内容紹介
Summary
Treatment containing FOLFIRINOX was planned to be administered to a 51-year-old man with locally advanced pancreatic cancer as second-line chemotherapy and to a 66-year-old woman with recurrent pancreatic cancer as third-line chemotherapy in their treatments. Since both patients were revealed to harbor UGT1A1 polymorphisms, which were highly associated with irinotecan-induced toxicity(the former: UGT1A1*6/*28, the latter: UGT1A1*6/*6), there was no alternative hopeful treatment other than FOLFIRINOX for them. Therefore, FOLFIRINOX was administered very carefully. Although both patients showed Grade 4 neutropenia during the initial course, it was controllable with G-CSF administration and following stepwise reduction of the irinotecan dose. Severe diarrhea and other adverse events were not observed in both cases. Since the determined regimen of FOLFIRINOX for patients with high-risk UGT1A1 polymorphisms has not been developed yet, it would be critical to accumulate and review an experience of FOLFIRINOX administration for these patients.
要旨
症例は51歳,男性および66歳,女性。それぞれ治癒切除不能な局所進行膵癌と再発膵癌に対し,二次治療および三次治療としてFOLFIRINOX療法が計画された。irinotecan(CPT-11)に対する有害事象の高リスクUGT1A1遺伝子多型とされるUGT1A1*6/*28ダブルヘテロ接合体およびUGT1A1*6/*6ホモ接合体を有していたが,他に有望な治療選択肢もなかったこともあり,強い患者希望の下,FOLFIRINOX療法を開始した。有害事象の程度に応じCPT-11の段階的減量と投与間隔の調節により両者とも安全に7コースの継続実施が可能であった。投与初期のGrade 4の好中球減少に対してはG-CSFにて対処可能であり,制御困難な下痢やその他の有害事象は認めなかった。FOLFIRINOX療法は予後の改善が期待できる新規治療であるため,高リスクUGT1A1遺伝子多型をもつ症例に対しても症例を蓄積し安全な投与方法を確立させることが重要である。
目次
Treatment containing FOLFIRINOX was planned to be administered to a 51-year-old man with locally advanced pancreatic cancer as second-line chemotherapy and to a 66-year-old woman with recurrent pancreatic cancer as third-line chemotherapy in their treatments. Since both patients were revealed to harbor UGT1A1 polymorphisms, which were highly associated with irinotecan-induced toxicity(the former: UGT1A1*6/*28, the latter: UGT1A1*6/*6), there was no alternative hopeful treatment other than FOLFIRINOX for them. Therefore, FOLFIRINOX was administered very carefully. Although both patients showed Grade 4 neutropenia during the initial course, it was controllable with G-CSF administration and following stepwise reduction of the irinotecan dose. Severe diarrhea and other adverse events were not observed in both cases. Since the determined regimen of FOLFIRINOX for patients with high-risk UGT1A1 polymorphisms has not been developed yet, it would be critical to accumulate and review an experience of FOLFIRINOX administration for these patients.
要旨
症例は51歳,男性および66歳,女性。それぞれ治癒切除不能な局所進行膵癌と再発膵癌に対し,二次治療および三次治療としてFOLFIRINOX療法が計画された。irinotecan(CPT-11)に対する有害事象の高リスクUGT1A1遺伝子多型とされるUGT1A1*6/*28ダブルヘテロ接合体およびUGT1A1*6/*6ホモ接合体を有していたが,他に有望な治療選択肢もなかったこともあり,強い患者希望の下,FOLFIRINOX療法を開始した。有害事象の程度に応じCPT-11の段階的減量と投与間隔の調節により両者とも安全に7コースの継続実施が可能であった。投与初期のGrade 4の好中球減少に対してはG-CSFにて対処可能であり,制御困難な下痢やその他の有害事象は認めなかった。FOLFIRINOX療法は予後の改善が期待できる新規治療であるため,高リスクUGT1A1遺伝子多型をもつ症例に対しても症例を蓄積し安全な投与方法を確立させることが重要である。