内容紹介
A Case of Platinum-Resistant, Recurrent Ovarian Clear Cell Adenocarcinoma Successfully Treated with Irinotecan(CPT-11)and Paclitaxel(PTX)Chemotherapy
Summary
A 40-year-old woman presented to a local clinic with abdominal distension. She was referred to our hospital for suspected ovarian cancer. Computed tomography(CT)and magnetic resonance imaging(MRI)revealed an ovarian tumor with mural nodules, ascites, pleural effusion, and peritoneal dissemination. Laparotomy revealed a 20-cm right ovarian tumor with strong adhesion to the uterus and rectum. Bilateral salpingo-oophorectomy was performed as a primary surgery. The histopathological diagnosis was stage Ⅳ ovarian clear cell adenocarcinoma, and 6 cycles of postoperative chemotherapy with a combination of TC(paclitaxel[PTX]and carboplatin)and the mTOR inhibitor temsirolimus was administered. During maintenance treatment with temsirolimus, the lesion recurred, and progressive disease was confirmed. Because relapse occurred after 5 months from the last TC treatment, the disease was considered platinum-resistant ovarian cancer, and second-line chemotherapy with 6 cycles of irinotecan(CPT-11)and PTX was administered. Partial response was observed after 2 cycles, and the response period was 7 months. We suggest that chemotherapy with CPT-11/PTX could be a treatment option for platinum-resistant recurrent ovarian clear cell adenocarcinoma.
要旨
症例は40歳,女性。腹部膨満感を主訴に近医受診し,画像検査で卵巣癌が疑われ当科受診となった。CT,MRIで壁在結節を伴う右卵巣腫瘍と腹膜播種,胸腹水を指摘され,胸水中に腺癌細胞を認めた。開腹時,20 cm大の右卵巣腫瘍と子宮,直腸は強固に癒着しており,初回手術として両側付属器摘出術を行った。病理組織学的に卵巣明細胞腺癌Ⅳ期と診断し,術後化学療法としてTC+mTOR inhibitor(テムシロリムス)併用療法を6サイクル施行した。テムシロリムスの投与中に病変の増大を認めたため,増悪と判断した。TC療法終了後から5か月での再発でプラチナ製剤抵抗性と判断し,塩酸イリノテカン(CPT-11)+パクリタキセル(PTX)療法を実施した。2サイクルよりPRとなり,奏効期間は7か月で有害事象はGrade 1の疲労と悪心のみであった。卵巣明細胞腺癌のプラチナ製剤抵抗性再発症例に対しCPT-11+PTX療法は,考慮すべきレジメンの一つと考えられた。
目次
Summary
A 40-year-old woman presented to a local clinic with abdominal distension. She was referred to our hospital for suspected ovarian cancer. Computed tomography(CT)and magnetic resonance imaging(MRI)revealed an ovarian tumor with mural nodules, ascites, pleural effusion, and peritoneal dissemination. Laparotomy revealed a 20-cm right ovarian tumor with strong adhesion to the uterus and rectum. Bilateral salpingo-oophorectomy was performed as a primary surgery. The histopathological diagnosis was stage Ⅳ ovarian clear cell adenocarcinoma, and 6 cycles of postoperative chemotherapy with a combination of TC(paclitaxel[PTX]and carboplatin)and the mTOR inhibitor temsirolimus was administered. During maintenance treatment with temsirolimus, the lesion recurred, and progressive disease was confirmed. Because relapse occurred after 5 months from the last TC treatment, the disease was considered platinum-resistant ovarian cancer, and second-line chemotherapy with 6 cycles of irinotecan(CPT-11)and PTX was administered. Partial response was observed after 2 cycles, and the response period was 7 months. We suggest that chemotherapy with CPT-11/PTX could be a treatment option for platinum-resistant recurrent ovarian clear cell adenocarcinoma.
要旨
症例は40歳,女性。腹部膨満感を主訴に近医受診し,画像検査で卵巣癌が疑われ当科受診となった。CT,MRIで壁在結節を伴う右卵巣腫瘍と腹膜播種,胸腹水を指摘され,胸水中に腺癌細胞を認めた。開腹時,20 cm大の右卵巣腫瘍と子宮,直腸は強固に癒着しており,初回手術として両側付属器摘出術を行った。病理組織学的に卵巣明細胞腺癌Ⅳ期と診断し,術後化学療法としてTC+mTOR inhibitor(テムシロリムス)併用療法を6サイクル施行した。テムシロリムスの投与中に病変の増大を認めたため,増悪と判断した。TC療法終了後から5か月での再発でプラチナ製剤抵抗性と判断し,塩酸イリノテカン(CPT-11)+パクリタキセル(PTX)療法を実施した。2サイクルよりPRとなり,奏効期間は7か月で有害事象はGrade 1の疲労と悪心のみであった。卵巣明細胞腺癌のプラチナ製剤抵抗性再発症例に対しCPT-11+PTX療法は,考慮すべきレジメンの一つと考えられた。