内容紹介
Summary
A 77-year-old woman was admitted to our hospital with complaints of lumbago. Based on MRI, bone marrow biopsy, and upper endoscopy, she was diagnosed as having advanced gastric cancer accompanied by bone marrow metastasis and multiple bone metastases. She underwent combination chemotherapy containing S-1 and docetaxel(TXT). However, during the first course of chemotherapy, she developed Grade 4 neutropenia and sepsis, and her ADL worsened. The anticancer agent doses were reduced drastically to 40% of the initial dose from the next course of chemotherapy. She was able to continue treatment without developing severe adverse events, and the disease did not progress for 11 months. However, during the 6 course of chemotherapy, she developed Grade 4 neutropenia and sepsis again, and it became difficult to continue treatment. Subsequent S-1 monotherapy was not efficacious, and she died 17 months after diagnosis. From the view of persistence and efficacy, we believe that low-dose combination chemotherapy containing S-1 and TXT may be a suitable regimen for advanced gastric cancer with bone marrow metastasis.
要旨
症例は77歳,女性。腰痛を主訴に来院し,骨髄転移を伴う進行胃癌と診断された。S-1+docetaxel(TXT)併用療法を開始したが,Grade 4の血液毒性と敗血症を併発しADLの低下を来した。このため2コース目からは40% doseと大幅な減量を行ったところ,大きな有害事象なく治療継続が可能で11か月間病勢の悪化を認めなかった。しかし6コース目で再度Grade 4の血液毒性と敗血症を併発し,治療の継続が困難となった。以降はS-1単独療法とするも奏効せず,診断から約1年5か月で死亡した。治療に対する忍容性と抗腫瘍効果の観点から,低用量S-1+TXT併用療法は胃癌骨髄転移に対する有効な選択肢の一つと考える。
目次
A 77-year-old woman was admitted to our hospital with complaints of lumbago. Based on MRI, bone marrow biopsy, and upper endoscopy, she was diagnosed as having advanced gastric cancer accompanied by bone marrow metastasis and multiple bone metastases. She underwent combination chemotherapy containing S-1 and docetaxel(TXT). However, during the first course of chemotherapy, she developed Grade 4 neutropenia and sepsis, and her ADL worsened. The anticancer agent doses were reduced drastically to 40% of the initial dose from the next course of chemotherapy. She was able to continue treatment without developing severe adverse events, and the disease did not progress for 11 months. However, during the 6 course of chemotherapy, she developed Grade 4 neutropenia and sepsis again, and it became difficult to continue treatment. Subsequent S-1 monotherapy was not efficacious, and she died 17 months after diagnosis. From the view of persistence and efficacy, we believe that low-dose combination chemotherapy containing S-1 and TXT may be a suitable regimen for advanced gastric cancer with bone marrow metastasis.
要旨
症例は77歳,女性。腰痛を主訴に来院し,骨髄転移を伴う進行胃癌と診断された。S-1+docetaxel(TXT)併用療法を開始したが,Grade 4の血液毒性と敗血症を併発しADLの低下を来した。このため2コース目からは40% doseと大幅な減量を行ったところ,大きな有害事象なく治療継続が可能で11か月間病勢の悪化を認めなかった。しかし6コース目で再度Grade 4の血液毒性と敗血症を併発し,治療の継続が困難となった。以降はS-1単独療法とするも奏効せず,診断から約1年5か月で死亡した。治療に対する忍容性と抗腫瘍効果の観点から,低用量S-1+TXT併用療法は胃癌骨髄転移に対する有効な選択肢の一つと考える。