内容紹介
Summary
The present study reports the case of a 45-year-old pre-menopausal woman treated with 6 courses of TAC chemotherapy by the pegfilgrastim for preoperative chemotherapy. The patient visited our hospital in February 2010 with the chief complaint of a mass in the right breast. A 40 mm tumor in the outer lower area of the right breast and the axillary lymph nodes was palpable. Pathological findings revealed scirrhous carcinoma with an ER(+), PgR(+), HER2(1+), and Ki-67 80% profile. Pre-operatively, the patient underwent 6 courses of triweekly TAC(docetaxel[75 mg/m2], adriamycin[50 mg/m2], cyclophosphamide[500 mg/m2])chemotherapy. Pegfilgrastim(3.6 mg)was subcutaneously injected on the next day of each course. The side effect of 6 courses of TAC was stomatitis and low back pain(Grade 2). Relative dose intensity(RDI)was not reduced and there was no occurrence of febrile neutropenia(FN). Partial resection of the tumor was facilitated. Pathologically viable tumor cells still lay scattered in the range of 45 mm, and a ductal carcinoma in situ was seen. However, metastasis to axillary lymph nodes was not observed. Radiation therapy(50 Gy)was performed on the residual breast. There was no recurrence, and now she survival free with tamoxifen(20 mg/day)of 8 years four months after operation. TAC with pegfilgrastim therapy could be an effective pre-operative chemotherapy regimen in breast cancer.
要旨 症例は45歳,閉経前女性。主訴は右乳房腫瘤。現病歴として2010年2月右乳房腫瘤に気付き当院を受診した。右乳房外下領域に40 mmの腫瘍が触れ,腋窩リンパ節も触れた。腫瘍は浸潤性乳管癌(硬癌)でプロファイルはER(+),PgR(+),HER2(1+),Ki-67 80%であった。術前化学療法としてTAC療法[docetaxel(75 mg/m2),adriamycin(50 mg/m2),cyclophosphamide(500 mg/m2)]を3週毎6コース行った。各コースの投与翌日にpegfilgrastim(3.6 mg)を皮下注した。TAC 6コースで減量,休薬なく副作用は口内炎と腰痛(Grade 2)のみで発熱性好中球減少症(FN)は生じなかった。手術は部分切除が可能となった。病理学的にはviableな腫瘍が45 mmの範囲に散在し,非浸潤癌の成分も認めたが腋窩リンパ節には転移を認めなかった。術後残存乳房に放射線治療50 Gyを行った。tamoxifen(20 mg)1T/日の内服を行い術後8年の現在,無再発生存中である。乳癌術前化学療法にpegfilgrastim併用TAC療法が有効である可能性が示された。
目次
The present study reports the case of a 45-year-old pre-menopausal woman treated with 6 courses of TAC chemotherapy by the pegfilgrastim for preoperative chemotherapy. The patient visited our hospital in February 2010 with the chief complaint of a mass in the right breast. A 40 mm tumor in the outer lower area of the right breast and the axillary lymph nodes was palpable. Pathological findings revealed scirrhous carcinoma with an ER(+), PgR(+), HER2(1+), and Ki-67 80% profile. Pre-operatively, the patient underwent 6 courses of triweekly TAC(docetaxel[75 mg/m2], adriamycin[50 mg/m2], cyclophosphamide[500 mg/m2])chemotherapy. Pegfilgrastim(3.6 mg)was subcutaneously injected on the next day of each course. The side effect of 6 courses of TAC was stomatitis and low back pain(Grade 2). Relative dose intensity(RDI)was not reduced and there was no occurrence of febrile neutropenia(FN). Partial resection of the tumor was facilitated. Pathologically viable tumor cells still lay scattered in the range of 45 mm, and a ductal carcinoma in situ was seen. However, metastasis to axillary lymph nodes was not observed. Radiation therapy(50 Gy)was performed on the residual breast. There was no recurrence, and now she survival free with tamoxifen(20 mg/day)of 8 years four months after operation. TAC with pegfilgrastim therapy could be an effective pre-operative chemotherapy regimen in breast cancer.
要旨 症例は45歳,閉経前女性。主訴は右乳房腫瘤。現病歴として2010年2月右乳房腫瘤に気付き当院を受診した。右乳房外下領域に40 mmの腫瘍が触れ,腋窩リンパ節も触れた。腫瘍は浸潤性乳管癌(硬癌)でプロファイルはER(+),PgR(+),HER2(1+),Ki-67 80%であった。術前化学療法としてTAC療法[docetaxel(75 mg/m2),adriamycin(50 mg/m2),cyclophosphamide(500 mg/m2)]を3週毎6コース行った。各コースの投与翌日にpegfilgrastim(3.6 mg)を皮下注した。TAC 6コースで減量,休薬なく副作用は口内炎と腰痛(Grade 2)のみで発熱性好中球減少症(FN)は生じなかった。手術は部分切除が可能となった。病理学的にはviableな腫瘍が45 mmの範囲に散在し,非浸潤癌の成分も認めたが腋窩リンパ節には転移を認めなかった。術後残存乳房に放射線治療50 Gyを行った。tamoxifen(20 mg)1T/日の内服を行い術後8年の現在,無再発生存中である。乳癌術前化学療法にpegfilgrastim併用TAC療法が有効である可能性が示された。