内容紹介
A Case Report of Successful Chemotherapy with Tegafur/Gimeracil/Oteracil and Nab-Paclitaxel for Gastric Cancer with Chronic Renal Failure
Summary
An 80-year-old Japanese woman with chronic renal failure was diagnosed with gastric cancer and 2 primary colon cancers. The colon cancers were treated with laparoscopic colectomy, but the gastric cancer metastasized to the liver with inoperable dissemination. After operative treatment of the colon cancers, 1 year of combination chemotherapy consisting of tegafur/gimeracil/oteracil(TS-1®)and nab-PTX was administered to treat the advanced gastric cancer. Tegafur is a well-known prodrug of 5-FU. Serum densitometry of 5-FU was performed to determine the correct dose of TS-1®. After completion of chemotherapy, no tumor was detected on gastroscopy or dynamic computed tomography. The patient was well with no recurrence 6 months after completion of chemotherapy. CDDP, CPT-11, 5-FU, PTX, and DTX are known chemotherapy agents for treating gastric cancer. Renal excretion is not involved in the metabolism of CPT-11, 5-FU, PTX, or DTX. These agents are metabolized in the liver. CPT-11 metabolism depends on individual hepatic enzymes. Therefore, we believe that nab-PTX and TS-1® are safe and effective agents for patients with chronic renal failure and advanced gastric cancer. Additionally, we also conclude that using serum densitometry of 5-FU to guide the administration of TS-1® can improve both safety and efficacy.
要旨
慢性腎不全で7年前より血液透析中の80歳,女性が,便潜血陽性で当科に紹介された。2か所の結腸癌と胃癌が診断された。腹腔鏡下手術時に胃癌の肝転移と腹腔内播種が確認され,胃癌は切除しないで横行結腸切除とS状結腸切除が施行された。術後,胃癌に対してヒトアルブミン結合型パクリタキセル(アブラキサン®)とtegafur/gimeracil/oteracil合剤(TS-1®)が1年間投与された。投与に先立ち,TS-1® 40 mgの投与での5-FU血中濃度が測定された。1年投与後,上部消化器内視鏡検査と腹部dynamic CTで胃癌の原発部と肝転移巣が消失し,化学療法終了後6か月経過するが再燃を認めていない。進行胃癌ではCDDPやCPT-11,5-FU製剤,PTX,DTXが投与されるが,このうち肝で安定に代謝されるのは5-FU製剤,PTX,DTXで,CPT-11は個人差がある。慢性腎不全を有する進行胃癌の患者には化学療法施行が難しいが,薬理作用を詳細に検討し積極的な抗癌剤治療を行えば,自験例のようにQOLを害さず良好な予後が得られる可能性が示唆された。
目次
Summary
An 80-year-old Japanese woman with chronic renal failure was diagnosed with gastric cancer and 2 primary colon cancers. The colon cancers were treated with laparoscopic colectomy, but the gastric cancer metastasized to the liver with inoperable dissemination. After operative treatment of the colon cancers, 1 year of combination chemotherapy consisting of tegafur/gimeracil/oteracil(TS-1®)and nab-PTX was administered to treat the advanced gastric cancer. Tegafur is a well-known prodrug of 5-FU. Serum densitometry of 5-FU was performed to determine the correct dose of TS-1®. After completion of chemotherapy, no tumor was detected on gastroscopy or dynamic computed tomography. The patient was well with no recurrence 6 months after completion of chemotherapy. CDDP, CPT-11, 5-FU, PTX, and DTX are known chemotherapy agents for treating gastric cancer. Renal excretion is not involved in the metabolism of CPT-11, 5-FU, PTX, or DTX. These agents are metabolized in the liver. CPT-11 metabolism depends on individual hepatic enzymes. Therefore, we believe that nab-PTX and TS-1® are safe and effective agents for patients with chronic renal failure and advanced gastric cancer. Additionally, we also conclude that using serum densitometry of 5-FU to guide the administration of TS-1® can improve both safety and efficacy.
要旨
慢性腎不全で7年前より血液透析中の80歳,女性が,便潜血陽性で当科に紹介された。2か所の結腸癌と胃癌が診断された。腹腔鏡下手術時に胃癌の肝転移と腹腔内播種が確認され,胃癌は切除しないで横行結腸切除とS状結腸切除が施行された。術後,胃癌に対してヒトアルブミン結合型パクリタキセル(アブラキサン®)とtegafur/gimeracil/oteracil合剤(TS-1®)が1年間投与された。投与に先立ち,TS-1® 40 mgの投与での5-FU血中濃度が測定された。1年投与後,上部消化器内視鏡検査と腹部dynamic CTで胃癌の原発部と肝転移巣が消失し,化学療法終了後6か月経過するが再燃を認めていない。進行胃癌ではCDDPやCPT-11,5-FU製剤,PTX,DTXが投与されるが,このうち肝で安定に代謝されるのは5-FU製剤,PTX,DTXで,CPT-11は個人差がある。慢性腎不全を有する進行胃癌の患者には化学療法施行が難しいが,薬理作用を詳細に検討し積極的な抗癌剤治療を行えば,自験例のようにQOLを害さず良好な予後が得られる可能性が示唆された。