肺癌術後再発症例に対するGemcitabine（Gem），Vinorelbine（VNR）の外来併用化学療法について

摘要

目的．非小細胞肺癌切除後の再発治療は一般に困難である．予後不良であることから長期入院治療や副作用が強く，QOLの低い治療法は疑問である．近年，副作用が少なく，外来治療も可能な新規抗癌剤が登場している．今回，ゲムシタビン（GEM），ビノレルビン（VNR）にて術後再発治療を行った症例を検討した．方法．2001年3月から2002年10月までに非小細胞肺癌術後の再発症例に対し外来にてGEM800mg/m~2，VNR20mg/m~2を2週間毎に静脈内投与し，X-P，CT，採血，問診票によりその効果，副作用，QOいこ閲し検討した．結果．同意の得られた症例は19例，男性12例，女性7例．年齢は平均68.2歳，組織型は腺癌17例，腺扁平上皮癌2例，再発部位は肺12例，縦隔リンパ節10例，悪性胸水4例，骨3例，皮膚2例，脳2例，肝1例．治療は平均14.2回行った．副作用は骨髄抑制12例，全身倦怠感9例，食欲低下4例，口内炎1例，静脈炎1例を認めたが，Grade3以上の副作用はなかった．治療効果はCR2例，PR6例，NC7例，PD4例であった．全例，外来治療可瀧でQOLは良好に保たれた．結論．GEMとVNRの併用療法は術後再発症例に対し，外来治療において安全で有用な治療法である．Objective. Generally speaking, it is difficult to cure recurrence after resected non-small cell lung cancer (NSCLC). Treatment options regarding second therapy have been limited so far because of poor prognosis. Recently, a number of new agents which have favorable efficacy and toxicity have been introduced. This report shows the clinical experiences of gemcitabine (GEM) and vinorelbine (VNR) combinations in recurrence after resected NSCLC. Patients and Methods. From March 2001 to October 2002, 19 patients with recurrence after resection of NSCLC received combination chemotherapy of GEM 800mg/m~2 and VNR 20mg/m~2 biweekly in the outpatient clinic. Results. The mean age was 68.2 years with 12 men and 7 women. The types of histology were adenocarcinoma (n = 17) and adenosquamous (n = 2). Metastatic sites included: lung (n - 12), lymph nodes (n = 10), malignant effusion (n = 4), bone (n = 3), skin (n = 2), brain (n = 2), liver (n = 1). The mean number of prescriptions of combination chemotherapy per patient was 14.2. Gradel-2 myelosuppression (n = 12), general fatigue (n = 9), anorexia (n = 4), stomatitis (n = l) and phlebitis (n = l) was seen. Objective responses were; complete response (CR): 2/19 (10.5%), partial response (PR): 6/19 (31.6%), no change (NC):7/19 (36.8%), progressive disease (PD):4/19 (21.1%). Quality of life (QOL) during treatment in all patients has been stable. Conclusion. The regimen of GEM and VNR combination chemotherapy in the outpatient clinic represents a tolerable and effective treatment to apply in the palliative treatment of relapsed NSCLC.