内容紹介
Long-Term Successful Management of Recurrent Rectal Cancer in the Predialysis State with FOLFIRI Chemotherapy
Summary
A 71-year-old man with predialysis terminal renal insufficiency experienced peritoneal dissemination 1.5 years after low anterior resection for advanced rectal cancer. He received FOLFIRI therapy(70% dose); he achieved partial response(PR)under computed tomography and stable disease(SD)was maintained over a long term. Although Grade 3 myelosuppression was occasionally noted, he was treated with FOLFIRI for 2 years without other severe complications and without requiring the initiation of hemodialysis. After the initiation of hemodialysis, FOLFIRI treatment was continued for 1 year until progressive disease(PD). He received mFOLFOX6 as second-line therapy for 6 months, followed by LV-5-FU and a molecular targeting agent. These treatments prolonged his survival for 1 year and 8 months. FOLFIRI can be administered as an effective first-line therapy even for patients with predialysis terminal renal impairment without major renal damage. FOLFOX and molecular targeting agents should be made available and prolonged survival can be expected for advanced colorectal cancer patients with terminal renal disease after the initiation of hemodialysis.
要旨
症例は71歳,男性。直腸癌切除術1年半後,腹膜播種で再発。血液透析導入直前の末期腎不全であったが,70%ドーズでFOLFIRIを導入したところ画像上partial response(PR)となる。Grade 3の骨髄抑制が時折みられたものの他に著明な副作用なく,2年間stable disease(SD)のまま非透析を維持できた。血液透析導入後もprogressive disease(PD)になるまでFOLFIRIを1年,二次治療はmFOLFOX6を6か月,その後LV-5-FU療法,分子標的薬を順次導入し,さらに1年8か月延命することができた。透析前の末期腎不全患者であっても,FOLFIRIは比較的腎障害を進行させることなく長期継続でき一次治療として有効で,透析導入後は投与量を適宜調節して有害事象に注意して行えば,他の抗癌剤も非透析患者同様に長期継続でき,延命が望めると思われた。
目次
Summary
A 71-year-old man with predialysis terminal renal insufficiency experienced peritoneal dissemination 1.5 years after low anterior resection for advanced rectal cancer. He received FOLFIRI therapy(70% dose); he achieved partial response(PR)under computed tomography and stable disease(SD)was maintained over a long term. Although Grade 3 myelosuppression was occasionally noted, he was treated with FOLFIRI for 2 years without other severe complications and without requiring the initiation of hemodialysis. After the initiation of hemodialysis, FOLFIRI treatment was continued for 1 year until progressive disease(PD). He received mFOLFOX6 as second-line therapy for 6 months, followed by LV-5-FU and a molecular targeting agent. These treatments prolonged his survival for 1 year and 8 months. FOLFIRI can be administered as an effective first-line therapy even for patients with predialysis terminal renal impairment without major renal damage. FOLFOX and molecular targeting agents should be made available and prolonged survival can be expected for advanced colorectal cancer patients with terminal renal disease after the initiation of hemodialysis.
要旨
症例は71歳,男性。直腸癌切除術1年半後,腹膜播種で再発。血液透析導入直前の末期腎不全であったが,70%ドーズでFOLFIRIを導入したところ画像上partial response(PR)となる。Grade 3の骨髄抑制が時折みられたものの他に著明な副作用なく,2年間stable disease(SD)のまま非透析を維持できた。血液透析導入後もprogressive disease(PD)になるまでFOLFIRIを1年,二次治療はmFOLFOX6を6か月,その後LV-5-FU療法,分子標的薬を順次導入し,さらに1年8か月延命することができた。透析前の末期腎不全患者であっても,FOLFIRIは比較的腎障害を進行させることなく長期継続でき一次治療として有効で,透析導入後は投与量を適宜調節して有害事象に注意して行えば,他の抗癌剤も非透析患者同様に長期継続でき,延命が望めると思われた。