進行非小細胞肺癌に対するピノレルビンとシスプラチン併用療法

摘要

進行非小細胞肺癌に対するビノレルビン（VNR）とシスプラチン（CDDP）併用療法（VC）の現状について述べる．治療効果はVNR，CDDP単剤及びCDDP＋旧薬剤に比べ有効である．プラチナ＋他の新規薬剤併用療法と比べほぼ同等の成績である．副作用は主に好中球減少症と悪心·嘔吐である．Qudity of lifeはプラチナ＋他の新規薬剤併用療法と比べ同等である．利便性はweekly VNR＋CDDP（4週間隔）はPaclitaxol＋Carboplatin（PCb）に比べ劣っているが，3週間隔のVCでは同等と考えられる．費用はPCbに比べ安価である．VC療法の投与方法について，VNR25mg/m~2（毎週），CDDP80mg/m~2（第1日）を4週間隔で投与する方法では第15日目のVNR投与実施率は50％以下であり，VNRの投与スケジュールに問題がある．一方，我々の試験を含めVNR25mg/m~2（第1，8日），CDDP80mg/m~2（第1日）を3週間隔で投与する方法では，VNRの投与はほぼスケジュール通り投与され，Median delivered dose-intensityは各コースのCDDP，VNR（days1 and 8）ともに90％以上であった．3週間隔投与法での臨床成績は奏効率29～57％で，平均余命約10カ月前後であった．VC療法は3週間隔投与方法が推奨される．This paper reviews the clinical outcomes presently achieved for the combination regimen of vinorelbine (VNR) plus cisplatin (CDDP) in advanced non-small-cell lung cancer (NSCLC). The combination regimen (VC) was more effective than VNR alone, CDDP alone, or CDDP plus old drugs. The results were almost identical to those obtained for combination regimens of platinum plus other new drugs. The main adverse reactions were neutropenia and nausea/vomiting. Quality of life on VC was equivalent to that on platinum plus other new drugs. In terms of convenience, weekly VNR+CDDP (every 4 weeks) was inferior to paclitaxel + carboplatin (PCb) but appeared to be equivalent to VC every 3 weeks. The VC regimen is less expensive than PCb. There are problems with the dosing schedule of VNR in VC however, with VNR delivered on day 15 in less than 50% of patients receiving a regimen of VNR 25mg/m~2 (weekly) and CDDP 80mg/m~2 (day l) every 4 weeks. In contrast, analysis of data including that in our study revealed that the median delivered dose intensity was at least 90% for each course of CDDP and VNR (days 1 and 8) in a regimen of VNR 25mg/m~2 (days 1 and 8), CDDP 80mg/m~2 (day 1) every 3 weeks, showing that VNR was administered almost in accordance with the schedule. The clinical outcome in a 3-weekly dosing schedule was a response rate of 29 to 57%, and mean survival was approximately 10 months. VC administered in a 3-weekly dosing schedule is therefore recommended.