Palonosetron, a second-generation 5-hydroxytryptamine 3 receptor antagonist (5-HT3RA), has a higher binding affinity for the 5-HT3 receptor and a longer half-life than the first-generation 5-HT3RAs. The efficacy of palonosetron as prophylaxis for chemotherapy-induced nausea and vomiting has been reported. However, there are no reports of efficacy in patients with failure of antiemetic prophylaxis. In this study, we retrospectively investigated the efficacy of palonosetron used in subsequent chemotherapy cycles in patients with failure of antiemetic prophylaxis. A total of 50 patients were included from August 2010 to January 2013; 27 patients received highly emetogenic chemotherapy and 23 received moderately emetogenic chemotherapy. Antiemetic was switched from granisetron to palonosetron for all patients. The proportion of patients who experienced reduced severity of nausea were 60% in the acute phase, and the proportion of patients with reduced severity of nausea and vomiting were 90% and 66% in the delayed phase, respectively. The proportion of patients who used rescue medications decreased from 48% to 24%. We confirmed improvement of chemotherapy-induced nausea and vomiting by switching from granisetron to palonosetron in patients with failure of antiemetic prophylaxis.

It is suggested that in the use of tacrolimus for treatment of ulcerative colitis, it is important to achieve and maintain a high trough level as soon as possible. We examined two cases, with a starting initial dose higher than that recommended in the package insert, and adjusted the dose by daily therapeutic drug monitoring. Improvement of symptoms was observed by maintaining a high trough level of 10 to 15 ng/mL in these 2 cases. This improvement was observed from 9 days after achieving the high trough level, and it took the same number of days as stated in the mode of administration in the package insert.

Trifluridine (FTD) / tipiracil hydrochloride (TPI) has been approved for the treatment of colorectal cancer, but its dose-limiting toxicity is neutropenia. Elderly patients are at high risk of febrile neutropenia and should be monitored carefully when administering FTD / TPI. In this study, we retrospectively investigated the incidence of adverse events, dose reduction, and number of administered courses in 8 old-old patients treated with FTD / TPI for colorectal cancer. The results showed that severe neutropenia of Grade 3 or higher occurred in 5 of the 8 patients. Six patients had a dose reduction, but 5 of them were able to continue treatment for at least 3 courses. The frequency and severity of adverse events, including neutropenia, appears to be higher in old-old patients, so it is important to take appropriate measures.