内容紹介
Summary
We retrospectively analyzed adverse effects(AEs), overall survival(OS), and progression-free survival(PFS)in 15 consecutive patients treated with FOLFIRINOX as the first-line treatment for recurrent or unresectable pancreatic ductal adenocarcinoma(PDAC)between February 2014 and December 2017 in our hospital. Eleven patients were treated for unresectable PDAC with distant metastases(UR-M), and 4 were treated for locally advanced unresectable PDAC(UR-LA). The median age was 56(range: 40-75)years. Nine patients were male, and 6 were female. The performance status was 0 or 1 in all patients. Tumors were located in the pancreas head in 8 cases and in the body-tail in 7 cases. Grade 5 AEs were observed in 1 case in which liver abscess causing sepsis resulted in mortality. The response rate was 20.0%, and the disease control rate was 66.7%. Two patients underwent conversion surgery after FOLFIRINOX treatment. Seven patients received a nab-paclitaxel plus gemcitabine regimen as second-line treatment. The median OS and PFS were 17.0 and 8.4 months, respectively, and the 1-year survival rate was 66.7%. FOLFIRINOX for recurrent and unresectable PDAC showed relatively good tumor control. However, strict attention is required for severe AEs. Conversion surgery might be effective in patients who are good responders even if they have metastatic disease.
要旨
当院における再発・切除不能膵癌に対する一次治療としてFOLFIRINOX療法の治療成績を検討した。2014年2月～2017年12月までに当院で一次化学療法としてFOLFIRINOX療法を行った再発・切除不能膵癌患者15例を対象とし,有害事象と有効性を検討した。対象の内訳は,遠隔転移を有する切除不能(UR-M)膵癌11例,局所進行切除不能(UR-LA)膵癌が4例であった。年齢の中央値は56(40～75)歳,男性9例,女性6例であり,原発巣の局在は頭部8例,体尾部が7例であった。Grade 5の有害事象を1例に認め,肝膿瘍からの敗血症が原因であった。治療効果は,奏効率20.0%,病勢制御率は66.7%であった。2例でFOLFIRINOX療法後にconversion surgeryを行った。7例で二次治療としてゲムシタビン塩酸塩+ナブパクリタキセル併用療法(GnP療法)を選択していた。治療開始後の全生存期間(OS)・無増悪生存期間(PFS)の中央値はそれぞれ17.0か月・8.4か月であり,1年生存率は66.7%であった。再発・切除不能膵癌に対するFOLFIRINOX療法の成績は良好であったが,重篤な副作用に注意が必要である。UR-M症例でも奏効例では切除により比較的長期の無増悪生存が得られており,今後さらなる検討が必要と考えられた。
目次
We retrospectively analyzed adverse effects(AEs), overall survival(OS), and progression-free survival(PFS)in 15 consecutive patients treated with FOLFIRINOX as the first-line treatment for recurrent or unresectable pancreatic ductal adenocarcinoma(PDAC)between February 2014 and December 2017 in our hospital. Eleven patients were treated for unresectable PDAC with distant metastases(UR-M), and 4 were treated for locally advanced unresectable PDAC(UR-LA). The median age was 56(range: 40-75)years. Nine patients were male, and 6 were female. The performance status was 0 or 1 in all patients. Tumors were located in the pancreas head in 8 cases and in the body-tail in 7 cases. Grade 5 AEs were observed in 1 case in which liver abscess causing sepsis resulted in mortality. The response rate was 20.0%, and the disease control rate was 66.7%. Two patients underwent conversion surgery after FOLFIRINOX treatment. Seven patients received a nab-paclitaxel plus gemcitabine regimen as second-line treatment. The median OS and PFS were 17.0 and 8.4 months, respectively, and the 1-year survival rate was 66.7%. FOLFIRINOX for recurrent and unresectable PDAC showed relatively good tumor control. However, strict attention is required for severe AEs. Conversion surgery might be effective in patients who are good responders even if they have metastatic disease.
要旨
当院における再発・切除不能膵癌に対する一次治療としてFOLFIRINOX療法の治療成績を検討した。2014年2月～2017年12月までに当院で一次化学療法としてFOLFIRINOX療法を行った再発・切除不能膵癌患者15例を対象とし,有害事象と有効性を検討した。対象の内訳は,遠隔転移を有する切除不能(UR-M)膵癌11例,局所進行切除不能(UR-LA)膵癌が4例であった。年齢の中央値は56(40～75)歳,男性9例,女性6例であり,原発巣の局在は頭部8例,体尾部が7例であった。Grade 5の有害事象を1例に認め,肝膿瘍からの敗血症が原因であった。治療効果は,奏効率20.0%,病勢制御率は66.7%であった。2例でFOLFIRINOX療法後にconversion surgeryを行った。7例で二次治療としてゲムシタビン塩酸塩+ナブパクリタキセル併用療法(GnP療法)を選択していた。治療開始後の全生存期間(OS)・無増悪生存期間(PFS)の中央値はそれぞれ17.0か月・8.4か月であり,1年生存率は66.7%であった。再発・切除不能膵癌に対するFOLFIRINOX療法の成績は良好であったが,重篤な副作用に注意が必要である。UR-M症例でも奏効例では切除により比較的長期の無増悪生存が得られており,今後さらなる検討が必要と考えられた。