内容紹介
Summary
Chemotherapy for unresectable pancreatic cancer has moved from using gemcitabine(GEM)and/or S-1 to using 5-fluorouracil plus Leucovorin plus oxaliplatin plus irinotecan(FOLFIRINOX)or GEM and nano albumin-bound paclitaxel(nab-PTX). We administered weekly PTX 80 mg/m2(days 1, 8, 15 every 4 weeks)in 22 patients with both GEM and S-1 resistance before nab-PTX became available through medical insurance in Japan. This regimen was used as a second-line in 3 cases, as the third-line in 14 cases and as a later line in 5 cases. The mean number of chemotherapy courses was 2.7, and the mean dose intensity was 86.1%. Postponement and dose reduction was made in 15 and 5 cases, respectively. The best overall response was 1 PR, 5 SD, 15 PD and 1 NE. The response rate was 4.5%, and disease control rate was 27.3%. The median progression-free survival was 1.7 months, and the median overall survival was 4.6 months. The main adverse events included anorexia, general malaise, and peripheral neurotoxicity and they were tolerable. This study wherein nab-PTX plus GEM was one of the standard therapies, indicated that the PTX alone was effective in pancreatic cancer patients who were resistant to GEM and S-1.
要旨
切除不能・再発進行膵癌の化学療法はゲムシタビン(GEM),S-1の単独投与から,FOLFIRINOXまたはナノアルブミン結合パクリタキセル(nab-PTX)+GEMの併用療法に移行した。われわれはnab-PTXの保険適応前にGEMおよびS-1の標準治療に無効な膵癌症例に対して,当科で実施したweekly PTX療法(PTX 80 mg/m2 day 1,8,15の4週ごと)を後方視的に検討した。対象は22例であり,二次治療3例,三次治療14例,四次治療以降で5例に使用された。施行コース数は平均2.7コース,dose intensityは平均86.1%,治療スケジュールの延期は15例において行われ,投与量減量は5例で行われた。最良治療効果はPR 1例,SD 5例,PD 15例,NE 1例で,奏効率4.5%,腫瘍制御率27.3%,無増悪生存期間中央値1.7(0.6～7.0)か月,全生存期間中央値は4.6(1.7～15.6)か月であった。有害事象は食欲不振,倦怠感,末梢神経障害が多くみられたが認容可能であった。nab-PTX+GEM療法が標準治療となる現状において,GEMおよびS-1治療抵抗性膵癌におけるPTX単独の効力が示された。
目次
Chemotherapy for unresectable pancreatic cancer has moved from using gemcitabine(GEM)and/or S-1 to using 5-fluorouracil plus Leucovorin plus oxaliplatin plus irinotecan(FOLFIRINOX)or GEM and nano albumin-bound paclitaxel(nab-PTX). We administered weekly PTX 80 mg/m2(days 1, 8, 15 every 4 weeks)in 22 patients with both GEM and S-1 resistance before nab-PTX became available through medical insurance in Japan. This regimen was used as a second-line in 3 cases, as the third-line in 14 cases and as a later line in 5 cases. The mean number of chemotherapy courses was 2.7, and the mean dose intensity was 86.1%. Postponement and dose reduction was made in 15 and 5 cases, respectively. The best overall response was 1 PR, 5 SD, 15 PD and 1 NE. The response rate was 4.5%, and disease control rate was 27.3%. The median progression-free survival was 1.7 months, and the median overall survival was 4.6 months. The main adverse events included anorexia, general malaise, and peripheral neurotoxicity and they were tolerable. This study wherein nab-PTX plus GEM was one of the standard therapies, indicated that the PTX alone was effective in pancreatic cancer patients who were resistant to GEM and S-1.
要旨
切除不能・再発進行膵癌の化学療法はゲムシタビン(GEM),S-1の単独投与から,FOLFIRINOXまたはナノアルブミン結合パクリタキセル(nab-PTX)+GEMの併用療法に移行した。われわれはnab-PTXの保険適応前にGEMおよびS-1の標準治療に無効な膵癌症例に対して,当科で実施したweekly PTX療法(PTX 80 mg/m2 day 1,8,15の4週ごと)を後方視的に検討した。対象は22例であり,二次治療3例,三次治療14例,四次治療以降で5例に使用された。施行コース数は平均2.7コース,dose intensityは平均86.1%,治療スケジュールの延期は15例において行われ,投与量減量は5例で行われた。最良治療効果はPR 1例,SD 5例,PD 15例,NE 1例で,奏効率4.5%,腫瘍制御率27.3%,無増悪生存期間中央値1.7(0.6～7.0)か月,全生存期間中央値は4.6(1.7～15.6)か月であった。有害事象は食欲不振,倦怠感,末梢神経障害が多くみられたが認容可能であった。nab-PTX+GEM療法が標準治療となる現状において,GEMおよびS-1治療抵抗性膵癌におけるPTX単独の効力が示された。