尿路移行上皮癌に対するrG-CSF併用によるM-VAC療法のDose intensity

Abstract

転移性尿路上皮癌に対するrG-CSF併用によるM-VAC療法の効果をdose intensityによって検討した。rG-CSFを使用しないM-VAC療法のrelative dose intensityは平均72%であったが, rG-CSFの併用によりrelative dose intensityは平均88%となった。rG-CSFを使用しないM-VACの有効率は42%, rG-CSFの併用では73%であった。rG-CSFの治療的投与ではM-VAC療法における1cycleの期間を短縮することはできず, relative dose intensityの向上にはrG-CSFの計画的投与が必要である

The effect of M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy supported recombinant human granulocyte stimulating factor (rG-CSF) was studied in 18 patients with metastatic urothelal cancer. The mean age of the patients was 66 years. Of the patients 6 had lung metastasis and 12 had distant lymph node metastasis. In this study recombinant human granulocyte stimulating factor was administered therapeutically at 100 to 250 micrograms subcutaneously after the white blood cell count was less than 3, 000/mm. Relative dose-intensity (RDI) was 0.88 +/- 0.11 and 0.72 +/- 0.19 for 11 patients with rG-CSF and 7 without rG-CSF, respectively. The relative dose regardless of the interval of the cycle of M-VAC chemotherapy (%Dose) was 0.95 +/- 0.06 and 0.86 +/- 0.09 for the patients with rG-CSF and those without rG-CSF, respectively. Of seven patients without rG-CSF 3 patients responded (response rate 42%, mean survival period 7.4 months). Of 11 patients treated with rG-CSF 3 patients responded (response rate 72.7%, mean survival period 20.0 months). Although rG-CSF increased the RDI of M-VAC chemotherapy, the correlation of response with RDI was not clearly demonstrated. The therapeutical administrations of rG-CSF fail to improve the mean white blood cell nadir and to prevent the decrease of the platelet and reticulocyte count.