内容紹介
Analysis of Factors Affecting the Duration of Treatment with Sorafenib in Patients with Hepatocellular Carcinoma
Summary
The current status of treatment with sorafenib, and factors affecting the duration of treatment in patients started on sorafenib for hepatocellular carcinoma from July 2009 until April 2011 in the Department of Gastroenterology at Kobe City Medical Center General Hospital, were examined. Of 21 patients, 12 were able to continue the administration of sorafenib for more than one month, but 9 had to be discontinued within one month due to disease progression, worsening of general condition, and severe adverse reactions. In the group that was discontinued early, the rate of discontinuation due to side effects such as general fatigue, diarrhea, and hepatic encephalopathy was higher than in the long-term treatment group. On the other hand, hand-foot syndrome developed only in one case in both groups. The median value of PIVKA-Ⅱ at the start of treatment in the long-term and early discontinued treatment groups were 672.5 and 14,203 mAU/mL, respectively, and the values in the long-term group were significantly lower than those in the early-discontinued group(p<0.05). From these results, the values of PIVKA-Ⅱ at the start of sorafenib were considered to be factors affecting the continuation of sorafenib treatment. In addition, the dosing period was considered to be extended to focus on measures to take against the side effects of sorafenib within the early phase. Therefore, it was considered that these factors improved the effect of treatment with sorafenib in patients with hepatocellular carcinoma.
要旨
2009年7月～2011年4月までに神戸市立医療センター中央市民病院・消化器内科において,肝がんに対しソラフェニブの投与を開始した患者を対象に,ソラフェニブを用いた肝がん治療の現状とソラフェニブ投薬期間に影響を与える因子について検討した。対象患者21例中12例は1か月以上ソラフェニブを投与することができたのに対し,9例は1か月未満で病勢進行・全身状態悪化あるいは重度の副作用発現により中止となっていた。倦怠感,下痢,肝性脳症などの副作用による投与中止の割合は,長期投与群よりも早期中止群で高率であった。しかし,手足症候群による投与中止は両群でわずかに1例のみであった。長期投与群および早期中止群での治療開始時におけるPIVKA-Ⅱの中央値はそれぞれ672.5および14,203 mAU/mLであり,長期投与群での値は早期中止群に比べ有意に低値であった(p<0.05)。今回の結果から,ソラフェニブの治療継続に影響を与える因子として,ソラフェニブ導入前のPIVKA-Ⅱ値があげられた。また,ソラフェニブ投与初期の副作用対策を重点的に行うことで,投薬期間を延長できると考えられた。今後これら因子を考慮することで,ソラフェニブの治療効果が改善されると考えられた。
目次
Summary
The current status of treatment with sorafenib, and factors affecting the duration of treatment in patients started on sorafenib for hepatocellular carcinoma from July 2009 until April 2011 in the Department of Gastroenterology at Kobe City Medical Center General Hospital, were examined. Of 21 patients, 12 were able to continue the administration of sorafenib for more than one month, but 9 had to be discontinued within one month due to disease progression, worsening of general condition, and severe adverse reactions. In the group that was discontinued early, the rate of discontinuation due to side effects such as general fatigue, diarrhea, and hepatic encephalopathy was higher than in the long-term treatment group. On the other hand, hand-foot syndrome developed only in one case in both groups. The median value of PIVKA-Ⅱ at the start of treatment in the long-term and early discontinued treatment groups were 672.5 and 14,203 mAU/mL, respectively, and the values in the long-term group were significantly lower than those in the early-discontinued group(p<0.05). From these results, the values of PIVKA-Ⅱ at the start of sorafenib were considered to be factors affecting the continuation of sorafenib treatment. In addition, the dosing period was considered to be extended to focus on measures to take against the side effects of sorafenib within the early phase. Therefore, it was considered that these factors improved the effect of treatment with sorafenib in patients with hepatocellular carcinoma.
要旨
2009年7月～2011年4月までに神戸市立医療センター中央市民病院・消化器内科において,肝がんに対しソラフェニブの投与を開始した患者を対象に,ソラフェニブを用いた肝がん治療の現状とソラフェニブ投薬期間に影響を与える因子について検討した。対象患者21例中12例は1か月以上ソラフェニブを投与することができたのに対し,9例は1か月未満で病勢進行・全身状態悪化あるいは重度の副作用発現により中止となっていた。倦怠感,下痢,肝性脳症などの副作用による投与中止の割合は,長期投与群よりも早期中止群で高率であった。しかし,手足症候群による投与中止は両群でわずかに1例のみであった。長期投与群および早期中止群での治療開始時におけるPIVKA-Ⅱの中央値はそれぞれ672.5および14,203 mAU/mLであり,長期投与群での値は早期中止群に比べ有意に低値であった(p<0.05)。今回の結果から,ソラフェニブの治療継続に影響を与える因子として,ソラフェニブ導入前のPIVKA-Ⅱ値があげられた。また,ソラフェニブ投与初期の副作用対策を重点的に行うことで,投薬期間を延長できると考えられた。今後これら因子を考慮することで,ソラフェニブの治療効果が改善されると考えられた。