抗EGFR抗体の再投与が五次治療で奏効した黄疸を伴う大腸癌肝転移の1例 [in Japanese] A Case of Sigmoid Colon Cancer with Hepatic Metastases and Jaundice Treated with Rechallenge of Anti-epidermal Growth Factor Receptors as Fifth-line Treatment [in Japanese]
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症例は62歳，男性．S状結腸癌，多発肝転移．KRAS は野生型．化学療法としてPmab+FOLFOX療法，Bmab+FOLFIRI療法TAS-102，レゴラフェニブを使用したがすべて不応の判断．T-Bil16.3mg/dlであったがPS0かつ患者本人および妻より化学療法継続の強い意志が示されたため十分なICの上，Cmab単剤投与を開始．4コース施行したところでT-Bil2.1mg/dlと改善しS-1を併用．大きな副作用なく行えたため，SOX+Cmab療法へ移行した．Cmab16コース投与時にT-Bil 4.2mg/dlに増悪．CTで新規病変を認め，RAM+FOLFIRI療法へ変更した．初診から36カ月，Cmab投与開始から6カ月後に原病死した．抗EGFR抗体での治療歴があり，高度黄疸を伴っている症例に対しても五次治療としてCmab投与が有用である可能性が示された．
A 62-year-old man had unresectable sigmoid colon cancer with hepatic and pulmonary metastases and jaundice. The cancer was a wild-type <I>KRAS</I> tumor. He received 5-fluorouracil (5-FU), leucovorin and oxaliplatin (FOLFOX) and panitumumab as first-line chemotherapy ; 5-FU, leucovorin, and irinotecan (FOLFIRI) and bevacizumab as second-line chemotherapy ; TAS-102 as third-line chemotherapy ; and regorafenib as fourth-line chemotherapy. Because he was eager to initiate the next course of chemotherapy and his performance status (PS) was PS0, cetuximab monotherapy was initiated as fifth-line chemotherapy in spite of his hyperbilirubinemia (total bilirubin, 16.3mg/dl). After 4 courses of cetuximab monotherapy, S-1 and cetuximab combination therapy was initiated because hyperbilirubinemia disappeared. He exhibited no serious adverse reactions, so S-1, oxaliplatin, and cetuximab combination therapy was initiated. Thereafter, the appearance of new hepatic metastases and elevation in total bilirubin levels resulted in a change in the combination therapy to ramucirumab and FOLFIRI. However, the patient subsequently died due to disease progression 36 months after his first visit and 6 months after his first cetuximab chemotherapy.
- Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 79(4), 849-853, 2018
Japan Surgical Association