatment Sub-committee” consisting of 18 experts, established under the “Clinical Practice Guideline Committee” of the JBCS, was involved in publishing the 2018 edition. Dr. Hiroji Iwata served as the chairperson of the “Clinical Practice Guideline Committee” and Dr. Tatsuya Toyama as the chairperson of the “Systemic Treatment Sub-committee”. The sub-committee was subcategorized into five groups, and each group addressed approximately 10 clinical questions (CQs), background questions (BQs), or future research questions (FQs); a total of 27 CQs, 14 BQs, and 15 FQs were discussed. Where applicable, the sub-committee members performed systematic reviews and meta-analyses for the 27 CQs. CQs are important for patients with breast cancer and their physicians because the results of meta-analyses are useful for optimal decision-making. However, among all CQs, we selected the following CQs that can be considered particularly important and requested the sub-committee members in charge of CQs to publish articles focusing on meta-analyses:

Tumor mutational load predicts survival after immunotherapy across multiple cancer types.

Abstract: Immune checkpoint inhibitor (ICI) treatments benefit some patients with metastatic cancers, but predictive biomarkers are needed. Findings in selected cancer types suggest that tumor mutational burden (TMB) may predict clinical response to ICI. To examine this association more broadly, we analyzed the clinical and genomic data of 1,662 advanced cancer patients treated with ICI, and 5,371 non-ICI-treated patients, whose tumors underwent targeted next-generation sequencing (MSK-IMPACT). Among all patients, higher somatic TMB (highest 20% in each histology) was associated with better overall survival. For most cancer histologies, an association between higher TMB and improved survival was observed. The TMB cutpoints associated with improved survival varied markedly between cancer types. These data indicate that TMB is associated with improved survival in patients receiving ICI across a wide variety of cancer types, but that there may not be one universal definition of high TMB.

A guide to cancer immunotherapy: from T cell basic science to clinical practice.

Abstract: The T lymphocyte, especially its capacity for antigen-directed cytotoxicity, has become a central focus for engaging the immune system in the fight against cancer. Basic science discoveries elucidating the molecular and cellular biology of the T cell have led to new strategies in this fight, including checkpoint blockade, adoptive cellular therapy and cancer vaccinology. This area of immunological research has been highly active for the past 50 years and is now enjoying unprecedented bench-to-bedside clinical success. Here, we provide a comprehensive historical and biological perspective regarding the advent and clinical implementation of cancer immunotherapeutics, with an emphasis on the fundamental importance of T lymphocyte regulation. We highlight clinical trials that demonstrate therapeutic efficacy and toxicities associated with each class of drug. Finally, we summarize emerging therapies and emphasize the yet to be elucidated questions and future promise within the field of cancer immunotherapy.

Breast Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology

Abstract: This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Bladder Cancer focuses on the clinical presentation and workup of suspected bladder cancer, treatment of non-muscle-invasive urothelial bladder cancer, and treatment of metastatic urothelial bladder cancer because important updates have recently been made to these sections. Some important updates include recommendations for optimal treatment of non-muscle-invasive bladder cancer in the event of a bacillus Calmette-Guerin (BCG) shortage and details about biomarker testing for advanced or metastatic disease. The systemic therapy recommendations for second-line or subsequent therapies have also been revised. Treatment and management of muscle-invasive, nonmetastatic disease is covered in the complete version of the NCCN Guidelines for Bladder Cancer available at NCCN.org. Additional topics covered in the complete version include treatment of nonurothelial histologies and recommendations for nonbladder urinary tract cancers such as upper tract urothelial carcinoma, urothelial carcinoma of the prostate, and primary carcinoma of the urethra.