内容紹介
A Case Report of Recurrent Small Bowel Adenocarcinoma Successfully Treated with Monoclonal Antibody against EGFR and S-1
Summary
A man in 30s was admitted to our hospital with a complaint of abdominal and back pain. Abdominal CT scan showed a large mass and double balloon endoscopy detected a tumor of the jejunum. The pathological diagnosis of biopsy samples was poorly differentiated adenocarcinoma. After radical resection, adjuvant chemotherapy with mFOLFOX6 was administered, however, a recurrent lesion developed. Although the lesion was successfully removed again, it did not react to the combination therapy with irinotecan and cisplatin. Because the tumor showed a high percentage of epidermal growth factor receptor(EGFR) expression and also had a wild-type KRAS status, a therapeutic strategy targeting EGFR was selected. The patient started on panitumumab associated with S-1 and obtained a complete response on CT 6 weeks later. Small bowel adenocarcinoma is an aggressive malignancy with a poor prognosis and little information about its definitive chemotherapy. Analysis of molecular characterization, an increase in reported experience, and prospective trials are needed to improve a prognosis.
要旨
症例は30歳台,男性。腹痛と背部痛を主訴に受診した。腹部CTで腹腔内の腫瘍性病変を指摘され,小腸内視鏡検査で空腸腫瘍が明らかとなり,生検で低分化型腺癌と診断された。根治切除後,mFOLFOX6療法を行ったが,再発を来し再切除を行った。その後,irinotecan+cisplatin療法を行うも,再発を起こし切除不能となった。組織検査でEGFRが高発現でKRASがwild-typeであったため,panitumumabとS-1を併用したところ,6週間後には画像上complete response(CR)を認めた。小腸癌は確立された化学療法もなく,予後不良とされている。分子レベルでの解析が進み,症例の集積や臨床試験が行われることを期待したい。
目次
Summary
A man in 30s was admitted to our hospital with a complaint of abdominal and back pain. Abdominal CT scan showed a large mass and double balloon endoscopy detected a tumor of the jejunum. The pathological diagnosis of biopsy samples was poorly differentiated adenocarcinoma. After radical resection, adjuvant chemotherapy with mFOLFOX6 was administered, however, a recurrent lesion developed. Although the lesion was successfully removed again, it did not react to the combination therapy with irinotecan and cisplatin. Because the tumor showed a high percentage of epidermal growth factor receptor(EGFR) expression and also had a wild-type KRAS status, a therapeutic strategy targeting EGFR was selected. The patient started on panitumumab associated with S-1 and obtained a complete response on CT 6 weeks later. Small bowel adenocarcinoma is an aggressive malignancy with a poor prognosis and little information about its definitive chemotherapy. Analysis of molecular characterization, an increase in reported experience, and prospective trials are needed to improve a prognosis.
要旨
症例は30歳台,男性。腹痛と背部痛を主訴に受診した。腹部CTで腹腔内の腫瘍性病変を指摘され,小腸内視鏡検査で空腸腫瘍が明らかとなり,生検で低分化型腺癌と診断された。根治切除後,mFOLFOX6療法を行ったが,再発を来し再切除を行った。その後,irinotecan+cisplatin療法を行うも,再発を起こし切除不能となった。組織検査でEGFRが高発現でKRASがwild-typeであったため,panitumumabとS-1を併用したところ,6週間後には画像上complete response(CR)を認めた。小腸癌は確立された化学療法もなく,予後不良とされている。分子レベルでの解析が進み,症例の集積や臨床試験が行われることを期待したい。