内容紹介
Summary
We herein report a case of lung metastases from rectal cancer treated with FOLFIRI plus ramucirumab(Ram)therapy after salvage for a long time. A 44-year-old woman underwent low anterior resection for rectal cancer. Fifteen months after the surgery, mFOLFOX6 plus bevacizumab(BV)therapy was initiated for left obturator lymph node metastases. Although the target lesion shrunk, left lung metastasis was found 36 months after the surgery. Partial resection of the lung metastasis was performed, and carbon-ion radiotherapy for pelvic recurrence was administered. Following these treatments, mFOLFOX6 plus BV therapy was administered again for multiple lung metastases 42 months after the surgery. FOLFIRI plus BV therapy, TAS-102 plus BV therapy, and regorafenib were then administered because of the disease progression. Although the best supportive care was provided after disease progression, FOLFIRI plus Ram therapy was initiated owing to the patient's wish. Although Grade 3 hematological toxicity was observed, severe digestive symptoms were not noted. Long-term administration(approximately 1 year, 21 courses)of the drugs was possible with withdrawal. The patient died due to disease progression 66 months after recurrence. We experienced a case in which FOLFIRI plus Ram therapy after salvage line could be administered for a quite long time. It has been suggested that anti-VEGF drugs with different targets may improve the prognosis even as a late line of therapy if it is tolerable.
要旨
直腸癌肺転移に対し,サルベージライン終了後の終末期にFOLFIRI+ramucirumab(Ram)療法を導入し,長期施行可能であった症例を経験したので報告する。症例は44歳,女性。直腸癌術後15か月後,左閉鎖リンパ節転移で mFOLFOX6+bevacizumab(BV)療法を開始した。対象病変は縮小した(PR)が消失はしなかった。術後36か月に左肺転移(下葉S8 9 mm)が出現し,胸腔鏡下左肺部分切除術施行,左閉鎖リンパ節に対しては重粒子線治療(73.6 Gy)を施行した。しかし両側多発肺転移が出現したため,術後42か月よりmFOLFOX6+BV療法を再開した。その後FOLFIRI+BV,TAS-102+BV,regorafenibを施行するも再PDとなった。BSCも考慮されたが患者の強い希望もあり,術後64か月よりFOLFIRI+Ram療法を開始した。Grade 3の血液毒性は認めたが,強い消化器症状はなく休薬しながら長期投与(約1年,計21コース)が可能であった。最終的には肺転移の増悪により再発後66か月で原癌死した。サルベージライン後のFOLFIRI+Ram療法を比較的長期に施行可能であった症例を経験した。患者が許容可能であれば,ターゲットが異なる抗VEGF薬は後方治療でも予後改善する可能性が示唆された。
目次
We herein report a case of lung metastases from rectal cancer treated with FOLFIRI plus ramucirumab(Ram)therapy after salvage for a long time. A 44-year-old woman underwent low anterior resection for rectal cancer. Fifteen months after the surgery, mFOLFOX6 plus bevacizumab(BV)therapy was initiated for left obturator lymph node metastases. Although the target lesion shrunk, left lung metastasis was found 36 months after the surgery. Partial resection of the lung metastasis was performed, and carbon-ion radiotherapy for pelvic recurrence was administered. Following these treatments, mFOLFOX6 plus BV therapy was administered again for multiple lung metastases 42 months after the surgery. FOLFIRI plus BV therapy, TAS-102 plus BV therapy, and regorafenib were then administered because of the disease progression. Although the best supportive care was provided after disease progression, FOLFIRI plus Ram therapy was initiated owing to the patient's wish. Although Grade 3 hematological toxicity was observed, severe digestive symptoms were not noted. Long-term administration(approximately 1 year, 21 courses)of the drugs was possible with withdrawal. The patient died due to disease progression 66 months after recurrence. We experienced a case in which FOLFIRI plus Ram therapy after salvage line could be administered for a quite long time. It has been suggested that anti-VEGF drugs with different targets may improve the prognosis even as a late line of therapy if it is tolerable.
要旨
直腸癌肺転移に対し,サルベージライン終了後の終末期にFOLFIRI+ramucirumab(Ram)療法を導入し,長期施行可能であった症例を経験したので報告する。症例は44歳,女性。直腸癌術後15か月後,左閉鎖リンパ節転移で mFOLFOX6+bevacizumab(BV)療法を開始した。対象病変は縮小した(PR)が消失はしなかった。術後36か月に左肺転移(下葉S8 9 mm)が出現し,胸腔鏡下左肺部分切除術施行,左閉鎖リンパ節に対しては重粒子線治療(73.6 Gy)を施行した。しかし両側多発肺転移が出現したため,術後42か月よりmFOLFOX6+BV療法を再開した。その後FOLFIRI+BV,TAS-102+BV,regorafenibを施行するも再PDとなった。BSCも考慮されたが患者の強い希望もあり,術後64か月よりFOLFIRI+Ram療法を開始した。Grade 3の血液毒性は認めたが,強い消化器症状はなく休薬しながら長期投与(約1年,計21コース)が可能であった。最終的には肺転移の増悪により再発後66か月で原癌死した。サルベージライン後のFOLFIRI+Ram療法を比較的長期に施行可能であった症例を経験した。患者が許容可能であれば,ターゲットが異なる抗VEGF薬は後方治療でも予後改善する可能性が示唆された。