内容紹介
A Case of Metastatic Colorectal Cancer with Brain Metastasis Treated with Combined TFTD and Bevacizumab Therapy
Summary
A woman in her 70s was confirmed as presenting with multiple liver and lung metastases from transverse colon cancer. After undergoing resection of the primary lesion, partial response(PR)was achieved after undergoing the first regimen(sLV5FU2 and bevacizumab[Bmab]); therefore, partial hepatectomy was performed. Adjuvant chemotherapy was administered for 7 months, but liver metastasis recurrence, multiple lung metastases, and brain metastasis were confirmed. As the brain metastasis was a single lesion and was accompanied by symptoms, resection of the lesion was performed. Treatment with regorafenib was initiated, but Grade 3 severe erythema multiforme was detected, and the treatment had to be discontinued. Therefore, combined TFTD and Bmab therapy was initiated as the third regimen. Liver and lung metastases were maintained as stable disease(SD), and the treatment was continued for approximately 1 year together with stereotaxic radiation therapy for the new brain metastatic lesion. The utility of combined TFTD and Bmab therapy has been reported in a phaseⅡ trial, and it has also been indicated that Bmab is effective for reducing brain edema. As this treatment was effective in this case, we will report on it together with a discussion of the literature.
要旨
症例は70歳台,女性。初診時より多発肝転移・肺転移を有する横行結腸癌に対して,原発巣切除術後に一次治療[sLV5FU2+bevacizumab(Bmab)]施行後,画像上PRを得て肝部分切除術を施行した。補助化学療法施行後,7か月後に肝転移再発,多発肺転移,さらに脳転移が出現した。脳転移は単発で有症状であったため,開頭腫瘍摘出術を施行した。間質性肺炎の既往があり,regorafenibを開始したがGrade 3の重症多型紅斑を呈し,治療中止を余儀なくされた。三次治療としてTFTD+Bmab併用療法を開始した。肝転移および肺転移は病勢コントロールを得ることができ,微小な新規脳転移病変に対しては定位放射線治療を併用しながら,約1年間外来治療を継続した。TFTD+Bmab併用療法は第Ⅱ相臨床試験でその有用性が報告されている。さらにBmabは脳浮腫軽減においても効果があることも報告されており,同療法の有効性が期待できる症例を経験したため,文献的考察を加えて報告する。
目次
Summary
A woman in her 70s was confirmed as presenting with multiple liver and lung metastases from transverse colon cancer. After undergoing resection of the primary lesion, partial response(PR)was achieved after undergoing the first regimen(sLV5FU2 and bevacizumab[Bmab]); therefore, partial hepatectomy was performed. Adjuvant chemotherapy was administered for 7 months, but liver metastasis recurrence, multiple lung metastases, and brain metastasis were confirmed. As the brain metastasis was a single lesion and was accompanied by symptoms, resection of the lesion was performed. Treatment with regorafenib was initiated, but Grade 3 severe erythema multiforme was detected, and the treatment had to be discontinued. Therefore, combined TFTD and Bmab therapy was initiated as the third regimen. Liver and lung metastases were maintained as stable disease(SD), and the treatment was continued for approximately 1 year together with stereotaxic radiation therapy for the new brain metastatic lesion. The utility of combined TFTD and Bmab therapy has been reported in a phaseⅡ trial, and it has also been indicated that Bmab is effective for reducing brain edema. As this treatment was effective in this case, we will report on it together with a discussion of the literature.
要旨
症例は70歳台,女性。初診時より多発肝転移・肺転移を有する横行結腸癌に対して,原発巣切除術後に一次治療[sLV5FU2+bevacizumab(Bmab)]施行後,画像上PRを得て肝部分切除術を施行した。補助化学療法施行後,7か月後に肝転移再発,多発肺転移,さらに脳転移が出現した。脳転移は単発で有症状であったため,開頭腫瘍摘出術を施行した。間質性肺炎の既往があり,regorafenibを開始したがGrade 3の重症多型紅斑を呈し,治療中止を余儀なくされた。三次治療としてTFTD+Bmab併用療法を開始した。肝転移および肺転移は病勢コントロールを得ることができ,微小な新規脳転移病変に対しては定位放射線治療を併用しながら,約1年間外来治療を継続した。TFTD+Bmab併用療法は第Ⅱ相臨床試験でその有用性が報告されている。さらにBmabは脳浮腫軽減においても効果があることも報告されており,同療法の有効性が期待できる症例を経験したため,文献的考察を加えて報告する。