内容紹介
Indication of Alternate-Day Treatment with S-1 in Patients with Oral Cancer
Summary
The recommended S-1 chemotherapy schedule for head and neck cancer is daily treatment for 4 weeks, followed by 2 weeks of rest. However, this can lead to adverse events and sometimes treatment withdrawal. Alternate-day treatment with a pyrimidine anticancer agent is reported to reduce adverse events without compromising anticancer activity. We examined the indication of alternate-day treatment with S-1 for oral cancer. Fifteen patients(3 men and 12 women; average age: 81.3 years)with oral squamous cell carcinoma started consecutive-day treatment with S-1. Treatment had to be interrupted after 0.5-10 courses because of grade >2 myelosuppression, hepatorenal and electrolyte disorder, and grade 1 digestive toxicity. After a recovery period of 8-168 days from adverse events, alternate-day treatment with S-1 was started. Adverse events on this regimen were grade 2 leucopenia and hyperbilirubinemia in some patients. It was possible for 10 of the patients to continue this treatment for longer than 1 year or until death, but 5 patients could not continue because of a recurrence of a renal or electrolyte disorder, pneumonia, or disease progression. It is thought that alternate-day treatment with S-1 reduces the incidence of adverse events compared to consecutive-day treatment, and can allow continuous administration. Alternate-day treatment with S-1 for female patients aged over 80 years with grade 1 leucopenia and/or thrombocytopenia before administration may help to maintain their quality of life.
要旨
頭頸部癌化学療法におけるS-1投与法は,通常4週投与2週休薬である。しかし,有害事象のため中止せざるを得ない症例を経験する。ピリミジン系抗癌薬の隔日投与法は抗腫瘍効果を損なうことなく有害事象を軽減できるという理論に基づき,S-1隔日投与法を試み,その適用について検討した。口腔扁平上皮癌症例15例(男性3例,女性12例,平均81.3歳)に対しS-1を連日投与した。0.5～10コース後,grade 2以上の骨髄機能低下,肝・腎機能異常,電解質異常およびgrade 1の消化器症状が出現し休薬した。8～168日後,有害事象から回復したため,隔日投与法によりS-1投与を再開した。再開後の有害事象はgrade 2の白血球数低下,総ビリルビン上昇が数例に認められたが,連日投与法と比較し軽度であった。10例は継続投与が可能であったが,腎機能障害,電解質異常の再発,肺炎発症,病変進行の5例は中止となった。S-1隔日投与法は連日投与法による有害事象を軽減し,投与継続が可能になるものと考えられた。また,80歳以上の女性で投与前の白血球数,血小板数がgrade 1となっている症例に対しては,QOL維持が可能な投与法として隔日投与法を適用できるものと考えられた。
目次
Summary
The recommended S-1 chemotherapy schedule for head and neck cancer is daily treatment for 4 weeks, followed by 2 weeks of rest. However, this can lead to adverse events and sometimes treatment withdrawal. Alternate-day treatment with a pyrimidine anticancer agent is reported to reduce adverse events without compromising anticancer activity. We examined the indication of alternate-day treatment with S-1 for oral cancer. Fifteen patients(3 men and 12 women; average age: 81.3 years)with oral squamous cell carcinoma started consecutive-day treatment with S-1. Treatment had to be interrupted after 0.5-10 courses because of grade >2 myelosuppression, hepatorenal and electrolyte disorder, and grade 1 digestive toxicity. After a recovery period of 8-168 days from adverse events, alternate-day treatment with S-1 was started. Adverse events on this regimen were grade 2 leucopenia and hyperbilirubinemia in some patients. It was possible for 10 of the patients to continue this treatment for longer than 1 year or until death, but 5 patients could not continue because of a recurrence of a renal or electrolyte disorder, pneumonia, or disease progression. It is thought that alternate-day treatment with S-1 reduces the incidence of adverse events compared to consecutive-day treatment, and can allow continuous administration. Alternate-day treatment with S-1 for female patients aged over 80 years with grade 1 leucopenia and/or thrombocytopenia before administration may help to maintain their quality of life.
要旨
頭頸部癌化学療法におけるS-1投与法は,通常4週投与2週休薬である。しかし,有害事象のため中止せざるを得ない症例を経験する。ピリミジン系抗癌薬の隔日投与法は抗腫瘍効果を損なうことなく有害事象を軽減できるという理論に基づき,S-1隔日投与法を試み,その適用について検討した。口腔扁平上皮癌症例15例(男性3例,女性12例,平均81.3歳)に対しS-1を連日投与した。0.5～10コース後,grade 2以上の骨髄機能低下,肝・腎機能異常,電解質異常およびgrade 1の消化器症状が出現し休薬した。8～168日後,有害事象から回復したため,隔日投与法によりS-1投与を再開した。再開後の有害事象はgrade 2の白血球数低下,総ビリルビン上昇が数例に認められたが,連日投与法と比較し軽度であった。10例は継続投与が可能であったが,腎機能障害,電解質異常の再発,肺炎発症,病変進行の5例は中止となった。S-1隔日投与法は連日投与法による有害事象を軽減し,投与継続が可能になるものと考えられた。また,80歳以上の女性で投与前の白血球数,血小板数がgrade 1となっている症例に対しては,QOL維持が可能な投与法として隔日投与法を適用できるものと考えられた。