内容紹介
A Case of Recurrent Colorectal Cancer with Bilateral Ovarian Metastases That Were Reduced with Regorafenib Therapy
Summary
A 63-year-old woman had recurrences of metastatic rectal cancer in the lung, peritoneum, and ovary. Regorafenib was administered at 160 mg/day as third-line chemotherapy. The patient developed Grade(Gr)3 hand-foot syndrome(HFS)and Gr 2 rash, but the abdominal distension and pain were relieved by the 1st course. Analgesics could be reduced and regorafenib was administrated at reduced dosage. The patient received keishi-bukuryo-gan(EK-25)and sai-rei-tou(TJ-114)for HFS. At the beginning of therapy, ovarian metastases were not reduced and showed poor contrast enhancement on CT. Serum levels of lactate dehydrogenase(LDH)and tumor markers were increased. During the 4th course of therapy, ovarian metastases tended to shrink and serum levels of LDH and tumor markers were decreased. Ovarian metastases showed a partial response(PR)after the 6th course. Lung metastases showed a progressive disease during the 2nd course, but a PR after the 3rd course, and were not apparent after the 6th course. Reduction of metastases was maintained at 16 months after the start of therapy, and HFS was assessed at Gr 2 or lower. Physical, laboratory, and imaging findings should be carefully evaluated prior to long-term administration of regorafenib.
要旨
症例は63歳,女性。直腸癌術後,腹膜転移,両側多発肺転移,卵巣転移で再発した。三次治療でregorafenib錠を4錠(160 mg)/日で開始した。1コース目にGrade(Gr)3の手足症候群とGr 2の発疹を認めたが,腹部膨満感と腹痛が軽減し鎮痛剤を減量でき,以後regorafenibを減量し継続投与した。手足症候群には通常の外用剤以外に桂枝茯苓丸,柴苓湯を併用した。治療初期では卵巣転移は縮小せずLDHと腫瘍マーカーが上昇したが,CT上で内部壊死を示唆する造影効果の低下を認めた。4コース目投与中に卵巣転移は縮小傾向を認めLDHと腫瘍マーカーも漸減し,6コース終了後にPRとなった。肺転移は2コース目投与中にPDとなるも3コース目終了後にPRとなり,6コース終了後に大部分は不明瞭化した。regorafenib開始1年4か月後も奏効を維持し,手足症候群もGr 2以下となっている。regorafenib継続可否を判断する上で理学的所見,血液検査所見,画像所見を注意深く観察する必要があると思われた。
目次
Summary
A 63-year-old woman had recurrences of metastatic rectal cancer in the lung, peritoneum, and ovary. Regorafenib was administered at 160 mg/day as third-line chemotherapy. The patient developed Grade(Gr)3 hand-foot syndrome(HFS)and Gr 2 rash, but the abdominal distension and pain were relieved by the 1st course. Analgesics could be reduced and regorafenib was administrated at reduced dosage. The patient received keishi-bukuryo-gan(EK-25)and sai-rei-tou(TJ-114)for HFS. At the beginning of therapy, ovarian metastases were not reduced and showed poor contrast enhancement on CT. Serum levels of lactate dehydrogenase(LDH)and tumor markers were increased. During the 4th course of therapy, ovarian metastases tended to shrink and serum levels of LDH and tumor markers were decreased. Ovarian metastases showed a partial response(PR)after the 6th course. Lung metastases showed a progressive disease during the 2nd course, but a PR after the 3rd course, and were not apparent after the 6th course. Reduction of metastases was maintained at 16 months after the start of therapy, and HFS was assessed at Gr 2 or lower. Physical, laboratory, and imaging findings should be carefully evaluated prior to long-term administration of regorafenib.
要旨
症例は63歳,女性。直腸癌術後,腹膜転移,両側多発肺転移,卵巣転移で再発した。三次治療でregorafenib錠を4錠(160 mg)/日で開始した。1コース目にGrade(Gr)3の手足症候群とGr 2の発疹を認めたが,腹部膨満感と腹痛が軽減し鎮痛剤を減量でき,以後regorafenibを減量し継続投与した。手足症候群には通常の外用剤以外に桂枝茯苓丸,柴苓湯を併用した。治療初期では卵巣転移は縮小せずLDHと腫瘍マーカーが上昇したが,CT上で内部壊死を示唆する造影効果の低下を認めた。4コース目投与中に卵巣転移は縮小傾向を認めLDHと腫瘍マーカーも漸減し,6コース終了後にPRとなった。肺転移は2コース目投与中にPDとなるも3コース目終了後にPRとなり,6コース終了後に大部分は不明瞭化した。regorafenib開始1年4か月後も奏効を維持し,手足症候群もGr 2以下となっている。regorafenib継続可否を判断する上で理学的所見,血液検査所見,画像所見を注意深く観察する必要があると思われた。