内容紹介
A Case of Lung Cancer in an Elderly Patient with Malignant Pleural Effusion and Pneumothorax Treated with Carboplatin, Pemetrexed, and Bevacizumab
Summary
We report a case of an elderly patient with non-squamous non-small cell lung cancer who was successfully treated with chemotherapy using carboplatin(CBDCA), pemetrexed(PEM), and bevacizumab(Bev). The patient was an 84-year-old man who presented with a chief complaint of dyspnea. The right lung was completely collapsed due to malignant pleural effusion, and the mediastinum was shifted to the left. Right thoracic drainage was performed, but this was complicated by pneumothorax and a thoracotomy was performed. An absorbent tissue reinforcing agent was attached to the site of the air leakage and fibrin glue was applied. After discharge, the patient was administered 500 mg/m2 PEM plus 15 mg/kg Bev for the first course of chemotherapy and experienced no serious side effects. CBDCA(area under the curve[AUC]4)was added from the second course. After the administration of seven courses, pleural effusion had almost disappeared and the primary tumor in the upper right lobe was observed to have shrunk. Administration of PEM+Bev was continued thereafter. The right pleural effusion was well controlled for up to 12 months(14 courses)from the start of the administration of chemotherapy, and shrinkage of the primary tumor was maintained. The side effects were mild and chemotherapy was administered safely. After the administration of 16 courses, a left malignant pleural effusion was observed, and the patient died 15 months after the initiation of chemotherapy.
要旨
超高齢者非小細胞非扁平上皮肺癌症例に対し,カルボプラチン(CBDCA),ペメトレキセド(PEM),ベバシズマブ(Bev)による化学療法が奏効した症例を経験したので報告する。症例は84歳,男性。主訴は呼吸困難,受診時右癌性胸水のため右肺は完全虚脱,縦隔は左方に偏位していた。右胸腔ドレナージ後気胸を合併し,開胸下,気瘻部に吸収性組織補強剤を貼付しフィブリン糊を塗布した。退院後外来にて1コース目はPEM 500 mg/m2+Bev 15 mg/kgを投与した。重篤な副作用を認めず,2コース目からCBDCA AUC4を追加した。7コース施行後胸水はほぼ消失し,右上葉原発巣は縮小した。その後PEM+Bevの投与を継続した。投与開始から12か月目(全14コース施行)まで右胸水は良好にコントロールされ,右上葉原発巣は縮小が維持されていた。化学療法による副作用は軽度で安全に施行可能であった。16コース施行後左癌性胸水を認め,化学療法開始後15か月目に永眠された。
目次
Summary
We report a case of an elderly patient with non-squamous non-small cell lung cancer who was successfully treated with chemotherapy using carboplatin(CBDCA), pemetrexed(PEM), and bevacizumab(Bev). The patient was an 84-year-old man who presented with a chief complaint of dyspnea. The right lung was completely collapsed due to malignant pleural effusion, and the mediastinum was shifted to the left. Right thoracic drainage was performed, but this was complicated by pneumothorax and a thoracotomy was performed. An absorbent tissue reinforcing agent was attached to the site of the air leakage and fibrin glue was applied. After discharge, the patient was administered 500 mg/m2 PEM plus 15 mg/kg Bev for the first course of chemotherapy and experienced no serious side effects. CBDCA(area under the curve[AUC]4)was added from the second course. After the administration of seven courses, pleural effusion had almost disappeared and the primary tumor in the upper right lobe was observed to have shrunk. Administration of PEM+Bev was continued thereafter. The right pleural effusion was well controlled for up to 12 months(14 courses)from the start of the administration of chemotherapy, and shrinkage of the primary tumor was maintained. The side effects were mild and chemotherapy was administered safely. After the administration of 16 courses, a left malignant pleural effusion was observed, and the patient died 15 months after the initiation of chemotherapy.
要旨
超高齢者非小細胞非扁平上皮肺癌症例に対し,カルボプラチン(CBDCA),ペメトレキセド(PEM),ベバシズマブ(Bev)による化学療法が奏効した症例を経験したので報告する。症例は84歳,男性。主訴は呼吸困難,受診時右癌性胸水のため右肺は完全虚脱,縦隔は左方に偏位していた。右胸腔ドレナージ後気胸を合併し,開胸下,気瘻部に吸収性組織補強剤を貼付しフィブリン糊を塗布した。退院後外来にて1コース目はPEM 500 mg/m2+Bev 15 mg/kgを投与した。重篤な副作用を認めず,2コース目からCBDCA AUC4を追加した。7コース施行後胸水はほぼ消失し,右上葉原発巣は縮小した。その後PEM+Bevの投与を継続した。投与開始から12か月目(全14コース施行)まで右胸水は良好にコントロールされ,右上葉原発巣は縮小が維持されていた。化学療法による副作用は軽度で安全に施行可能であった。16コース施行後左癌性胸水を認め,化学療法開始後15か月目に永眠された。