内容紹介
A Case with Multiple Liver Metastases from Rectal Cancer Responding Completely to FOLFOX for a Long Duration without Exacerbation of Peripheral Neuropathy
Summary
A 61-year-old man had undergone five courses of modified FOLFOX6(mFOLFOX6)chemotherapy with calcium-magnesium(Ca/Mg)infusion for a rectal cancer with multiple liver metastases from October 2008. After this treatment, the primary rectal tumor and metastatic tumors were considered as a partial response(PR), and lower anterior resection was carried out in February 2009. After the operation, mFOLFOX6 chemotherapy with bevacizumab was started in March 2009. After 15 courses of chemotherapy, the patient received 7.5 g of gosha-jinki-gan(TJ-107)daily from August 2009, and the drug compliance was 69%. From the 18th course of chemotherapy in October 2009, glutathione(GSH)was given at a dose of 200 mg before each oxaliplatin administration. From the 35th course of chemotherapy in November 2010, the patient received 1.5 g of powdered processed aconite root(TJ-3027)daily. TJ-3027 administration was escalated to 4.5 g daily, and drug compliance was 73%. Grade 4 neutropenia was observed in December 2010, and we reduced oxaliplatin to 65 mg/m2 from the 37th course. Fifty chemotherapy courses were administered until October 2011. The patient received a total 3,970 mg/m2 of oxaliplatin, however, the neurotoxicity level of the patient remained at grade 2. Ca/Mg infusion and TJ-107 administration have been reported not to reduce the activity of FOLFOX individually, and severe side effects are rare. So one must consider the combination treatment of Ca/Mg and TJ-107 for prevention of oxaliplatin-related neurotoxicity.
要旨
症例は61歳,男性。2008年10月より多発性肝転移を伴う直腸癌に対して,カルシウム/マグネシウム(Ca/Mg)療法併用でmodified FOLFOX6(mFOLFOX6)療法を5コース施行した。肝転移巣と原発巣ともにPRを得,2009年2月原発巣を切除した。術後,bevacizumab併用にてmFOLFOX6を再開した。15コース施行後の2009年8月より牛車腎気丸7.5 g/日を併用し,服薬コンプライアンスは69%である。18コースの2009年10月よりglutathione 200 mgを前投薬に追加している。35コースの2010年11月よりブシ末1.5 g/日を追加し,漸増して現在4.5 g/日で継続中であり,服薬コンプライアンスは73%である。Grade 4の好中球減少が2010年12月にみられ,37コースよりoxaliplatinを65 mg/m2に減量した。2011年10月まで計50コースを施行し,oxaliplatin総投与量は3,970 mg/m2に達したが,末梢神経障害はGrade 2に止まっている。Ca/Mg療法と牛車腎気丸の併用は,各々単独ではFOLFOXの奏効を減弱しないことが示され,副作用が少なく,oxaliplatinによる末梢神経障害の予防対策として考慮してよいと思われた。
目次
Summary
A 61-year-old man had undergone five courses of modified FOLFOX6(mFOLFOX6)chemotherapy with calcium-magnesium(Ca/Mg)infusion for a rectal cancer with multiple liver metastases from October 2008. After this treatment, the primary rectal tumor and metastatic tumors were considered as a partial response(PR), and lower anterior resection was carried out in February 2009. After the operation, mFOLFOX6 chemotherapy with bevacizumab was started in March 2009. After 15 courses of chemotherapy, the patient received 7.5 g of gosha-jinki-gan(TJ-107)daily from August 2009, and the drug compliance was 69%. From the 18th course of chemotherapy in October 2009, glutathione(GSH)was given at a dose of 200 mg before each oxaliplatin administration. From the 35th course of chemotherapy in November 2010, the patient received 1.5 g of powdered processed aconite root(TJ-3027)daily. TJ-3027 administration was escalated to 4.5 g daily, and drug compliance was 73%. Grade 4 neutropenia was observed in December 2010, and we reduced oxaliplatin to 65 mg/m2 from the 37th course. Fifty chemotherapy courses were administered until October 2011. The patient received a total 3,970 mg/m2 of oxaliplatin, however, the neurotoxicity level of the patient remained at grade 2. Ca/Mg infusion and TJ-107 administration have been reported not to reduce the activity of FOLFOX individually, and severe side effects are rare. So one must consider the combination treatment of Ca/Mg and TJ-107 for prevention of oxaliplatin-related neurotoxicity.
要旨
症例は61歳,男性。2008年10月より多発性肝転移を伴う直腸癌に対して,カルシウム/マグネシウム(Ca/Mg)療法併用でmodified FOLFOX6(mFOLFOX6)療法を5コース施行した。肝転移巣と原発巣ともにPRを得,2009年2月原発巣を切除した。術後,bevacizumab併用にてmFOLFOX6を再開した。15コース施行後の2009年8月より牛車腎気丸7.5 g/日を併用し,服薬コンプライアンスは69%である。18コースの2009年10月よりglutathione 200 mgを前投薬に追加している。35コースの2010年11月よりブシ末1.5 g/日を追加し,漸増して現在4.5 g/日で継続中であり,服薬コンプライアンスは73%である。Grade 4の好中球減少が2010年12月にみられ,37コースよりoxaliplatinを65 mg/m2に減量した。2011年10月まで計50コースを施行し,oxaliplatin総投与量は3,970 mg/m2に達したが,末梢神経障害はGrade 2に止まっている。Ca/Mg療法と牛車腎気丸の併用は,各々単独ではFOLFOXの奏効を減弱しないことが示され,副作用が少なく,oxaliplatinによる末梢神経障害の予防対策として考慮してよいと思われた。