Cisplatin療法に伴う消化器症状に対するhydrocortisoneの効果について

Abstract

Cisplatin療法にhydrocortisone succinateを使用し, 消化器合併症を4段階評価で査定した.1) Cisplatin 7～20 mg/m2/日×5日間を中心とする多剤併用療法にhydrocortisone 900～1, 800 mg/日を使用した場合, 嘔気, 嘔吐回数, 食欲不振の症状は有意に軽減した.2) Cisplatin 30～40 mg/m2/日×1日を中心とする多剤併用療法では, hydrocortisone 1, 500～2, 400 mgの使用は, 化学療法日の嘔吐回数を改善しなかった.3)大量のhydrocortisoneが5日間連用された場合, 液性免疫の低下が認められた

The effect of high-dose hydrocortisone on the emesis of patients treated with cisplatin was examined by controlled trial on 37 patients and 52 courses of chemotherapy with cisplatin combined with other cytotoxic drugs. Patients received either high-dose hydrocortisone or standard-dose of conventional antiemetics 30 minutes before chemotherapy, 4 hours after chemotherapy, and an additional dose was followed 8 hours after chemotherapy in some instances. Hydrocortisone in a dosage of 900-1, 800 mg reduced cisplatin-induced nausea, vomiting and anorexia significantly when the dose of cisplatin was less than 20 mg/m2. At the dose of 1, 500-2, 400 mg, hydrocortisone had no efficacy for the gastro-intestinal toxicity when 30-40 mg/m2 of cisplatin was administered. After the high-dose hydrocortisone treatment for five days successively, the serum immunoglobulin level was lowered significantly. This study showed that high-dose hydrocortisone treatment was effective as an antiemetic in patients given a relatively low dose of cisplatin. However, prolonged use of high-dose steroids should be avoided. Other effective antiemetics such as metoclopramide with concomitant use of hydrocortisone would be helpful.