進行性尿路上皮癌に対するM-VAC変法療法の成績  [in Japanese] RESULTS OF MODIFIED M-VAC CHEMOTHERAPY FOR ADVANCED UROTHELIAL CARCINOMA  [in Japanese]

(目的)局所進行,及び転移性尿路上皮癌に対し,M-VAC変法を施行し,その奏効率,奏効期間および有害事象についてretrospectiveに検討した.(対象と方法) 1993年10月から2005年2月までに, M-VAC変法を施行した局所進行及び転移性尿路上皮癌患者28例のうち,評価可能病変を有する25例を対象とした. M-VAC変法は, MTX 30mg/m^2(day 1), VLB 3mg/m^2 (day 2), ADM 30mg/m^2 (day 2), CDDP 70mg/m^2 (day 2)の併用化学療法を3週毎に施行した.(結果) M-VAC変法の治療回数は中央値3回で,効果判定は25例中CR6例. PR6例で,奏効率は48%であった.観察期間中央値65.6ヵ月で,全生存期間中央値は9.3ヵ月, 1年及び2年全生存率はそれぞれ33.5%, 9.6%であった.奏効症例の奏効期間中央値は6.0ヵ月であった.有害事象はGrade 3/4 の好中球減少が84.4%, Grade 3/4の血小板減少が40.0%, Grade 3/4のヘモグロビン減少が56.0%,発熱性好中球減少が20.0%, Grade 3の悪心嘔吐が8.0%にみられた. (結論)今回のM-VAC変法療法の検討で, M-VAC療法と比較して奏効率は同等ながら,奏効期間は短く,有害事象の頻度も同等以上であった.以上より,今回施行したM-VAC変法の有用性は見出せなかった.

(Purpose) We retrospectively evaluated the efficacy and toxicity of modified M-VAC therapy for locally advanced or metastatic urothelial carcinoma. (Patients and method) From 1993 October to 2005 February, 28 patients were treated with modified M-VAC therapy and 25 of 28 patients had lesions suitable for the evaluation. The modified regimen was the combination of methotrexate at a dose of 30 mg/m^2 on dayl, vinblastine at a dose of 3 mg/m^2 on day 2, doxorubicin at a dose of 30 mg/m^2 on day 2, and cisplatin at a dose of 70 mg/m^2 on day 2 with courses repeated every three weeks. (Results) The median number of cycle was 3 (1〜7 cycles). Six of 25 patients achieved complete response (CR) and six partial response (PR), resulting in a 48% response rate. With a median follow-up time of 65.6 months, the median survival was 9.3 months and the 1-year and 2-year survival rates were 33.5% and 9.6%, respectively. The median progression-free survival was 6.0 months. Grade 3 and 4 toxicities included neutropenia (84.4%), thrombocytopenia (40%), anemia (56%), febrile neutropenia (20 %), nausea, vomiting (8 %). (Conclusion) Although response rate of modified M-VAC therapy was similar to classic M-VAC therapy, but modified M-VAC therapy had shorter response duration and more frequent toxicities. We were not able to find the benefits of modified M-VAC therapy.