MVAC療法後の転移性尿路上皮癌に対するGemcitabine, Docetaxel, Carboplatin併用化学療法の検討

Abstract

MVAC療法後の転移性尿路上皮癌対し, 2次化学療法としてgemcitabine+docetaxel+carboplatinの3剤を併用したGDC療法を行い, その効果と有害事象を検討した。対象とした11症例は平均3.8コースを施行, 1コースあたり平均25.2日を要した。1)54%で腫瘍縮小効果があったが, 奏功期間は中央値3ヵ月と短く, MVAC療法後の症例にGDC療法を行う治療方針でのmedian survivalは13ヵ月であり, MVAC療法単独の成績と比べて著明な予後の改善は得られなかった。しかし, MVAC療法だけでは長期生存は望めないと予想されたが, GDC療法追加によって明らかに予後が改善したと思われた2症例があった。2)評価可能病変部位の部位別奏功率は, 肝, リンパ節が100%, 75%と高く, 肺の奏功率は0%であった。3)有害事象は, grade 3以上の白血球減少が69%, 血小板減少が47.6%と骨髄抑制がやや強く, 濃厚血小板輸血を全コースの35.7%, 全例の54.4%で必要とした。また, 下痢, 嘔吐・嘔気も比較的多く出現した。

From 2001 to 2006, 11 patients with MVAC-treated metastatic urothelial carcinoma received as a second-line therapy GDC therapy consisting of gemcitabine (1, 000 mg/m2) on day land 8, docetaxel (80 mg/m2) on day 1 and carboplatin (AUC 5) on day 1 in each 21-day cycle. The 11 patients received a total of 42 cycles. The median progression-free survival and the median overall survival were 3 months (range 0-51) and 10 months (range 2-51), respectively. The median overall survival from diagnosis of the metastasis was 13.0 months (range 7-55). Complete response and partial response rates were 1/11 (9%) and 5/11 (45%), respectively. One- and two-year survival rates were 36 and 9%, respectively. Grade 3 or 4 hematologic toxicity included neutropenia (69.0%), thrombocytopenia (47.6%) and anemia (45.2%). Non-hematologic toxicity of grade 3 or 4 consisted mainly of diarrhea (23.8%) and anorexia (21.4%). GDC regimen as a second-line chemotherapy was effective in 54% of patients with MVAC-treated metastatic urothelial carcinoma, although the high incidence of hematologic toxicities and short period of progression-free survival remain to be major problems.