内容紹介
Efficacy of Supportive Care for Albumin-Bound Paclitaxel(Nab-Paclitaxel)in 20 Patients with Metastatic Breast Cancer
Summary
Purpose: The objective of this retrospective study was to evaluate the efficacy of albumin-bound paclitaxel(nab-paclitaxel)treatment and the required supportive care for severe adverse events. Methods: A total of 20 patients with advanced or recurrent breast cancer received nab-paclitaxel every 3 weeks between February 1, 2011 and December 31, 2012. The treatment course was repeated for 6 cycles thereafter, until evidence of disease progression or unacceptable toxicity was noted. Results: The median number of treatment cycles was 6.0(range 2-6), the median cumulative dose was 1,560(range 440-1,560)mg/m2, and the median delivered dose intensity was 82.3(range 65.0-86.7)mg/m2/week. Primary chemotherapy was associated with higher response rates than second-line or subsequent chemotherapy(42.9% v 23.1%). The response rate was 26.7% for cases with taxane pretreatment. Adverse events included neutropenia in 15 cases(75%), of Grade 4 severity in 4 cases(20%), and febrile neutropenia after 1 cycle in 1 patient(5%). In addition, Grade 3 peripheral neuropathy was observed in 2 cases(10%)during the treatment period. Conclusion: Nab-paclitaxel therapy was efficacious as primary chemotherapy and was effective for patients pretreated with taxanes. To prevent severe adverse events, supportive care is important, primarily for febrile neutropenia and neuropathy.
要旨
2011年2月~2012年12月の間にnab-particle albumin bound paclitaxel(nab-paclitaxel)を投与した転移・再発乳がん20例を対象に,本薬剤の至適患者および特徴的な有害事象への支持療法について後方視的に検討を行った。nab-paclitaxel投与は3週毎に繰り返し,病勢の改善または認容できない有害事象が認められない限り6サイクル施行した。治療サイクル数の中央値は6.0(2~6),総投与量の中央値は1,560(440~1,560)mg/m2,dose intensityの中央値は82.3(65.0~86.7)mg/m2/weekで,奏効率は30.0%であった。一次化学療法で使用した群の奏効率が42.9%であったのに対し,二次化学療法以降では23.1%と低率であった。タキサン系薬剤既治療群で,奏効率が26.7%であった。特徴的な有害事象は,1サイクル目において好中球数減少を15例(75%)に認め,うちGrade 4を4例(20%)認め,1例(5%)で発熱性好中球減少症を発症した。全治療期間中においてGrade 3の末梢神経障害を2例(10%)認めた。以上から,nab-paclitaxelは一次化学療法での奏効率が高い傾向にあり,タキサン系薬剤既治療群においても有効性を示した。有害事象として好中球減少が多い傾向にあることから,発熱性好中球減少症に対する初期治療の指導を行い,末梢神経障害に留意することが重要である。
目次
Summary
Purpose: The objective of this retrospective study was to evaluate the efficacy of albumin-bound paclitaxel(nab-paclitaxel)treatment and the required supportive care for severe adverse events. Methods: A total of 20 patients with advanced or recurrent breast cancer received nab-paclitaxel every 3 weeks between February 1, 2011 and December 31, 2012. The treatment course was repeated for 6 cycles thereafter, until evidence of disease progression or unacceptable toxicity was noted. Results: The median number of treatment cycles was 6.0(range 2-6), the median cumulative dose was 1,560(range 440-1,560)mg/m2, and the median delivered dose intensity was 82.3(range 65.0-86.7)mg/m2/week. Primary chemotherapy was associated with higher response rates than second-line or subsequent chemotherapy(42.9% v 23.1%). The response rate was 26.7% for cases with taxane pretreatment. Adverse events included neutropenia in 15 cases(75%), of Grade 4 severity in 4 cases(20%), and febrile neutropenia after 1 cycle in 1 patient(5%). In addition, Grade 3 peripheral neuropathy was observed in 2 cases(10%)during the treatment period. Conclusion: Nab-paclitaxel therapy was efficacious as primary chemotherapy and was effective for patients pretreated with taxanes. To prevent severe adverse events, supportive care is important, primarily for febrile neutropenia and neuropathy.
要旨
2011年2月~2012年12月の間にnab-particle albumin bound paclitaxel(nab-paclitaxel)を投与した転移・再発乳がん20例を対象に,本薬剤の至適患者および特徴的な有害事象への支持療法について後方視的に検討を行った。nab-paclitaxel投与は3週毎に繰り返し,病勢の改善または認容できない有害事象が認められない限り6サイクル施行した。治療サイクル数の中央値は6.0(2~6),総投与量の中央値は1,560(440~1,560)mg/m2,dose intensityの中央値は82.3(65.0~86.7)mg/m2/weekで,奏効率は30.0%であった。一次化学療法で使用した群の奏効率が42.9%であったのに対し,二次化学療法以降では23.1%と低率であった。タキサン系薬剤既治療群で,奏効率が26.7%であった。特徴的な有害事象は,1サイクル目において好中球数減少を15例(75%)に認め,うちGrade 4を4例(20%)認め,1例(5%)で発熱性好中球減少症を発症した。全治療期間中においてGrade 3の末梢神経障害を2例(10%)認めた。以上から,nab-paclitaxelは一次化学療法での奏効率が高い傾向にあり,タキサン系薬剤既治療群においても有効性を示した。有害事象として好中球減少が多い傾向にあることから,発熱性好中球減少症に対する初期治療の指導を行い,末梢神経障害に留意することが重要である。