内容紹介
A Case of Recurrent Pancreatic Cancer Effectively Responding to S-1 Combined Irinotecan Third-Line Chemotherapy with PSK
Summary
A case of recurrent pancreatic cancer effectively responded to S-1 and irinotecan combined with third-line chemotherapy(IRIS)with PSK. The patient was a 75-year-old female. In October 2007, a pancreatoduodenectomy was performed, followed with 6 courses of systemic adjuvant chemotherapy of gemcitabine(GEM). Three months after finishing the adjuvant chemotherapy, a recurrence of para-aortic lymph node metastasis was confirmed. We resumed the second-line chemotherapy of S-1/GEM(GS)with PSK. GS therapy was continued for about 3 years, until the recurrent lesion was found to have increased after 30 courses. Nevertheless, we continued up to 39 courses. In November 2011, we started third-line chemotherapy using S-1/irinotecan(IRIS)with PSK. The regimen was S-1 of 80 mg/body/day, continuously administered for day 1-14th, followed by a discontinuation for 2 weeks. CPT-11 100 mg/body/day was administered on day 1 and 15th; and PSK of 3 g/body/day was continued, until it resulted in increased recurrent lesions. After the end of 4 courses, recurrent lesions started to respond partially. Currently, the patient is being treated as an outpatient. This case indicates that IRIS(S-1/CPT-11)is an effective therapy when pancreatic cancer fails to respond to GS therapy.
要旨
症例は75歳,女性。2007年10月,閉塞性黄疸発症を契機に発見された膵頭部癌に対して膵頭十二指腸切除術(D2リンパ節郭清)を施行した。術後病理診断はT3N1M(-)→StageⅢ,cur Aであった。術後塩酸ゲムシタビン(GEM 11,000 mg/m2 3週投与,1週休薬)による術後補助化学療法6コース完了後は経過観察としていたが,化学療法中止3か月後に傍大動脈リンパ節再発を来したため,second-line化学療法としてS-1/GEM+PSK併用療法(S-1 80 mg/m2 2週投薬2週休薬,GEM 1,000 mg/m2 1 and 15日目点滴,PSK 3 g/連日投与)を開始。30コース目でPDと判断するも39コース目まで同regimenで治療継続していた。2011年11月から患者の治療継続希望もあり,IRIS療法(S-1+CPT-11)+PSKによるthird-line化学療法(S-1 80 mg/body 2週投与2週休薬,CPT-11 100 mg/body 1 and 15日目点滴,PSK 3 g/連日投与)を開始したところ4コース目でPRとなり,現在12コース終了しているがSDを保っている状態であり,2012年8月現在,治療継続中である。IRIS療法は,GS療法無効膵癌に対して効果が期待できるregimenの一つであると考えられた。
目次
Summary
A case of recurrent pancreatic cancer effectively responded to S-1 and irinotecan combined with third-line chemotherapy(IRIS)with PSK. The patient was a 75-year-old female. In October 2007, a pancreatoduodenectomy was performed, followed with 6 courses of systemic adjuvant chemotherapy of gemcitabine(GEM). Three months after finishing the adjuvant chemotherapy, a recurrence of para-aortic lymph node metastasis was confirmed. We resumed the second-line chemotherapy of S-1/GEM(GS)with PSK. GS therapy was continued for about 3 years, until the recurrent lesion was found to have increased after 30 courses. Nevertheless, we continued up to 39 courses. In November 2011, we started third-line chemotherapy using S-1/irinotecan(IRIS)with PSK. The regimen was S-1 of 80 mg/body/day, continuously administered for day 1-14th, followed by a discontinuation for 2 weeks. CPT-11 100 mg/body/day was administered on day 1 and 15th; and PSK of 3 g/body/day was continued, until it resulted in increased recurrent lesions. After the end of 4 courses, recurrent lesions started to respond partially. Currently, the patient is being treated as an outpatient. This case indicates that IRIS(S-1/CPT-11)is an effective therapy when pancreatic cancer fails to respond to GS therapy.
要旨
症例は75歳,女性。2007年10月,閉塞性黄疸発症を契機に発見された膵頭部癌に対して膵頭十二指腸切除術(D2リンパ節郭清)を施行した。術後病理診断はT3N1M(-)→StageⅢ,cur Aであった。術後塩酸ゲムシタビン(GEM 11,000 mg/m2 3週投与,1週休薬)による術後補助化学療法6コース完了後は経過観察としていたが,化学療法中止3か月後に傍大動脈リンパ節再発を来したため,second-line化学療法としてS-1/GEM+PSK併用療法(S-1 80 mg/m2 2週投薬2週休薬,GEM 1,000 mg/m2 1 and 15日目点滴,PSK 3 g/連日投与)を開始。30コース目でPDと判断するも39コース目まで同regimenで治療継続していた。2011年11月から患者の治療継続希望もあり,IRIS療法(S-1+CPT-11)+PSKによるthird-line化学療法(S-1 80 mg/body 2週投与2週休薬,CPT-11 100 mg/body 1 and 15日目点滴,PSK 3 g/連日投与)を開始したところ4コース目でPRとなり,現在12コース終了しているがSDを保っている状態であり,2012年8月現在,治療継続中である。IRIS療法は,GS療法無効膵癌に対して効果が期待できるregimenの一つであると考えられた。