大腸癌の標準的薬物治療の成り立ちと現状について

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  • An overview of chemotherapy and current topics for colorectal cancer in Japan

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Many dramatic advances have been made recently in the treatment of gastrointestinal cancer. For advanced colorectal cancer, fluorouracil (5-FU), long the only mainstay of chemotherapy, has been joined by new, effective anticancer agents such as irinotecan (CPT-11) and oxaliplatin (L-OHP). First-line chemotherapy has been refined continuously and updated annually. The latest regimens in order of survival benefits are 5-FU/LV=irinotecan<IFL<FOLFOX=FOLFIRI. FOLFIRI and FOLFOX, which consist of 5-FU/LV combined with irinotecan and oxaliplatin, are considered the latest first-line chemotherapy for advanced colorectal cancer. In the course of their development, aspects of their metabolism and pharmacology, and the relative advantages of 5-FU administration by continuous infusion or bolus administration, have been clarified.<BR>The introduction of orally administered drugs such as UFTTM, TS-1TM, and capecitabine are likely to further improve the results of 5-FU therapy. Their potential role, impact, and convenience as replacements for intravenously administered drugs, which include FOLFIRI and FOLFOX, are attracting attention. Bevacizumab and cetuximab, which inhibit the effect of VEGF or EGFR, have also become available. Their use for combination treatment is expected to increase median survival time to as much as two years.<BR>Median survival time for advanced colorectal cancer patients not treated with chemotherapy is somewhere between three and six months. This makes the value of chemotherapy for colorectal cancer beyond dispute.

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