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 <\/p>\n

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\u30ad\u30fc\u30c8\u30eb\u30fc\u30c0\u306e\u8853\u524d\u30fb\u8853\u5f8c\u88dc\u52a9\u5316\u5b66\u7642\u6cd5\u3078\u306e\u5c0e\u5165\uff082022\u5e749\u670826\u65e5\u9069\u5fdc\u62e1\u5927\u627f\u8a8d\uff09<\/strong><\/h3>\n

\u6297PD-1\u6297\u4f53\u85ac\u3067\u3042\u308b\u30ad\u30a4\u30c8\u30eb\u30fc\u30c0\uff08\u4e00\u822c\u540d\uff1a\u30da\u30e0\u30d6\u30ed\u30ea\u30ba\u30de\u30d6\uff09\u304c\u30c8\u30ea\u30d7\u30eb\u30cd\u30ac\u30c6\u30a3\u30d6\uff08TNBC\uff09\u4e73\u764c\u306e\u6cbb\u7642\u85ac\u3068\u3057\u3066\u56fd\u5185\u3067\u9069\u5fdc\u62e1\u5927\u627f\u8a8d\u3055\u308c\u307e\u3057\u305f\u3002\u3053\u308c\u307e\u3067\u3082\u9032\u884c\u518d\u767a\u4f8b\u306b\u306f\u627f\u8a8d\u3055\u308c\u3066\u3044\u307e\u3057\u305f\u304c\u3001Stage\u2161\uff5e\u2162\u306e\u3044\u308f\u3086\u308b\u65e9\u671f\u4e73\u764c\u306e\u8853\u524d\u3001\u8853\u5f8c\u7642\u6cd5\u306b\u3082\u9069\u5fdc\u62e1\u5927\u3055\u308c\u305f\u3053\u3068\u3067\u3001\u5bfe\u8c61\u60a3\u8005\u3055\u3093\u304c\u4e00\u6c17\u306b\u62e1\u5927\u3055\u308c\u307e\u3057\u305f\u3002\u3053\u306e\u627f\u8a8d\u306fKEYNOTE-522\u8a66\u9a13\u306e\u7d50\u679c\u306b\u57fa\u3065\u304f\u3082\u306e\u3067\u3059\u3002\u30ad\u30a4\u30c8\u30eb\u30fc\u30c0\u306f\u514d\u75ab\u30c1\u30a7\u30c3\u30af\u30dd\u30a4\u30f3\u30c8\u963b\u5bb3\u85ac\u306e1\u3064\u3067\u3001\u514d\u75ab\u306b\u95a2\u4e0e\u3059\u308b\u6d3b\u6027\u5316T\u7d30\u80de\u4e0a\u306b\u767a\u73fe\u3059\u308bPD-1\u3068\u7d50\u5408\u3059\u308b\u3053\u3068\u3067\u3001\u304c\u3093\u7d30\u80de\u4e0a\u306ePD-L1\/2\u3068PD-1\u304c\u7d50\u5408\u3059\u308b\u306e\u3092\u963b\u5bb3\u3057\u307e\u3059\u3002\u3053\u308c\u306b\u3088\u308a\u304c\u3093\u7d30\u80de\u304cT\u7d30\u80de\u306e\u50cd\u304d\u3092\u6291\u5236\u3059\u308b\u306e\u3092\u963b\u5bb3\u3057\u3001T\u7d30\u80de\u304c\u518d\u6d3b\u6027\u5316\u3055\u308c\u308b\u3053\u3068\u306b\u3088\u308a\u304c\u3093\u7d30\u80de\u3092\u6392\u9664\u3059\u308b\u3053\u3068\u306b\u3088\u308a\u52b9\u679c\u3092\u767a\u63ee\u3057\u307e\u3059\u3002\u30ad\u30fc\u30c8\u30eb\u30fc\u30c0\u306e\u4f75\u7528\u306b\u3088\u3063\u3066\u3053\u308c\u307e\u3067\u306e\u6a19\u6e96\u6cbb\u7642\u3092\u304b\u306a\u308a\u4e0a\u56de\u308b\u6210\u7e3e\u304c\u793a\u3055\u308c\u307e\u3057\u305f\u304c\u3001\u514d\u75ab\u30c1\u30a7\u30c3\u30af\u30dd\u30a4\u30f3\u30c8\u963b\u5bb3\u5264\u306f\u306a\u304b\u306a\u304b\u5384\u4ecb\u306a\u6cbb\u7642\u85ac\u3067\u3001\u9593\u8cea\u6027\u80ba\u708e\u3001\u91cd\u75c7\u7b4b\u7121\u529b\u75c7\u3001\u795e\u7d4c\u969c\u5bb3\u3001\u809d\u969c\u5bb3\u3001\u7532\u72b6\u817a\u6a5f\u80fd\u969c\u5bb3\u3001\u4e0b\u5782\u4f53\u6a5f\u80fd\u969c\u5bb3\u3001\u526f\u814e\u6a5f\u80fd\u969c\u5bb3\u306a\u3069\u591a\u5f69\u306a\u526f\u4f5c\u7528\u304c\u767a\u751f\u3059\u308b\u53ef\u80fd\u6027\u304c\u3042\u308a\u3001\u6642\u306b\u91cd\u7be4\u5316\u3057\u3001\u6a5f\u80fd\u4e0d\u5168\u3092\u5f15\u304d\u8d77\u3053\u3059\u306a\u3069\u306e\u30ea\u30b9\u30af\u304c\u3042\u308a\u307e\u3059\u3002\u4f7f\u7528\u5bfe\u8c61\u304c\u3053\u308c\u307e\u3067\u306e\u6a19\u6e96\u6cbb\u7642\u3067\u3082\u304b\u306a\u308a\u306e\u6cbb\u7652\u304c\u671f\u5f85\u3055\u308c\u305f\u75c7\u4f8b\u306b\u4f7f\u7528\u3059\u308b\u308f\u3051\u3067\u3001\u3088\u308a\u614e\u91cd\u306a\u5bfe\u5fdc\u304c\u6c42\u3081\u3089\u308c\u308b\u3053\u3068\u306f\u3082\u3061\u308d\u3093\u3001\u547c\u5438\u5668\u5185\u79d1\u3001\u5185\u5206\u6ccc\u5185\u79d1\u3001\u795e\u7d4c\u5185\u79d1\u306a\u3069\u591a\u304f\u306e\u5c02\u9580\u5bb6\u306e\u652f\u63f4\u304c\u5fc5\u8981\u3067\u3001\u3053\u3046\u3057\u305f\u5404\u8a3a\u7642\u79d1\u304c\u5e38\u8a2d\u3055\u308c\u3066\u3044\u308b\u7dcf\u5408\u75c5\u9662\u3067\u306a\u3044\u3068\u6cbb\u7642\u304c\u5b89\u5168\u306b\u5b9f\u65bd\u3067\u304d\u306a\u3044\u3068\u3044\u3046\u50be\u5411\u304c\u307e\u3059\u307e\u3059\u5f37\u307e\u308b\u3068\u601d\u3044\u307e\u3059\u3002\u3053\u306e\u30ad\u30fc\u30c8\u30eb\u30fc\u30c0\u306b\u95a2\u3057\u3066\u306f\u30db\u30eb\u30e2\u30f3\u53d7\u5bb9\u4f53\u967d\u6027\u306e\u3044\u308f\u3086\u308b\u30eb\u30df\u30ca\u30eb\u30bf\u30a4\u30d7\u306e\u4e73\u764c\u306b\u5bfe\u3057\u3066\u3082\u6709\u671b\u3068\u3055\u308c\uff08KEYNOTE-756\u8a66\u9a13\uff09\u56fd\u5185\u5c0e\u5165\u306f2\u5e74\u5f8c\u304f\u3089\u3044\u3068\u671f\u5f85\u3055\u308c\u3066\u3044\u307e\u3059\u3002<\/p>\n

\u304a\u308f\u308a\u306b<\/h3>\n

\u6700\u8fd1\u306e\u4e73\u764c\u6cbb\u7642\u306e\u8a71\u984c\u3092\u6319\u3052\u3066\u307f\u307e\u3057\u305f\u304c\u3001\u9032\u884c\u518d\u767a\u4f8b\u3067\u306e\u30b2\u30ce\u30e0\u8a3a\u7642\u3001\u514d\u75ab\u30c1\u30a7\u30c3\u30af\u30dd\u30a4\u30f3\u30c8\u963b\u5bb3\u5264\u4ee5\u5916\u306e\u8907\u96d1\u306a\u7ba1\u7406\u3092\u8981\u3059\u308b\u5206\u5b50\u6a19\u7684\u85ac\u3001\u5c40\u6240\u6cbb\u7642\u306b\u95a2\u3057\u3066\u3082\u3053\u308c\u304b\u3089\u65e9\u671f\u4e73\u764c\u306b\u5bfe\u3059\u308b\u30e9\u30b8\u30aa\u6ce2\u713c\u707c\u7642\u6cd5\u304c\u5c0e\u5165\u3055\u308c\u3066\u304d\u307e\u3059\u3002\u3053\u306e30\u5e74\u3092\u632f\u308a\u8fd4\u3063\u3066\u624b\u8853\u7642\u6cd5\u306f\u7e2e\u5c0f\u3055\u308c\u3001\u85ac\u7269\u7642\u6cd5\u3082\u30d0\u30a4\u30aa\u30de\u30fc\u30ab\u30fc\u306a\u3069\u306b\u3088\u3063\u3066\u3088\u308a\u7684\u78ba\u306b\u5bfe\u8c61\u3092\u7d5e\u308b\u3053\u3068\u3067\u60a3\u8005\u3055\u3093\u306e\u8ca0\u62c5\u306f\u8efd\u6e1b\u3055\u308c\u305f\u3068\u601d\u3044\u307e\u3059\u3002\u307e\u305f\u6cbb\u7652\u304c\u671f\u5f85\u3067\u304d\u306a\u3044\u9032\u884c\u518d\u767a\u4e73\u764c\u3067\u30825\u5e74\u4ee5\u4e0a\u306e\u751f\u5b58\u671f\u9593\u304c\u671f\u5f85\u3067\u304d\u308b\u5834\u5408\u3082\u591a\u304f\u300110\u5e74\u4ee5\u4e0a\u306e\u610f\u5473\u306e\u3042\u308b\u5ef6\u547d\u304c\u3067\u304d\u308b\u3053\u3068\u3082\u5c11\u306a\u304f\u3042\u308a\u307e\u305b\u3093\u3002\u4e00\u65b9\u3067\u3053\u3046\u3057\u305f\u5148\u9032\u533b\u7642\u3092\u3059\u3079\u3066\u63d0\u4f9b\u3067\u304d\u308b\u75c5\u9662\u306f\u672c\u5f53\u306b\u9650\u3089\u308c\u3066\u304a\u308a\u3001\u3053\u306e\u3053\u3068\u304b\u3089\u4e2d\u6838\u75c5\u9662\u3001\u4e2d\u5805\u75c5\u9662\u3001\u30af\u30ea\u30cb\u30c3\u30af\u306e\u9593\u306e\u6709\u6a5f\u7684\u306a\u9023\u643a\u304c\u5fc5\u8981\u3067\u3067\u3001\u307e\u305f\u75c5\u9662\u5185\u3067\u306e\u8077\u7a2e\u9593\u3067\u306e\u30bf\u30b9\u30af\u30b7\u30d5\u30c8\u3082\u5fc5\u9808\u3060\u3068\u5b9f\u611f\u3057\u3066\u3044\u307e\u3059\u3002<\/p>\n

\"\"

Toranomon Hills Station Tower<\/p><\/div>\n

\u00a0<\/h2>\n

Recent Topics in Breast Cancer Treatment<\/h2>\n

Introduction.<\/h3>\n

\nAs of 8 August 2023, although the coronary scourge has not ended, new coronavirus infection was moved to category 5 infection on 8 May, and the world is returning to normal. Meanwhile, the wearing of masks in hospitals continues to be mandatory and the isolation of people infected or suspected to be infected with the virus continues. During the three and a half years of the coronary disaster, there have been many advances in breast cancer care, although they have not attracted much public attention. Although these advances have clearly directly benefited patients, there is concern that more and more work is being done in the field and patients are being rushed through tests and treatments with insufficient understanding, resulting in exhaustion in the field and a decline in patients’ satisfaction with their treatment. I am concerned that the result of this is a decline in patient satisfaction with medical care. During the 30 years that I have been involved in breast cancer treatment, the cure rate for patients has clearly improved and the survival period after distant recurrence, which is difficult to cure, has also been prolonged. On the other hand, the number of things that the medical profession has to do has really increased, and it is a daily headache for me. Now I would like to focus on three changes for 2020 and beyond.<\/p>\n

Tests and surgeries related to hereditary breast and ovarian cancer syndrome (HBOC) are now covered by insurance (April 2020).<\/h3>\n

\nAt a time when the world was in the throes of the Corona crisis, and a state of emergency was declared in Japan after reports of devastation in Italy and New York, genetic testing for HBOC and preventive surgery to reduce the risk of the disease became covered by insurance. Genetic testing and prophylactic surgery had been available for some time at private expense, and the tests and surgery themselves were not groundbreaking. However, the series of steps involved in carrying out the genetic test and preventive resection required an out-of-pocket expense of around 2-3 million yen, and the number of people who could afford it was limited to a certain extent. However, I believe that many patients would have been highly stressed if they had to make the decision whether or not to have the genetic test immediately after the diagnosis of breast cancer, and whether or not to have a contralateral prophylactic resection along with the breast cancer operation. Many people contributed to the insurance approval of the procedure, and as a specialist, I am grateful for this, but at the same time I feel that it is a difficult task.<\/p>\n

Introduction of scalp cooling therapy at Toranomon Hospital (August 2021).<\/h3>\n

The introduction of this technology in Japan has been increasing since it was approved by the Ministry of Health, Labour and Welfare in March 2019. The details of this are omitted as they were introduced in last year’s edition of this journal (Toto Clinic publication in 2022), but Dr Shozo Osumi of the Shikoku Cancer Centre (now Matsuyama Municipal Hospital) and Dr Takayuki Kinoshita of the National Cancer Centre (now Tokyo Medical Centre) played a major role in the clinical introduction of this technology in Japan in the early 2010s. However, the burden on the site where the treatment is carried out is heavy and it is difficult to operate even if the patient bears the cost (around 150,000-350,000 yen), so the number of facilities in Japan that carry out the treatment is limited to less than 100, and the number of facilities that are proactive in dealing with the problem is also limited. Toranomon Hospital was able to secure space for an outpatient chemotherapy room when the new hospital was built (43 rooms), and with the cooperation of various departments within the hospital, the number of new cases per year has now expanded to around 100 (the highest number of cases in the country: data from a domestic agency). The image of the effect of scalp cooling is that it can reduce hair loss from more than 50% of patients to about 50% of patients, considerably shortening the period of wig use and in some cases even eliminating its use. Another major advantage is that permanent hair loss (requiring a wig for life), which is seen in about 20% of patients, can be avoided with a high degree of certainty, and about 50% of patients choose this option, despite the cost, prolonged infusion time and pain during cooling.<\/p>\n

Introduction of Keytruda into pre- and post-operative adjuvant chemotherapy (approved for expanded indication on 26 September 2022).<\/h3>\n

\nThe anti-PD-1 antibody drug Keytruda (generic name: pembrolizumab) was approved for an expanded indication in Japan for the treatment of triple negative (TNBC) breast cancer. Although it had previously been approved for advanced recurrence, the indication has now been expanded to include pre- and post-operative treatment of Stage II-III so-called early-stage breast cancer, which means that the number of eligible patients has suddenly increased. This approval is based on the results of the KEYNOTE-522 study. Keytruda is an immune checkpoint inhibitor that binds to PD-1, which is expressed on activated T cells involved in immunity, thereby preventing PD-L1\/2 on cancer cells from binding to PD-1. This inhibits cancer cells from suppressing T-cell function, and the T-cells are reactivated, thereby eliminating the cancer cells, thereby demonstrating efficacy. Although the combination of Keytruda has shown considerably better results than previous standard treatments, immune checkpoint inhibitors are quite troublesome treatments and can cause a wide variety of side effects, including interstitial pneumonia, myasthenia gravis, neuropathy, liver damage, thyroid dysfunction, pituitary gland dysfunction and adrenal dysfunction, There is a risk of sometimes severe and dysfunctional effects. The use of the drug is targeted at patients who were expected to be cured by conventional standard treatment, so it is necessary to take a more careful approach and requires the support of many specialists, including respiratory medicine, endocrinology and neurology, and treatment can only be carried out safely in general hospitals where these departments are permanently located. This trend is likely to intensify. Keytruda is also promising for hormone receptor-positive luminal type breast cancer (KEYNOTE-756 trial) and is expected to be introduced in Japan in about two years’ time.<\/p>\n

Conclusion.<\/h3>\n

\nThe topics of recent breast cancer treatment are listed here, but genomic treatment for advanced recurrence, molecular targeted drugs requiring complex management other than immune checkpoint inhibitors, and radiofrequency ablation for local treatment of early-stage breast cancer will be introduced in the future. Looking back over the past 30 years, surgical treatment has been reduced and drug therapy has been more precisely targeted using biomarkers and other methods, which has reduced the burden on patients. In addition, even in advanced recurrent breast cancer, where a cure is not expected, a survival period of five years or more can often be expected, and in many cases, a meaningful life extension of 10 years or more can be achieved. On the other hand, the number of hospitals that can provide all these advanced medical services is really limited, and this makes me realise that organic collaboration between core hospitals, medium-sized hospitals and clinics is necessary, as well as task shifting between professions within hospitals is also essential.<\/p>\n

\"\"

Toranomon Hills Station Tower<\/p><\/div>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

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