進行尿路上皮癌に対するModified M-VAC療法(21日周期)の治療成績

Abstract

進行尿路上皮癌に対してmodified M-VAC療法を考案・施行した.1999年1月～2002年6月までに経験した進行尿路上皮癌17例を対象としてM-VAC原法と同様, 第1日目にmethotrexate(30mg/m2)を, 第2日目にvinblastine(3mg/m2), doxorubicin(30mg/m2)とcisplatin(70mg/m2)を投与し, 15日目と22日目を省略するmodified M-VAC療法を行った.1サイクル21日間として最大6サイクル(中央値4サイクル)を施行した結果, 奏効症例は完全寛解2例(12%), 部分寛解10例(59%), 奏効率71%, no evidence of disease8例(47%)とM-VAC原法と同様の効果が得られた.施行中grade3の白血球減少を71%に, grade4のそれを14%に認め, 症例の87%にG-CSFが投与されたものの, 全例で投薬の延期, 省略や減量を行うことなく予定治療の施行と治療期間の短縮が可能であった.しかし, 長期生存に関しては満足できる結果ではなかった

Although M-VAC therapy is a standard chemotherapy for advanced transitional cell carcinoma, the treatment schedule has to be delayed or cancelled in many patients because of the toxicity. To reduce the toxicity we modified the treatment schedule of M-VAC treatment. The dosages of this simplified M-VAC therapy were 30 mg/m2 methotrexate (on day 1), 3 mg/m2 vinblastine (on day 2), 30 mg/m2 doxorubicin (on day 2) and 70 mg/m2 cisplatin (on day 2), with courses repeated every 21 days for four cycles as a principle. Seventeen patients with histologically proven advanced transitional cell carcinoma were treated with this simplified M-VAC therapy without dose modification or delay. The median number of cycles was 4. Neutropenia, anemia and thrombopenia (grade 4) was observed in 2, 1 and 2 patients respectively, but no drug-related deaths were observed. Complete response and partial response were achieved in 2 (12%) and 10 (59%) patients respectively. Of 2 complete responders one patient was alive without evidence of disease at 12 months and another patient died of the disease at 42 months. Of 10 partial responders 6 patients underwent the additional surgical resection of residual tumors. Of these 6 patients 3 patients are alive without evidence of disease at 6, 30 and 31 months. The remaining 3 developed recurrence and 2 died of the disease at 13 and 29 months. Five non-responders died of the disease at 5 months after the start of the therapy. Response rate of simplified M-VAC therapy was excellent and treatment duration was short. However, relapses were commonly observed as well as the original M-VAC treatment.