内容紹介
Summary
With the standpoint of refining the chemotherapy regimen, we retrospectively reviewed adverse events encountered by the initial 10 cases during the first course of docetaxel plus ramucirumab for non-small-cell lung cancer that progressed after platinum-based chemotherapy. Febrile neutropenia(FN)was observed in 40% of cases, and a half of all patients experienced oral mucositis, including 2 Grade 3 cases. These results were concordant with a previous randomized phaseⅡ study on Japanese patients. We amended the treatment regimen by adding the prophylactic use of pegfilgrastim. Post-amendment, FN was not observed in all 10 cases. However, the frequency and severity of chemotherapy-induced oral mucositis were not affected; Therefore, some patients discontinued treatment due to this toxicity as well as diarrhea. In conclusion, prophylactic granulocyte-colony stimulating factor is considered effective for reducing the risk of FN. Further intervention by an oral care team is required to validate our findings.
要旨
レジメン管理の見地から,ドセタキセル+ラムシルマブ併用療法(DocRam)の初期適用10例における1コース目の毒性を調査した結果,40%に発熱性好中球減少症(FN)の発現がみられ,口腔粘膜炎も高頻度であった。日本人を対象とした既報でも同様な傾向がみられたことから,DocRamの支持療法にpegfilgrastimの予防的投与を組み込むレジメンに改訂した。改訂後の10例においてはFNの発現はなく,granulocyte-colony stimulating factor(G-CSF)の予防的投与はFNリスクの低減に有用と考えられた。一方,口腔粘膜炎は依然高頻度で下痢とともに治療中止の原因となっており,今後は口腔ケアチームの介入が必要と思われる。
目次
With the standpoint of refining the chemotherapy regimen, we retrospectively reviewed adverse events encountered by the initial 10 cases during the first course of docetaxel plus ramucirumab for non-small-cell lung cancer that progressed after platinum-based chemotherapy. Febrile neutropenia(FN)was observed in 40% of cases, and a half of all patients experienced oral mucositis, including 2 Grade 3 cases. These results were concordant with a previous randomized phaseⅡ study on Japanese patients. We amended the treatment regimen by adding the prophylactic use of pegfilgrastim. Post-amendment, FN was not observed in all 10 cases. However, the frequency and severity of chemotherapy-induced oral mucositis were not affected; Therefore, some patients discontinued treatment due to this toxicity as well as diarrhea. In conclusion, prophylactic granulocyte-colony stimulating factor is considered effective for reducing the risk of FN. Further intervention by an oral care team is required to validate our findings.
要旨
レジメン管理の見地から,ドセタキセル+ラムシルマブ併用療法(DocRam)の初期適用10例における1コース目の毒性を調査した結果,40%に発熱性好中球減少症(FN)の発現がみられ,口腔粘膜炎も高頻度であった。日本人を対象とした既報でも同様な傾向がみられたことから,DocRamの支持療法にpegfilgrastimの予防的投与を組み込むレジメンに改訂した。改訂後の10例においてはFNの発現はなく,granulocyte-colony stimulating factor(G-CSF)の予防的投与はFNリスクの低減に有用と考えられた。一方,口腔粘膜炎は依然高頻度で下痢とともに治療中止の原因となっており,今後は口腔ケアチームの介入が必要と思われる。