Department of Breast and Medical Oncology
Kenji Tamura, Chikako Shimizu, Kan Yonemori, Mayu Yunokawa, Makoto Kodaira, Tatsunori Shimoi, Akihiko Shimomura, Shinsuke Sasada, Aiko Maejima, Atsuko Kitano, Tadaaki Nishikawa, Emi Noguchi, Yasuhiro Fujiwara
The Department of Breast and Medical Oncology provides the most effective treatment by the use of chemotherapy, and works on the establishment of new standard care for adult malignancies including breast cancer, gynecologic cancer, soft-tissue sarcoma, extragonadal germ cell tumors, primary unknown tumors and other rare types of solid tumors.
We envision becoming a premier medical oncology department, which leads cancer care in Japan and in the world. Our mission is to provide patient-centered, state-of-the-art medical care to cancer patients, to develop new effective cancer treatment through clinical and translational research, and to nurture medical oncologists. An evidence-based, research-oriented and multidisciplinary approach is the core value of our practice.
Our Department consists of eight full-time attending physicians, four chief residents (fellows), and two to three clinical residents. We also provide educational opportunities to short-term (a half year) residents. Full-time attending physicians are on duty at the outpatient clinic two to three days per week. The management of hospitalized patients is undertaken by clinical teams, which consist on attending physicians and residents. A Grand Round is scheduled every Wednesday and Friday.
There were 1,423 first visits of new patients including second opinions in 2016 (Table 1). Approximately two thirds of the new patients were referred from other divisions of the National Cancer Center Hospital (NCCH). About half of the new patients are breast cancer patients, but it is noteworthy that there was an approximate 30% increase in patients with adult sarcoma this year because of our work with the Rare Cancer Center. The number of outpatient who received chemotherapy delivered by our Department delivered by our division was 8,580, which accounts for 27.3% of the total number and ranks first in the number of treatments delivered at the Outpatient Treatment Center.
We have approximately 32 (range 30-40) inpatients daily. Terminally ill patients are transferred to palliative care units or in-home care clinics outside the NCCH, whereas 33 patients of our Department passed away in the NCCH in 2016. Autopsies were undertaken on five patients
The one-hour briefing medical conferences are held every morning to discuss the evidenced-based care for individual patients. The phase 1 conference is held on Monday, Journal Club on Wednesday, Clinical trial conference on Thursday, and Weekend and Outpatient follow-up conference on Friday. Multidisciplinary Case Conferences with diagnostic radiologists, surgeons, and pathologists are held with members of the Department of Breast Surgery, Gynecology, Musculoskeletal Oncology and Rehabilitation, Radiation Oncology and Division of pathology once or twice (Breast) per week, respectively.
The Monthly Breast Cancer Conference is held with the participation of multidisciplinary specialists to discuss recent topics in breast oncology and to update institutional treatment guidelines. This year, we published "Nyugan-shinnryou Application Notebook" from Nankodo based on this guideline, which reflects the consensus of the breast team on the body of evidence on breast cancer management.
Coordination of care
Three board-certified Breast Cancer Specialist Nurses help provide seamless and comprehensive care to breast cancer patients. Group-assigned pharmacists support patients in the ward and in the clinic. Most patients are supported by the Consultation, Counseling and Support Service Center for coordination of care. Post-operative breast cancer patients without disease recurrence are referred to local breast cancer specialists participating in the Tokyo Breast Consortium network (http://breastcons.com/).
Our research interest extends across a wide range of topics related to treatment and clinical program development. A lot of our research is secured by public and consignment research grants. In 2015, we conducted many research programs as the primary investigator and participated in additional research programs as the co-investigator secured by competitive public research funds. We published 29 international manuscripts. We value cancer survivorship as a research theme in order to develop a patient-centered comprehensive care program. In 2015, we published a guideline on fertility and fertility preservation for young breast cancer patients in cooperation with gynecologists and reproductive specialists. In addition, we took the lead in a multidisciplinary collaborative study group on End-of-life decision support for patients with advanced cancer.
In 2015, we actively enrolled patients in phase I studies (including the first in human or global) as well as national and international phase II and III studies (Table 2). Of note, we launched a pharmacokinetic and dose-finding study of eribulin/olaparib, and a phase II study of eribulin in a neoadjuvant setting in triple negative breast cancer and phase I of Ribophorin (RPN)2 (first in human) as an investigator-initiated clinical trial (IIT in Table 2). New molecular imaging studies are launched in cooperation with research institutes. We also conducted many types of prospective cohort translational studies to find novel biomarkers.
We provide rich educational opportunities to both residents and chief residents through clinical experience as well as research activities. Residents are encouraged to make presentations at local and national conferences. We vigorously support basic, clinical, or translational research conducted by postgraduate students.
We will continue to establish new standard treatments and propose a near-future model of clinical management of adult solid tumors, including breast cancer and gynecologic cancer. Moreover, we aim to build a comprehensive program, which includes a tumor registry, translational research, clinical trials and patient care in rare adult tumors based on our rich clinical experience. We would also like to improve the efficiency of anti-cancer drug development by coordinating basic and translational research in early-phase clinical trials.
List of papers published in 2015
- Ono M, Tsuda H, Yunokawa M, Yonemori K, Shimizu C, Tamura K, Kinoshita T, Fujiwara Y. Prognostic impact of Ki-67 labeling indices with 3 different cutoff values, histological grade, and nuclear grade in hormone-receptor-positive, HER2-negative, node-negative invasive breast cancers. Breast Cancer, 22:141-152, 2015
- Yamamoto H, Ando M, Aogi K, Iwata H, Tamura K, Yonemori K, Shimizu C, Hara F, Takabatake D, Hattori M, Asakawa T, Fujiwara Y. Phase I and pharmacokinetic study of trastuzumab emtansine in Japanese patients with HER2-positive metastatic breast cancer. Jpn J Clin Oncol, 45:12-18, 2015
- Mori M, Shimizu C, Ogawa A, Okusaka T, Yoshida S, Morita T. A National Survey to Systematically Identify Factors Associated With Oncologists' Attitudes Toward End-of-Life Discussions: What Determines Timing of End-of-Life Discussions? Oncologist, 20:1304-1311, 2015
- Doi T, Tamura K, Tanabe Y, Yonemori K, Yoshino T, Fuse N, Kodaira M, Bando H, Noguchi K, Shimamoto T, Ohtsu A. Phase 1 pharmacokinetic study of the oral pan-AKT inhibitor MK-2206 in Japanese patients with advanced solid tumors. Cancer Chemother Pharmacol, 76:409-416, 2015
- Davies BR, Guan N, Logie A, Crafter C, Hanson L, Jacobs V, James N, Dudley P, Jacques K, Ladd B, D'Cruz CM, Zinda M, Lindemann J, Kodaira M, Tamura K, Jenkins EL. Tumors with AKT1E17K Mutations Are Rational Targets for Single Agent or Combination Therapy with AKT Inhibitors. Mol Cancer Ther, 14:2441-2451, 2015
- Hojo T, Masuda N, Mizutani T, Shibata T, Kinoshita T, Tamura K, Hara F, Fujisawa T, Inoue K, Saji S, Nakamura K, Fukuda H, Iwata H. Intensive vs. Standard Post-Operative Surveillance in High-Risk Breast Cancer Patients (INSPIRE): Japan Clinical Oncology Group Study JCOG1204. Jpn J Clin Oncol, 45:983-986, 2015
- Yasui N, Yoshida A, Kawamoto H, Yonemori K, Hosono A, Kawai A. Clinicopathologic analysis of spindle cell/sclerosing rhabdomyosarcoma. Pediatr Blood Cancer, 62:1011-1016, 2015
- Kondo S, Shiba S, Udagawa R, Ryushima Y, Yano M, Uehara T, Asanabe M, Tamura K, Hashimoto J. Assessment of adverse events via a telephone consultation service for cancer patients receiving ambulatory chemotherapy. BMC Res Notes, 8:315, 2015
- Kurihara H, Hamada A, Yoshida M, Shimma S, Hashimoto J, Yonemori K, Tani H, Miyakita Y, Kanayama Y, Wada Y, Kodaira M, Yunokawa M, Yamamoto H, Shimizu C, Takahashi K, Watanabe Y, Fujiwara Y, Tamura K. 64Cu-DOTA-trastuzumab PET imaging and HER2 specificity of brain metastases in HER2-positive breast cancer patients. EJNMMI Res, 5:8, 2015
- Guo J, Yonemori K, Le Marchand L, Turesky RJ. Method to Biomonitor the Cooked Meat Carcinogen 2-Amino-1-methyl-6-phenylimidazo[4,5-b]pyridine in Dyed Hair by Ultra-Performance Liquid Chromatography-Orbitrap High Resolution Multistage Mass Spectrometry. Anal Chem, 87:5872-5877, 2015
- Hara M, Nakashima T, Harashima H, Ryushima Y, Shimizu C, Kodaira M, Yunokawa M, Yamamoto H, Hashimoto J, Tanabe Y, Bun S, Makino Y, Iwase H, Fujiwara Y, Tamura K, Hayashi Y. Efficacy and safety of aprepitant and dexamethasone in the prevention of nausea and vomiting from neoadjuvant or adjuvant anthracyclines and cyclophosphamide combination therapy in patients with breast cancer. J Pharm Health Care Sci, 41:603-611, 2015
- Blake EA, Kodama M, Yunokawa M, Ross MS, Ueda Y, Grubbs BH, Matsuo K. Feto-maternal outcomes of pregnancy complicated by epithelial ovarian cancer: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol, 186:97-105, 2015
- Matsumoto K, Katsumata N, Shibata T, Satoh T, Saitou M, Yunokawa M, Takano T, Nakamura K, Kamura T, Konishi I. Phase II trial of oral etoposide plus intravenous irinotecan in patients with platinum-resistant and taxane-pretreated ovarian cancer (JCOG0503). Gynecol Oncol, 136:218-223, 2015
- Yunokawa M, Tsuta K, Tanaka T, Nara E, Koizumi F, Ito J, Sekine S, Fujiwara Y, Tamura K. Back with a vengeance: microvascular tumor embolism. Am J Med, 128:834-836, 2015
- Tominaga N, Kosaka N, Ono M, Katsuda T, Yoshioka Y, Tamura K, Lötvall J, Nakagama H, Ochiya T. Brain metastatic cancer cells release microRNA-181c-containing extracellular vesicles capable of destructing blood-brain barrier. Nat Commun, 6:6716, 2015
- Takahashi RU, Miyazaki H, Takeshita F, Yamamoto Y, Minoura K, Ono M, Kodaira M, Tamura K, Mori M, Ochiya T. Loss of microRNA-27b contributes to breast cancer stem cell generation by activating ENPP1. Nat Commun, 6:7318, 2015
- Ono M, Tsuda H, Kobayashi T, Takeshita F, Takahashi RU, Tamura K, Akashi-Tanaka S, Moriya T, Yamasaki T, Kinoshita T, Yamamoto J, Fujiwara Y, Ochiya T. The expression and clinical significance of ribophorin II (RPN2) in human breast cancer. Pathol Int, 65:301-308, 2015
- Tamura K. Development of cell-cycle checkpoint therapy for solid tumors. Jpn J Clin Oncol, 45(12):1097-1102, 2015
- Sasaki Y, Miwa K, Yamashita K, Sunakawa Y, Shimada K, Ishida H, Hasegawa K, Fujiwara K, Kodaira M, Fujiwara Y, Namiki M, Matsuda M, Takeuchi Y, Katsumata N. A phase I study of farletuzumab, a humanized anti-folate receptor α monoclonal antibody, in patients with solid tumors. Invest New Drugs, 33:332-340, 2015
- Fujiwara Y, Yonemori K, Shibata T, Okita N, Ushirozawa N. Japanese universal health care faces a crisis in cancer treatment. Lancet Oncol, 16:251-252, 2015
- Shimizu C, Kato T, Tamura N, Bando H, Asada Y, Mizota Y, Yamamoto S, Fujiwara Y. Perception and needs of reproductive specialists with regard to fertility preservation of young breast cancer patients. Int J Clin Oncol, 20:82-89, 2015