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Articles by K Kawai
Total Records ( 3 ) for K Kawai
  M Toyofuku , T Kimura , T Morimoto , Y Hayashi , H Ueda , K Kawai , Y Nozaki , S Hiramatsu , A Miura , Y Yokoi , S Toyoshima , H Nakashima , K Haze , M Tanaka , S Take , S Saito , T Isshiki , K Mitsudo and on Behalf of the j Cypher Registry Investigators
 

Background— Long-term outcomes after stenting of an unprotected left main coronary artery (ULMCA) with drug-eluting stents have not been addressed adequately despite the growing popularity of this procedure.

Methods and Results— j-Cypher is a multicenter prospective registry of consecutive patients undergoing sirolimus-eluting stent implantation in Japan. Among 12 824 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 3 years was significantly higher in patients with ULMCA stenting (n=582) than in patients without ULMCA stenting (n=12 242; 14.6% versus 9.2%, respectively; P<0.0001); however, there was no significant difference between the 2 groups in the adjusted risk of death (hazard ratio 1.23, 95% confidence interval 0.95 to 1.60, P=0.12). Among 476 patients whose ULMCA lesions were treated exclusively with a sirolimus-eluting stent, patients with ostial/shaft lesions (n=96) compared with those with bifurcation lesions (n=380) had a significantly lower rate of target-lesion revascularization for the ULMCA lesions (3.6% versus 17.1%, P=0.005), with similar cardiac death rates at 3 years (9.8% versus 7.6%, P=0.41). Among patients with bifurcation lesions, patients with stenting of both the main and side branches (n=119) had significantly higher rates of cardiac death (12.2% versus 5.5%; P=0.02) and target-lesion revascularization (30.9% versus 11.1%; P<0.0001) than those with main-branch stenting alone (n=261).

Conclusions— The higher unadjusted mortality rate of patients undergoing ULMCA stenting with a sirolimus-eluting stent did not appear to be related to ULMCA treatment itself but rather to the patients’ high-risk profile. Although long-term outcomes in patients with ostial/shaft ULMCA lesions were favorable, outcomes in patients with bifurcation lesions treated with stenting of both the main and side branches appeared unacceptable.

  H Akaza , K Kawai , T Tsukamoto , T Fujioka , Y Tomita , T Kitamura , S Ozono , T Miki , S Naito , H Zembutsu and Y. Nakamura
  Objective

In our previous study, a combination therapy of interleukin-2 and interferon- was found to be more effective than monotherapy, especially for lung metastasis. In order to determine the genetic markers of those who positively responded, a multi-institutional open study was conducted on the patients with lung metastasis. In this paper, the clinical response to our combination therapy is reported.

Methods

Untreated patients with lung metastasis were enrolled in this study. Patients received interleukin-2 (0.7 x 106 U/day) and interferon- (6 x 106 IU/day): interleukin-2, 5 days a week and interferon-, 3 days a week for the first 8 weeks, and then both interleukin-2 and interferon-, 2 or 3 days a week for 16 additional weeks.

Results

Forty-two patients were able to be evaluated for response. The overall positive response rate was 35.7% (15 of 42) including 2 patients with complete response. Progression-free patients were observed more frequently in patients with lung metastasis only (80.6%) than those with lung plus other organ metastasis (54.5%). Tumor shrinkage was observed in 81.0% (34 of 42) of patients. Progression-free survival rate at 200 days was 63.6%. Toxicities observed were primarily flu-like symptoms due to the cytokines and were typical of those observed with each single agent.

Conclusions

Combination therapy of interleukin-2 and interferon- was confirmed to be effective for renal cell carcinoma patients with lung metastasis. Identification of genetic markers is now ongoing with the tissue samples from this trial.

 
 
 
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