内容紹介
Summary
Herein, we report a case of unresectable lung cancer in which S-1 monotherapy contributed to an improvement in the patient's quality of life and to prolonged survival. A 44-year-old man with primary pulmonary adenocarcinoma(negative driver mutation and a PD-L1 tumor proportion score of 1-24%)of clinical stage ⅢA(cT4N0M0)underwent multidisciplinary treatment as follows: 1) weekly carboplatin and paclitaxel plus radiotherapy as induction chemoradiotherapy, 2) surgery that revealed that the lesion was unresectable, 3) cisplatin plus pemetrexed as second-line treatment, and 4) pembrolizumab as third-line treatment. However, the disease progressed after 19 courses of pembrolizumab, and the patient developed cachexia due to esophageal stenosis caused by tumor enlargement. He underwent percutaneous gastrostomy and was fed via a gastrostomy tube. S-1 monotherapy(2-week administration every 3 weeks)was introduced as fourth-line treatment. After 3 courses of S-1 monotherapy, the patient complained of regurgitation of stomach fluid. Computed tomography(CT)revealed that the primary tumor had decreased in size, and he developed the ability to drink water. After 6 courses of S-1, CT revealed progressive disease, so atezolizumab was administered as fifth-line treatment. However, after 2 courses, mediastinitis due to esophageal penetration into the mediastinum occurred. The patient died 28 months after the initial treatment.
要旨
切除不能局所進行原発性肺癌に対して多剤薬物治療耐性後にS-1単剤投与を行い,QOL改善および生存期間延長に有用であったため報告する。症例は44歳,男性。原発性肺腺癌(ドライバー遺伝子陰性,PD-L1発現1～24%),cT4(左房)N0M0,stage ⅢAに対して以下のような集学的治療を行った。① 導入放射線併用化学療法(同時照射およびweekly carboplatin+paclitaxelを5コース),② 手術施行したが切除不能,③ 二次薬物治療としてcisplatin+pemetrexedを4コース,④ 三次治療としてpembrolizumabを19コース行ったが,腫瘍増大による食道狭窄のため栄養状態不良となった。胃瘻造設し四次治療としてS-1単剤投与(2週投与1週休薬)を3コース行ったところ,腫瘍縮小と食道狭窄症状の改善を認め水分摂取可能となった。しかし6コース施行時点でPDとなり,五次治療としてatezolizumabを2コース行ったが,食道穿孔による縦隔炎を発症し,初回治療開始後2年4か月に死亡した。
目次
Herein, we report a case of unresectable lung cancer in which S-1 monotherapy contributed to an improvement in the patient's quality of life and to prolonged survival. A 44-year-old man with primary pulmonary adenocarcinoma(negative driver mutation and a PD-L1 tumor proportion score of 1-24%)of clinical stage ⅢA(cT4N0M0)underwent multidisciplinary treatment as follows: 1) weekly carboplatin and paclitaxel plus radiotherapy as induction chemoradiotherapy, 2) surgery that revealed that the lesion was unresectable, 3) cisplatin plus pemetrexed as second-line treatment, and 4) pembrolizumab as third-line treatment. However, the disease progressed after 19 courses of pembrolizumab, and the patient developed cachexia due to esophageal stenosis caused by tumor enlargement. He underwent percutaneous gastrostomy and was fed via a gastrostomy tube. S-1 monotherapy(2-week administration every 3 weeks)was introduced as fourth-line treatment. After 3 courses of S-1 monotherapy, the patient complained of regurgitation of stomach fluid. Computed tomography(CT)revealed that the primary tumor had decreased in size, and he developed the ability to drink water. After 6 courses of S-1, CT revealed progressive disease, so atezolizumab was administered as fifth-line treatment. However, after 2 courses, mediastinitis due to esophageal penetration into the mediastinum occurred. The patient died 28 months after the initial treatment.
要旨
切除不能局所進行原発性肺癌に対して多剤薬物治療耐性後にS-1単剤投与を行い,QOL改善および生存期間延長に有用であったため報告する。症例は44歳,男性。原発性肺腺癌(ドライバー遺伝子陰性,PD-L1発現1～24%),cT4(左房)N0M0,stage ⅢAに対して以下のような集学的治療を行った。① 導入放射線併用化学療法(同時照射およびweekly carboplatin+paclitaxelを5コース),② 手術施行したが切除不能,③ 二次薬物治療としてcisplatin+pemetrexedを4コース,④ 三次治療としてpembrolizumabを19コース行ったが,腫瘍増大による食道狭窄のため栄養状態不良となった。胃瘻造設し四次治療としてS-1単剤投与(2週投与1週休薬)を3コース行ったところ,腫瘍縮小と食道狭窄症状の改善を認め水分摂取可能となった。しかし6コース施行時点でPDとなり,五次治療としてatezolizumabを2コース行ったが,食道穿孔による縦隔炎を発症し,初回治療開始後2年4か月に死亡した。