内容紹介
Summary
Tacrolimus is a calcineurin inhibitor that has been used to prevent allograft rejection after organ transplantation. We report the case of a living-donor liver transplant recipient with breast cancer who received adjuvant chemotherapy at an appropriate relative dose intensity in spite of a decrease in the trough blood concentration of tacrolimus. The patient was a woman in her 50s who had undergone living-donor liver transplantation because of primary biliary cirrhosis and received maintenance therapy consisting of tacrolimus. She was diagnosed as having locally advanced breast cancer(ER and HER2 positive). After surgery, we administered 4 courses of EC followed by weekly administration of paclitaxel plus trastuzumab. During chemotherapy, although the trough blood concentration of tacrolimus was slightly decreased, neither severe adverse event nor allograft rejection was observed. Recently, organ transplantation outcomes have significantly improved as a result of the progress of immunosuppressive agents. However, the development of malignancies after transplantation is a serious problem.
要旨
症例は50歳台,女性。生体肝移植後,タクロリムス(Tac)内服中に原発性乳癌(ホルモン受容体陽性,HER2陽性)を発症した。術後補助化学療法としてTac血中濃度モニタリング下にEC療法および毎週パクリタキセル+トラスツズマブ療法の逐次治療を行った。化学療法の影響によるTacの血中濃度変動が懸念されたが,その変動は軽度であった。拒絶反応などの臨床症状の発現は認めず,乳癌化学療法は治療強度を損なうことなく安全に行うことができた。近年,臓器移植後の長期生存例が増加する一方,移植後に高頻度で悪性腫瘍が発生することが注目されている。免疫抑制剤と化学療法の併用における安全性・有効性が課題である。
目次
Tacrolimus is a calcineurin inhibitor that has been used to prevent allograft rejection after organ transplantation. We report the case of a living-donor liver transplant recipient with breast cancer who received adjuvant chemotherapy at an appropriate relative dose intensity in spite of a decrease in the trough blood concentration of tacrolimus. The patient was a woman in her 50s who had undergone living-donor liver transplantation because of primary biliary cirrhosis and received maintenance therapy consisting of tacrolimus. She was diagnosed as having locally advanced breast cancer(ER and HER2 positive). After surgery, we administered 4 courses of EC followed by weekly administration of paclitaxel plus trastuzumab. During chemotherapy, although the trough blood concentration of tacrolimus was slightly decreased, neither severe adverse event nor allograft rejection was observed. Recently, organ transplantation outcomes have significantly improved as a result of the progress of immunosuppressive agents. However, the development of malignancies after transplantation is a serious problem.
要旨
症例は50歳台,女性。生体肝移植後,タクロリムス(Tac)内服中に原発性乳癌(ホルモン受容体陽性,HER2陽性)を発症した。術後補助化学療法としてTac血中濃度モニタリング下にEC療法および毎週パクリタキセル+トラスツズマブ療法の逐次治療を行った。化学療法の影響によるTacの血中濃度変動が懸念されたが,その変動は軽度であった。拒絶反応などの臨床症状の発現は認めず,乳癌化学療法は治療強度を損なうことなく安全に行うことができた。近年,臓器移植後の長期生存例が増加する一方,移植後に高頻度で悪性腫瘍が発生することが注目されている。免疫抑制剤と化学療法の併用における安全性・有効性が課題である。