消化管がん治療の進歩(2012年,第53回日本心身医学会総会ならびに学術講演会(鹿児島))  [in Japanese] Advances in the Treatment of Gastrointestinal Cancers  [in Japanese]

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Author(s)

    • 篠村 恭久 Shinomura Yasuhisa
    • 札幌医科大学医学部消化器・免疫・リウマチ内科学講座 Department of Gastroenterology, Rheumatology and Clinical Immunology Sapporo Medical University School of Medicine

Abstract

内視鏡治療や分子標的治療の進歩により,消化管がんの治療成績が向上している,大腸癌や胃癌,食道癌は,画像強調観察など内視鏡診断の進歩により微小な早期癌が発見されて,内視鏡治療例が増加している.内視鏡的粘膜下層剥離術(ESD)の開発により大きな腫瘍の一括切除が可能になって,治療成績が向上している.分子標的薬imatinibは,消化管間質腫瘍(GIST)に高頻度に遺伝子変異がみられるKITやPDGFRαを標的としたチロシンキナーゼ阻害薬であり,切除不能・再発GIST症例に用いられて,劇的な効果を発揮し,生存期間を著明に延長させている.切除不能の大腸癌と胃癌においても,腫瘍細胞増殖や血管新生にかかわる分子を標的としたモノクロナール抗体医薬が開発されて,治療成績が向上している.分子標的薬は,副作用が少なく,優れた効果を発揮するが,薬剤耐性が出現する問題があり,薬剤耐性の克服は今後の重要な課題である.

Recent development of endoscopic treatments and targeted therapies has improved treatment outcomes in gastrointestinal cancers. Superficial gastrointestinal neoplasms, including early cancers with no risk of metastasis, can be removed by endoscopic resection. Endoscopic submucosal dissection (ESD), a new method of endoscopic resection, has enabled en bloc resection of large neoplasms. Moreover, targeted therapies have been approved for the treatment of advanced gastrointestinal stromal tumors (GIST), colorectal cancers, and gastric cancers. Targeted therapy drugs target specific molecules involved in tumor cell growth signaling or tumor blood vessel development. The targeted therapies can induce dramatic clinical responses with fewer side effects and prolong the overall survival of patients with gastrointestinal cancers, including GISTs. The effectiveness of targeted therapies is, however, limited because most patients develop drug resistance. Further studies should aim at overcoming drug resistance.

Journal

  • Japanese Journal of Psychosomatic Medicine

    Japanese Journal of Psychosomatic Medicine 53(7), 646-651, 2013

    Japanese Society of Psychosomatic Medicine

Codes

  • NII Article ID (NAID)
    110009615297
  • NII NACSIS-CAT ID (NCID)
    AN00121636
  • Text Lang
    JPN
  • Article Type
    REV
  • ISSN
    0385-0307
  • NDL Article ID
    024644208
  • NDL Call No.
    Z19-26
  • Data Source
    CJP  NDL  NII-ELS  J-STAGE 
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