内容紹介
Summary
Nanoparticle albumin-bound paclitaxel(nab-PTX)is effective as second-line chemotherapy for advanced gastric cancer. Long-term administration is generally impossible because of peripheral sensory neuropathy. However, we report 2 cases that were treated with>35 cycles of nab-PTX with dose reduction to control disease progression, which appears to be the highest number cycles so far reported. Case 1 was a male patient in his 70s, with distant lymph node metastases and an advanced primary lesion(tub2). He received 6 cycles S-1/CDDP and achieved a partial response; however, the treatment was changed to second-line chemotherapy with nab-PTX because of adverse effects; the dose of nab-PTX was reduced by 60% every 3 weeks. At the time of writing, 36 cycles have been administered and disease control has been maintained, with Grade 2 peripheral sensory neuropathy. Case 2 was another male patient in his 70s, who underwent total gastrectomy for gastric cancer(mucinous adenocarcinoma). Virchow metastasis was detected 6 months after surgery. He received 1 cycle S-1/CDDP and achieved a partial response; however, treatment was changed to second-line chemotherapy with nab-PTX because of adverse effects; the dose of nab-PTX was reduced by 60% every 3 weeks. At the time of writing, 41 cycles have been administered and disease control has been maintained, with Grade 2 peripheral sensory neuropathy.
要旨
進行再発胃癌に対するnanoparticle albumin-bound paclitaxel(nab-PTX)の3週毎投与は二次治療以後に有用とされていたが,感覚性末梢神経障害の有害事象のため,長期投与は困難である症例が多かった。今回われわれは,進行再発胃癌の二次治療としてnab-PTXを3週毎で1回投与を60%で減量投与したところ,長期にわたって病勢を制御しながら35 cycles以上施行し得た2例を経験した。検索し得た限り,症例2は本邦では最長の投与例と思われる。症例1: 70歳台,男性。門脈腫瘍栓と遠隔リンパ節転移を伴う根治手術不能胃癌(組織生検,tub2)に対しS-1/CDDP療法を6 cycles施行した。奏効したが,食欲不振など有害事象で中止した。以後nab-PTXを上記の減量投与で施行した。36 cyclesをGrade 2の感覚性末梢神経障害のみで施行し得た。その後胃の主病巣が進行して出血したため胃全摘を施行し,手術より2年を経過している。症例2: 70歳台,男性。進行胃癌に対し胃全摘後,Virchowリンパ節と傍大動脈リンパ節再発を来した症例に対し,S-1/CDDP療法を施行した。 しかし1 cycleの途中で発熱性好中球減少を来し,以後症例1と同様な方法でnab-PTXを投与した。41 cycles療法を施行し現在は化学療法を中断しているが,病勢は制御されている。有害事象はGrade 2の感覚性末梢神経障害であった。
目次
Nanoparticle albumin-bound paclitaxel(nab-PTX)is effective as second-line chemotherapy for advanced gastric cancer. Long-term administration is generally impossible because of peripheral sensory neuropathy. However, we report 2 cases that were treated with>35 cycles of nab-PTX with dose reduction to control disease progression, which appears to be the highest number cycles so far reported. Case 1 was a male patient in his 70s, with distant lymph node metastases and an advanced primary lesion(tub2). He received 6 cycles S-1/CDDP and achieved a partial response; however, the treatment was changed to second-line chemotherapy with nab-PTX because of adverse effects; the dose of nab-PTX was reduced by 60% every 3 weeks. At the time of writing, 36 cycles have been administered and disease control has been maintained, with Grade 2 peripheral sensory neuropathy. Case 2 was another male patient in his 70s, who underwent total gastrectomy for gastric cancer(mucinous adenocarcinoma). Virchow metastasis was detected 6 months after surgery. He received 1 cycle S-1/CDDP and achieved a partial response; however, treatment was changed to second-line chemotherapy with nab-PTX because of adverse effects; the dose of nab-PTX was reduced by 60% every 3 weeks. At the time of writing, 41 cycles have been administered and disease control has been maintained, with Grade 2 peripheral sensory neuropathy.
要旨
進行再発胃癌に対するnanoparticle albumin-bound paclitaxel(nab-PTX)の3週毎投与は二次治療以後に有用とされていたが,感覚性末梢神経障害の有害事象のため,長期投与は困難である症例が多かった。今回われわれは,進行再発胃癌の二次治療としてnab-PTXを3週毎で1回投与を60%で減量投与したところ,長期にわたって病勢を制御しながら35 cycles以上施行し得た2例を経験した。検索し得た限り,症例2は本邦では最長の投与例と思われる。症例1: 70歳台,男性。門脈腫瘍栓と遠隔リンパ節転移を伴う根治手術不能胃癌(組織生検,tub2)に対しS-1/CDDP療法を6 cycles施行した。奏効したが,食欲不振など有害事象で中止した。以後nab-PTXを上記の減量投与で施行した。36 cyclesをGrade 2の感覚性末梢神経障害のみで施行し得た。その後胃の主病巣が進行して出血したため胃全摘を施行し,手術より2年を経過している。症例2: 70歳台,男性。進行胃癌に対し胃全摘後,Virchowリンパ節と傍大動脈リンパ節再発を来した症例に対し,S-1/CDDP療法を施行した。 しかし1 cycleの途中で発熱性好中球減少を来し,以後症例1と同様な方法でnab-PTXを投与した。41 cycles療法を施行し現在は化学療法を中断しているが,病勢は制御されている。有害事象はGrade 2の感覚性末梢神経障害であった。