内容紹介
Summary
A 78-year-old man who developed metastatic liver and lung cancer after undergoing surgery for rectal and sigmoid colon cancer was treated with TAS-102 as fourth-line chemotherapy. He developed high fever and dyspnea and was referred to the emergency room 16 days after receiving the first course of TAS-102. Chest X-ray and computed tomography examinations showed bacterial pneumonia. He was treated with tazobactam/piperacillin, but developed severe dyspnea 4 days later. A diffuse ground-glass appearance was observed in both the lungs on chest X-ray examination, and drug-induced interstitial pneumonitis was suspected. Oxygenation and respiratory support were immediately administered, and steroid pulse therapy with methylprednisolone at 1,000 mg/day was initiated. His symptoms and radiographic findings dramatically improved. The TAS102-J003 trial, a double-blind phase 2 trial, showed that interstitial pneumonitis occurs at a rate of only 0.9%, but can lead to severe complications, as observed in the present case. The possibility of interstitial pneumonitis should always be considered when a patient develops a fever and respiratory disorder during treatment containing TAS-102.
要旨
症例は78歳,男性。下部直腸癌・S状結腸癌術後の肝・肺転移に対し化学療法を継続しており,四次治療としてTAS-102を導入した。1コースday 16に39℃の発熱と呼吸困難を主訴に救急搬送され,胸部X線とCT検査で肺炎と診断した。tazobactam/piperacillinの投与を開始したが,day 20に急激な呼吸状態の悪化を来した。再度臨床経過と胸部CT所見を検討し,間質性肺炎と診断した。methylprednisolone 1,000 mg/dayのステロイドパルス療法とBiPAPによる呼吸補助療法を行ったところ,症状・胸部X線所見ともに改善した。国内臨床試験(TAS102-J003試験)での間質性肺炎の頻度は0.9%と低いが,本症例のように急激な経過をたどることもあり,注意が必要な有害事象である。発熱・呼吸困難から間質性肺炎を疑うことが重要で,TAS-102使用時には常に念頭に置く必要がある。
目次
A 78-year-old man who developed metastatic liver and lung cancer after undergoing surgery for rectal and sigmoid colon cancer was treated with TAS-102 as fourth-line chemotherapy. He developed high fever and dyspnea and was referred to the emergency room 16 days after receiving the first course of TAS-102. Chest X-ray and computed tomography examinations showed bacterial pneumonia. He was treated with tazobactam/piperacillin, but developed severe dyspnea 4 days later. A diffuse ground-glass appearance was observed in both the lungs on chest X-ray examination, and drug-induced interstitial pneumonitis was suspected. Oxygenation and respiratory support were immediately administered, and steroid pulse therapy with methylprednisolone at 1,000 mg/day was initiated. His symptoms and radiographic findings dramatically improved. The TAS102-J003 trial, a double-blind phase 2 trial, showed that interstitial pneumonitis occurs at a rate of only 0.9%, but can lead to severe complications, as observed in the present case. The possibility of interstitial pneumonitis should always be considered when a patient develops a fever and respiratory disorder during treatment containing TAS-102.
要旨
症例は78歳,男性。下部直腸癌・S状結腸癌術後の肝・肺転移に対し化学療法を継続しており,四次治療としてTAS-102を導入した。1コースday 16に39℃の発熱と呼吸困難を主訴に救急搬送され,胸部X線とCT検査で肺炎と診断した。tazobactam/piperacillinの投与を開始したが,day 20に急激な呼吸状態の悪化を来した。再度臨床経過と胸部CT所見を検討し,間質性肺炎と診断した。methylprednisolone 1,000 mg/dayのステロイドパルス療法とBiPAPによる呼吸補助療法を行ったところ,症状・胸部X線所見ともに改善した。国内臨床試験(TAS102-J003試験)での間質性肺炎の頻度は0.9%と低いが,本症例のように急激な経過をたどることもあり,注意が必要な有害事象である。発熱・呼吸困難から間質性肺炎を疑うことが重要で,TAS-102使用時には常に念頭に置く必要がある。