内容紹介
Summary
The patient was a 69-year-old female diagnosed with cecum cancer, pMP, pN1, sH1, sP0, cM0, fStage Ⅳ. A laparoscopic cecal resection with D3 dissection was performed against the primary cecal cancer in January 2015. The histological diagnosis was moderately differentiated adenocarcinoma>mucinous adenocarcinoma, ly1, v0, RAS wild type(not known to start chemotherapy for primary treatment). Liver metastasis is very likely to invade the inferior vena cava, so the liver metastasis was judged unresectable, and mFOLFOX6 and bevacizumab(Bmab)chemotherapy was performed. After 4 courses of chemotherapy, the patient exhibited progressive disease(PD)and was transitioned to a secondary treatment with FOLFIRI plus panitumumab(Pmab)therapy. Lung metastases was observed(PD)upon computed tomography after 16 courses. Therefore, salvage line chemotherapy with TFTD and Bmab was performed. Long stable disease(SD)was obtained by the salvage line chemotherapy with TFTD and Bmab. We suspect that the effects of TFID increased in combination with Bmab. Moreover, the TFTD and Bmab chemotherapy was performed relatively safely.
要旨
症例は69歳,女性。盲腸癌,pMP,pN1,sH1,sP0,cM0,fStage Ⅳで,原発巣に対して2015年1月腹腔鏡下回盲部切除,D3郭清施行。病理組織診断は,moderately differentiated adenocarcinoma>mucinous adenocarcinoma,ly1,v0,RAS wild type(化学療法一次治療開始時には判明しておらず)であった。肝転移巣は下大静脈に浸潤している可能性が高く切除困難と診断して,肝転移巣に対しmFOLFOX6+bevacizumab(Bmab)療法を4コース施行し,効果判定はprogressive disease(PD)であった。このため二次治療へ移行し,FOLFIRI+panitumumab(Pmab)療法を開始した。16コース施行後のCTで新規病変として肺転移巣が出現し,PDの判断の下でsalvage lineへ移行した。TFTD+Bmab療法を施行しlong stable disease(SD)を得られた。TFTDは,Bmabの併用により有効性の増強が示唆された。また,比較的安全に施行できると考えられた。
目次
The patient was a 69-year-old female diagnosed with cecum cancer, pMP, pN1, sH1, sP0, cM0, fStage Ⅳ. A laparoscopic cecal resection with D3 dissection was performed against the primary cecal cancer in January 2015. The histological diagnosis was moderately differentiated adenocarcinoma>mucinous adenocarcinoma, ly1, v0, RAS wild type(not known to start chemotherapy for primary treatment). Liver metastasis is very likely to invade the inferior vena cava, so the liver metastasis was judged unresectable, and mFOLFOX6 and bevacizumab(Bmab)chemotherapy was performed. After 4 courses of chemotherapy, the patient exhibited progressive disease(PD)and was transitioned to a secondary treatment with FOLFIRI plus panitumumab(Pmab)therapy. Lung metastases was observed(PD)upon computed tomography after 16 courses. Therefore, salvage line chemotherapy with TFTD and Bmab was performed. Long stable disease(SD)was obtained by the salvage line chemotherapy with TFTD and Bmab. We suspect that the effects of TFID increased in combination with Bmab. Moreover, the TFTD and Bmab chemotherapy was performed relatively safely.
要旨
症例は69歳,女性。盲腸癌,pMP,pN1,sH1,sP0,cM0,fStage Ⅳで,原発巣に対して2015年1月腹腔鏡下回盲部切除,D3郭清施行。病理組織診断は,moderately differentiated adenocarcinoma>mucinous adenocarcinoma,ly1,v0,RAS wild type(化学療法一次治療開始時には判明しておらず)であった。肝転移巣は下大静脈に浸潤している可能性が高く切除困難と診断して,肝転移巣に対しmFOLFOX6+bevacizumab(Bmab)療法を4コース施行し,効果判定はprogressive disease(PD)であった。このため二次治療へ移行し,FOLFIRI+panitumumab(Pmab)療法を開始した。16コース施行後のCTで新規病変として肺転移巣が出現し,PDの判断の下でsalvage lineへ移行した。TFTD+Bmab療法を施行しlong stable disease(SD)を得られた。TFTDは,Bmabの併用により有効性の増強が示唆された。また,比較的安全に施行できると考えられた。