進行期尿路上皮癌に対するVincristine, Peplomycin, Methotrexate, cis-Diamminedichloroplatinum (2),Cytosine Arabinoside, 5-Fluorouracilからなる6者併用化学療法(VPM-CisCF)

Abstract

1) Vincristine, peplomycin, methotrexate, cis-diamminedichloroplatinum (2), cytosine arabinoside, 5-FUからなる6者併用化学療法を, 進行期尿路上皮癌17例に施行した.2)膀胱癌15例, 腎盂・尿管癌各1例で, 移行上皮癌16例, 扁平上皮癌と移行上皮癌の混合型1例であった.3)多剤併用療法は, 2週間投与1週休薬の第1法と, 1週間投与2週休薬の第2法投与の2種類あるが, 第1法投与症例6例中complete response (CR) 1例, partial response (PR) 3例(動注例2例), minor response (MR) 1例, no change (NC) 1例(動注例)であった.第2法投与症例11例中PR 4例, MR 2例, NC 3例, progressive disease 2例であった.4)副作用は悪心・嘔吐がほぼ全例に認められたが, 重篤なものはなく耐えうるものであった.Dose limiting factorとしては, 骨髄抑制であり, 約30%に認められたが耐えうるものであった.第1法動注投与84歳の症例に可逆性の肺腺維症をみとめた.5)効果および副作用の点で, 第2法投与がより有用である

Two VPM-CisCF chemotherapy regimens (vincristine (VCR), peplomycin (PEP), methotrexate (MTX), cis-diamminedichloroplatinum (II) (CDDP), cytosine arabinoside (Ara-C) and 5-fluorouracil (5-FU), established using human bladder cancer xenografts in nude mice were applied for advanced urothelial cancer. VPM-CisCF (I) consisted of 0.4 mg/m2 VCR on days 1 and 4, 2 mg/m2 PEP on days 1-7, 2 mg/m2 MTX on days 2, 3, 5 and 6, 20 mg/m2 CDDP on days 8, 20 mg/m2 Ara-C on days 8 and 13, and 150 mg/m2 5-FU on days 10-12. VPM-CisCF (II) consisted of 0.6 mg/m2 VCR on days 1 and 3, 3 mg/m2 PEP on days 1-4, 3 mg/m2 MTX on days 2 and 3, 35 mg/m2 CDDP on day 4, 20 mg/m2 Ara-C on days 4 and 7, and 200 mg/m2 5-FU on days 5 and 6. These doses were adjusted for each case: the above mentioned dose x [(80/(40 + Age))2 + (Karnofsky's performance status/100)2]. VPM-CisCF (I) was administered to 6 patients (bladder cancer and transitional cell carcinoma), intra-arterially in two cases. One patient showed a complete response and survived for 7 months, three partial response (PR) surviving for 13, 8 and 37 (arterial-infused case) months, one showed minor response (MR) surviving for 4 months, and one had no change (NC) surviving for 5 months. VPM-CisCF (II) was administered to 11 patients (1 ureteral cancer, 1 renal pelvic cancer, 9 bladder cancer, and 10 transitional cell carcinoma except a case of mixed type of transitional cell carcinoma and squamous cell carcinoma). Four of the patients who had PR survived for 9, 8, 8 and 7 (alive) months, two who had MR survived for 8 and 4 months, three who had NC survived for 6, 4 and 4 months, and who two had progressive disease survived for 8 and 6 months. The major toxicities were myelosuppression and gastrointestinal symptoms, especially nausea and vomiting, but the treatment was well-tolerated.