MVAC療法抵抗性肝転移に対してGemcitabine,Carboplatin,Docetaxelの3剤併用療法が奏効した尿路移行上皮癌の3例

Abstract

55歳男(症例1).左腎盂尿管移行部の診断で, 尿管癌の診断で左腎尿管全摘術を受けた.high-dose MVAC療法施行後, 多発性肝転移が出現した.gemecitabine+carboplatin(GC)療法3コースとGC療法にdocetaxelを加えたGCD療法を肝動注で3コース施行したところ, 肝転移巣は縮小率87.5%となった.2ヵ月後, 多発性の骨転移が出現したため, 放射線療法とGCD療法全身投与を施行中である.46歳男(症例2).局所性尿管癌に対し膀胱全摘術を受け, アジュバント療法としてhigh-dose MVAC療法を3コース施行した.その後, 多発肝, 肺転移および骨盤内リンパ節転移が出現した.全身投与でGC療法2コースとGCD療法2コースを行い, 肝転移巣は縮小しPRを得た.66歳男(症例3).浸潤性膀胱癌多発肝転移に対し, MVAC療法3コースを受けたがPDであった.肝動脈留置カテーテルからGC療法8コースを施行したところ, 無数の肝転移は著明に縮小した.しかし, CEAの上昇を認めたため, 肝動注でGCD療法を6コースを施行したところ, 肝転移巣は再び縮小率87.5%を得た

We report three cases with methotrexate-vinblastin-adriamycin-cisplatin (MVAC) resistant multiple liver metastases of urothelial carcinoma that responded to combination chemotherapy consisting of gemcitabine plus carboplatin (GC) with additional docetaxel (GCD) as salvage chemotherapy. Case 1: A 55-year-old man underwent left nephroureterectomy for ureteral cancer (TCC, G3, pT3pN1M0). Three courses of GC followed by three courses of GCD were given via intra-hepatic arterial infusion for multiple liver metastases, which appeared after adjuvant high-dose MVAC therapy. Complete response was obtained and maintained for 11 months. Case 2: A 46-year-old man underwent radical cystectomy for locally advanced bladder cancer (TCC G3 + adenocarcinoma. pT3pN0M0). Two courses of GC followed by 2 courses of GCD systemic therapies were performed for multiple liver metastases, which appeared after adjuvant high-dose MVAC therapy. Partial response was obtained and maintained for six months. Case 3: A 66-year-old man received three courses of MVAC for multiple metastases of the bladder cancer (TCC, G3, > pT2), which resulted in disease progression. Eight courses of GC followed by six courses of GCD were administrated via intra-hepatic arterial infusion. Partial response was obtained and maintained for 12 months. Although the response duration was still short, GC and GCD may be promising salvage chemotherapeutic regimens for the patients with MVAC-resistant liver metastases of urothelial carcinoma.