尿路性器進行癌に対するcis-Diamminedichloroplatinum(2) (CDDP)の治療成績

Abstract

Twenty-seven patients with advanced urogenital cancer, 14 prostatic adenocarcinoma, 5 urinary bladder cancer, 3 non-seminomatous testicular cancer, 1 prostatic transitional cell carcinoma, 1 urethral squamous cell carcinoma, 1 vVilms' tumor, 1 renal cell carcinoma, 1 penile cancer were treated with cis-diamminedichloroplatinum (II) (CDDP). Of 14 prostatic adenocarcinoma, 7 cases were received CDDP single treatment and 7 cases were received CDDP combined treatment with bil. orchiectomy, diethylstilbestrol diphosphate, futraful and picibanyl. Complete response was not observed, but partial responses were observed in 4 cases in single treatment group and 3 cases in combined treatment group. Overall response rate was 50% in advanced prostatic cancers with CDDP treatment, and response rate was 57% with single treatment and 43% with combined treatment. Of 7 cases with CDDP single treatment, however, 5 cases had been received bil. orchiectomy previously, so that response rate was 58% in the patients group with bil. orchiectomy, and no objective response was observed in 2 patients without bil. orchiectomy. Non-seminomatous testicular cancers well responsed to Einhorn's PVB regimen, CDDP, vinblastine and bleomycin. Complete responses were achieved in 2 patients with retroperitoneallymphadnectomy followed by CDDP combined treatment, and partial response was observed in a patient whose multiple bulky lung metastasis regressed remarkably, by 2 courses of CDDP combined treatment. The patient died of cancer 13 months after the CDDP treatment. Urinary bladder cancers responsed to CDDP single treatment. Complete response was not observed, but partial response was in all 5 cases. Prostatic transitional cell carcinoma was achieved complete response with CDDP single treatment. Wilms' tumor with local recurrence, liver and lung metastasis also responsed to CDDP with vinblastine. However, penile cancer, urethral squamous cell carcinoma and renal cell carcinoma did not response to CDDP treatment. In a view of the toxicity, moderate to severe nausea, vomiting and anorexia were observed in all cases during CDDP treatment and following several days. Nephrotoxity was mild in 4 cases and moderate in a case. Anemia was observed in 19 cases (70%), and leucopenia was observed in 8 cases (<3000) and 7 cases (<2000). In this study group, a prostatic cancer patient with liver and extensive bony metastasis died of severe pancytopenia. Peripheral neuropathy, muscle pain and alopecia were observed in all 4 cases treated with vinblastine and CDDP, but alopecia and muscle pain were not observed in other CDDP treatment, and mild peripheral neuropathy was observed in a patient treated without vinblastine. Azospermia was observed in a case treated with PVB regimen, and he was only a case who underwent semen examination. At present, we believe CDDP is one of the most promising chemotherapeutic agent for management of advanced urogenital cancers.