内容紹介
Remarkable Tumor Response to Cisplatin plus Gemcitabine Therapy in a Patient with Recurrent Gallbladder Cancer―A Case Report
Summary
We report a case of recurrent gallbladder cancer in which the patient's tumor showed a remarkable response to gemcitabine(GEM)plus cisplatin(CDDP)therapy. In January 2007, the patient underwent curative resection for gallbladder cancer(T2N1M0, Stage Ⅲ), and tegafur/uracil was administered for a year as adjuvant chemotherapy. In September 2009, elevated serum CA19-9 levels were observed, and para-aortic lymph node swelling was seen on CT scans. In addition to the indications reported by Valle et al, CDDP plus GEM therapy was initiated. After the first 2 courses of therapy, the para-aortic lymph nodes markedly decreased in size, and the serum CA19-9 levels normalized. Grade 4 neutropenia and grade 3 thrombocytopenia were observed after 3 courses of therapy. We decreased the drug doses because toxicities were observed. We hesitated to discontinue therapy because the indications for discontinuing chemotherapy while the patient showed a good response were not known. Finally, we discontinued therapy after 28 courses because recovery from the resultant toxicities became difficult in spite of decreasing the drug doses(CDDP 25 mg/body, GEM 600 mg/body), and because a good response to therapy was confirmed by CT. The patient is alive and has been disease-free for more than 2 years.
要旨
再発胆嚢癌に対してcisplatin(CDDP)+gemcitabine療法を行い著効した1例を経験したので報告する。患者は,2007年に胆嚢癌(T2N1M0,Stage Ⅲ)に対して根治術を受け,補助化学療法としてtegafur/uracilを1年間内服した。2009年9月にCA19-9の上昇とCTにて大動脈周囲リンパ節の腫大を指摘された。Valleらの報告に準じて,CDDP+GEM療法を開始した。2コース終了時点で大動脈周囲リンパ節は著明に縮小しCA19-9は正常化した。4コース以降でgrade 4の好中球減少とgrade 3の血小板減少が出現した。毒性の出現に合わせて投与量を減量した。化学療法が著効している状態で,いつ治療を中止するかどうかについては指標がなく治療中止の判断に難渋した。減量(CDDP 25 mg/body,GEM 600 mg/body)にもかかわらず毒性からの回復が困難になってきたことと,CT上,著効状態が維持されていたことから,最終的に28コースで治療を終了した。患者は治療開始から2年4か月を経過し無増悪生存中である。
目次
Summary
We report a case of recurrent gallbladder cancer in which the patient's tumor showed a remarkable response to gemcitabine(GEM)plus cisplatin(CDDP)therapy. In January 2007, the patient underwent curative resection for gallbladder cancer(T2N1M0, Stage Ⅲ), and tegafur/uracil was administered for a year as adjuvant chemotherapy. In September 2009, elevated serum CA19-9 levels were observed, and para-aortic lymph node swelling was seen on CT scans. In addition to the indications reported by Valle et al, CDDP plus GEM therapy was initiated. After the first 2 courses of therapy, the para-aortic lymph nodes markedly decreased in size, and the serum CA19-9 levels normalized. Grade 4 neutropenia and grade 3 thrombocytopenia were observed after 3 courses of therapy. We decreased the drug doses because toxicities were observed. We hesitated to discontinue therapy because the indications for discontinuing chemotherapy while the patient showed a good response were not known. Finally, we discontinued therapy after 28 courses because recovery from the resultant toxicities became difficult in spite of decreasing the drug doses(CDDP 25 mg/body, GEM 600 mg/body), and because a good response to therapy was confirmed by CT. The patient is alive and has been disease-free for more than 2 years.
要旨
再発胆嚢癌に対してcisplatin(CDDP)+gemcitabine療法を行い著効した1例を経験したので報告する。患者は,2007年に胆嚢癌(T2N1M0,Stage Ⅲ)に対して根治術を受け,補助化学療法としてtegafur/uracilを1年間内服した。2009年9月にCA19-9の上昇とCTにて大動脈周囲リンパ節の腫大を指摘された。Valleらの報告に準じて,CDDP+GEM療法を開始した。2コース終了時点で大動脈周囲リンパ節は著明に縮小しCA19-9は正常化した。4コース以降でgrade 4の好中球減少とgrade 3の血小板減少が出現した。毒性の出現に合わせて投与量を減量した。化学療法が著効している状態で,いつ治療を中止するかどうかについては指標がなく治療中止の判断に難渋した。減量(CDDP 25 mg/body,GEM 600 mg/body)にもかかわらず毒性からの回復が困難になってきたことと,CT上,著効状態が維持されていたことから,最終的に28コースで治療を終了した。患者は治療開始から2年4か月を経過し無増悪生存中である。