内容紹介
Summary
The case involved a 44-year-old man who underwent intersphincteric resection and lateral lymph node dissection for rectal cancer. Pathological diagnosis revealed a well-differentiated adenocarcinoma comprising KRAS wild type, and pT2N0M0(pathological StageⅠ). CapeOX(capecitabine plus oxaliplatin[L-OHP]), and bevacizumab therapy was initiated because of local recurrence. Although a partial response(PR)was observed, the therapy was terminated after 6 courses because of the development of hand-foot syndrome. FOLFIRI and cetuximab therapy was initiated after cancer recurrence was observed during a follow up. As the therapeutic efficiency is characterized by stability(stable disease: SD), and the tumor reduction effect observed was not sufficient, we performed an abdominoperineal resection to achieve local control. However, a left hydronephrosis occurred due to the pelvic recurrence, necessitating the emergency hospitalization of the patient. Because resistance to L-OHP was not confirmed, mFOLFOX6 and bevacizumab therapy was introduced in hopes of the effect of the former. As Grade 2 allergy(erythema)appeared immediately after the L-OHP was administered during the 3 courses, treatment was discontinued. We the reinitiated the treatment along with the desensitization therapy from the 4 courses. A total of 27 courses of mFOLFOX6 and bevacizumab therapy were administered until the state of disease progression(progression disease: PD)was determined. PR was defined as the best therapeutic efficiency. In some cases, discontinuation of treatment is necessary as observed in the present case due to the onset of L-OHP allergies, even if the overall effect of the treatment is expected to be good. Our case is essential as it demonstrates the successfulness of desensitization therapy for L-OHP allergies.
要旨
症例は44歳,男性。下血を契機に直腸癌と診断され,括約筋間直腸切除術+両側側方郭清術が施行された。病理診断は中分化型管状腺癌,KRAS野生型,pT2N0M0,pStageⅠであった。その後局所再発を認め,CapeOX[capecitabine+oxaliplatin(L-OHP)]+bevacizumab療法が導入され部分奏効(partial response: PR)であったが,手足症候群のため6コースで中止した。経過観察中に同再発部位の増大を認めたため,FOLFIRI+cetuximab療法が開始されたが十分な腫瘍縮小効果が得られず,局所コントロール目的に腹会陰式直腸切断術が施行された。しかし,術後経過観察中に骨盤内再発に起因する左側水腎症を来した。L-OHPの耐性は確認されていなかったため,L-OHPの効果を期待して尿管ステント留置後にmFOLFOX6+bevacizumab療法を導入した。3コース目のL-OHP投与開始直後にGrade 2のアレルギー(紅斑)が出現したため投与を中止したが,L-OHPの抗腫瘍効果を期待して4コース目から脱感作療法で治療を継続した。病勢進行(progression disease: PD)を認めるまでmFOLFOX6+bevacizumab療法を計27コース施行し,最良総合効果はPRであった。L-OHPの効果が期待できても,アレルギーのため中止を余儀なくされることがしばしばある。今回,L-OHPの脱感作療法が有用であった1例を経験したため報告する。
目次
The case involved a 44-year-old man who underwent intersphincteric resection and lateral lymph node dissection for rectal cancer. Pathological diagnosis revealed a well-differentiated adenocarcinoma comprising KRAS wild type, and pT2N0M0(pathological StageⅠ). CapeOX(capecitabine plus oxaliplatin[L-OHP]), and bevacizumab therapy was initiated because of local recurrence. Although a partial response(PR)was observed, the therapy was terminated after 6 courses because of the development of hand-foot syndrome. FOLFIRI and cetuximab therapy was initiated after cancer recurrence was observed during a follow up. As the therapeutic efficiency is characterized by stability(stable disease: SD), and the tumor reduction effect observed was not sufficient, we performed an abdominoperineal resection to achieve local control. However, a left hydronephrosis occurred due to the pelvic recurrence, necessitating the emergency hospitalization of the patient. Because resistance to L-OHP was not confirmed, mFOLFOX6 and bevacizumab therapy was introduced in hopes of the effect of the former. As Grade 2 allergy(erythema)appeared immediately after the L-OHP was administered during the 3 courses, treatment was discontinued. We the reinitiated the treatment along with the desensitization therapy from the 4 courses. A total of 27 courses of mFOLFOX6 and bevacizumab therapy were administered until the state of disease progression(progression disease: PD)was determined. PR was defined as the best therapeutic efficiency. In some cases, discontinuation of treatment is necessary as observed in the present case due to the onset of L-OHP allergies, even if the overall effect of the treatment is expected to be good. Our case is essential as it demonstrates the successfulness of desensitization therapy for L-OHP allergies.
要旨
症例は44歳,男性。下血を契機に直腸癌と診断され,括約筋間直腸切除術+両側側方郭清術が施行された。病理診断は中分化型管状腺癌,KRAS野生型,pT2N0M0,pStageⅠであった。その後局所再発を認め,CapeOX[capecitabine+oxaliplatin(L-OHP)]+bevacizumab療法が導入され部分奏効(partial response: PR)であったが,手足症候群のため6コースで中止した。経過観察中に同再発部位の増大を認めたため,FOLFIRI+cetuximab療法が開始されたが十分な腫瘍縮小効果が得られず,局所コントロール目的に腹会陰式直腸切断術が施行された。しかし,術後経過観察中に骨盤内再発に起因する左側水腎症を来した。L-OHPの耐性は確認されていなかったため,L-OHPの効果を期待して尿管ステント留置後にmFOLFOX6+bevacizumab療法を導入した。3コース目のL-OHP投与開始直後にGrade 2のアレルギー(紅斑)が出現したため投与を中止したが,L-OHPの抗腫瘍効果を期待して4コース目から脱感作療法で治療を継続した。病勢進行(progression disease: PD)を認めるまでmFOLFOX6+bevacizumab療法を計27コース施行し,最良総合効果はPRであった。L-OHPの効果が期待できても,アレルギーのため中止を余儀なくされることがしばしばある。今回,L-OHPの脱感作療法が有用であった1例を経験したため報告する。