肺癌化学療法における塩酸イリノテカンとカルボプラチン併用療法

摘要

目的·方法．トポイソメラーゼⅠ阻害剤の塩酸イリノテカン（CPT-11）とプラチナ製剤のカルボプラチン（CBDCA）には交叉耐性がなく，副作用のプロファイルが比較的異なり，またin vitro併用で相乗効果がみられている．ここでは肺癌におけるCPT-11＋CBDCA併用療法の成績とタキサンを加えた3剤療法について述べる．結果．第Ⅰ相とⅡ相試験の成績では，CPT-11＋CBDCAの奏効率は小細胞肺癌に対して79～89％，進行非小細胞肺癌に対して22～36％と1年生存率37.6～42.2％である．タキサンを加えた3剤併用では奏効率32～56％，中間生存期間は11～16カ月であるが有害事象の頻度は高い．主な有害事象は白血球減少，好中球減少，血小板減少，下痢である．結論．CPT-11十CBDCAは他の併用療法と比較的同等の有用性を示し，とくにシスプラチン投与ができない症例，心機能や腎機能低下症例，外来治療には推奨される．Objective and Methods. No cross-resistance is observed between irinotecan (CPT-ll) and carboplatin (CBDCA) in vitro. The two drugs show clinically different toxicity profiles and synergistic antitumor effect in cancer cells in vitro. Here, we describe the results of combination chemotherapy with CPT-ll and CBDCA, and a three-drug regimen including taxane, in lung cancer. Results. Phase I and Ⅱtrials of CPT-ll and CBDCA yielded response rates of 79 to 89% in small-cell lung cancer, and in advanced non-small-cell lung cancer the response rules were 22 to 36% with a 1-year survival rate of 37.6 to 42.2% . CPT-ll and CBDCA including taxane yielded response rate of 32 to 56% and median survival time of 11 to 16 months in non-small-cell lung cancer, however, adverse events occurred more frequently than in CPT-ll and CBDCA. The principal toxicites of CPT-ll and CBDCA were leukopenia, neutropenia, thrombocytopenia, and diarrhea. Conclusions. CPT-ll and CBDCA have shown similar effectiveness to those of other chemotherapy regimens in lung cancer. This regimen is recommended especially for patients who cannot have cisplatin and have decreased cardiac or renal function, and is useful for chemotherapy of outpatients.