内容紹介
A Retrospective Investigation of Lacrimation in Patients Treated with S-1
Summary
Lacrimation is among the typical adverse drug reactions associated with S-1 treatment. However, lacrimation frequencies differ between reports, and a clear consensus regarding reaction times, risk factors, and symptomatic treatment for lacrimation is lacking. We retrospectively investigated the reaction times, risk factors, and outcomes of symptomatic treatment for lacrimation in 202 patients treated with S-1. The median estimated creatinine clearance noted upon initiation of cancer treatment was 75.8 mL/min. The median of the relative treatment intensity was 87.1%, while the incidence of lacrimation was 26.7%. The median cumulative dose of S-1 before the onset of lacrimation was 23,520 mg in all patients, and 5,050 mg in those who developed lacrimation. Of the patients who developed lacrimation, 40.7% developed this symptom within 2 months after starting S-1 treatment. There were no apparent risk factors. The most frequently employed symptomatic treatment was a physiological saline ophthalmic solution provided as a hospital preparation. After treatment with this ophthalmic solution, 29.4% of the affected patients showed improvement and 70.6% showed no change; none however, experienced worsening of symptoms. These results suggest that clinicians should assess the presence of lacrimation after starting treatment with S-1. Symptomatic treatment with an ophthalmic solution that does not have a tear retention capacity may be useful in patients who have developed lacrimation.
要旨
S-1に特徴的な副作用として流涙がある。流涙発現頻度は報告ごとに乖離があり,流涙発現時期や危険因子,対症療法のコンセンサスが確立しているとはいい難い。2014年4月～2016年9月までのS-1服用患者202名を対象に,流涙発現時期および危険因子,対症療法の転帰を後方視的に検討した。がん薬物療法開始時におけるクレアチニン・クリアランス推定値の中央値は75.8 mL/min,相対的治療強度の中央値は87.1%であった。流涙発現率は26.7%であった。流涙発現までのS-1累積投与量中央値は23,520 mgであった。流涙発現患者のみで解析すると5,050 mgとなり,うち40.7%はS-1服用開始後2か月以内に流涙が発現していた。危険因子の検討を行ったが,統計学的に明らかなものは認められなかった。流涙への対症療法は,院内製剤である生理食塩液点眼液が最も多く処方されていた。生理食塩液点眼液の転帰は症状改善29.4%,不変70.6%,増悪例は認められなかった。S-1服用開始時から流涙を確認することが必要であり,涙液保持作用のない点眼薬での対症療法が有用と考える。
目次
Summary
Lacrimation is among the typical adverse drug reactions associated with S-1 treatment. However, lacrimation frequencies differ between reports, and a clear consensus regarding reaction times, risk factors, and symptomatic treatment for lacrimation is lacking. We retrospectively investigated the reaction times, risk factors, and outcomes of symptomatic treatment for lacrimation in 202 patients treated with S-1. The median estimated creatinine clearance noted upon initiation of cancer treatment was 75.8 mL/min. The median of the relative treatment intensity was 87.1%, while the incidence of lacrimation was 26.7%. The median cumulative dose of S-1 before the onset of lacrimation was 23,520 mg in all patients, and 5,050 mg in those who developed lacrimation. Of the patients who developed lacrimation, 40.7% developed this symptom within 2 months after starting S-1 treatment. There were no apparent risk factors. The most frequently employed symptomatic treatment was a physiological saline ophthalmic solution provided as a hospital preparation. After treatment with this ophthalmic solution, 29.4% of the affected patients showed improvement and 70.6% showed no change; none however, experienced worsening of symptoms. These results suggest that clinicians should assess the presence of lacrimation after starting treatment with S-1. Symptomatic treatment with an ophthalmic solution that does not have a tear retention capacity may be useful in patients who have developed lacrimation.
要旨
S-1に特徴的な副作用として流涙がある。流涙発現頻度は報告ごとに乖離があり,流涙発現時期や危険因子,対症療法のコンセンサスが確立しているとはいい難い。2014年4月～2016年9月までのS-1服用患者202名を対象に,流涙発現時期および危険因子,対症療法の転帰を後方視的に検討した。がん薬物療法開始時におけるクレアチニン・クリアランス推定値の中央値は75.8 mL/min,相対的治療強度の中央値は87.1%であった。流涙発現率は26.7%であった。流涙発現までのS-1累積投与量中央値は23,520 mgであった。流涙発現患者のみで解析すると5,050 mgとなり,うち40.7%はS-1服用開始後2か月以内に流涙が発現していた。危険因子の検討を行ったが,統計学的に明らかなものは認められなかった。流涙への対症療法は,院内製剤である生理食塩液点眼液が最も多く処方されていた。生理食塩液点眼液の転帰は症状改善29.4%,不変70.6%,増悪例は認められなかった。S-1服用開始時から流涙を確認することが必要であり,涙液保持作用のない点眼薬での対症療法が有用と考える。