ソラフェニブ投与開始直後は進行（PD）であったが，少量投与にて4カ月以後に著明な抗腫瘍効果を認めた肝細胞癌の1例
症例は79歳女性．多発肝細胞癌に対しTACEを繰り返していたが，肝細胞癌の増加増大を認めTACE不応例と判断した．肝予備能がChild-Pugh grade Aであったためソラフェニブ800 mg/日の投与を開始したが，投与開始1週間後にgrade 2の手足症候群，筋肉痛および肝酵素の上昇を認め，400 mg/日に減量した．投与2カ月後のCTでは，多発する腫瘍の更なる増加増大を認め，進行（PD）と判断した．投与2.5カ月後に再度のgrade 2の手足症候群のため200 mg/日へと減量した．投与4カ月後のCTでは，腫瘍は著明な縮小傾向を示し，部分奏効（PR）に転じた．また，AFP，PIVKA-...
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| Published in | 肝臓 Vol. 53; no. 9; pp. 564 - 569 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本肝臓学会
2012
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0451-4203 1881-3593 |
| DOI | 10.2957/kanzo.53.564 |
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| Abstract | 症例は79歳女性．多発肝細胞癌に対しTACEを繰り返していたが，肝細胞癌の増加増大を認めTACE不応例と判断した．肝予備能がChild-Pugh grade Aであったためソラフェニブ800 mg/日の投与を開始したが，投与開始1週間後にgrade 2の手足症候群，筋肉痛および肝酵素の上昇を認め，400 mg/日に減量した．投与2カ月後のCTでは，多発する腫瘍の更なる増加増大を認め，進行（PD）と判断した．投与2.5カ月後に再度のgrade 2の手足症候群のため200 mg/日へと減量した．投与4カ月後のCTでは，腫瘍は著明な縮小傾向を示し，部分奏効（PR）に転じた．また，AFP，PIVKA-IIも投与3カ月目までは増加傾向を示していたが，4カ月後には減少に転じた．投与9カ月後の現在までソラフェニブ200 mg/日での加療を継続し，RECIST基準にてPRが得られている．本例は投与4カ月後にPDからPRに転じ，少量にても著明な腫瘍縮小効果がみられている. |
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| AbstractList | 症例は79歳女性．多発肝細胞癌に対しTACEを繰り返していたが，肝細胞癌の増加増大を認めTACE不応例と判断した．肝予備能がChild-Pugh grade Aであったためソラフェニブ800 mg/日の投与を開始したが，投与開始1週間後にgrade 2の手足症候群，筋肉痛および肝酵素の上昇を認め，400 mg/日に減量した．投与2カ月後のCTでは，多発する腫瘍の更なる増加増大を認め，進行（PD）と判断した．投与2.5カ月後に再度のgrade 2の手足症候群のため200 mg/日へと減量した．投与4カ月後のCTでは，腫瘍は著明な縮小傾向を示し，部分奏効（PR）に転じた．また，AFP，PIVKA-IIも投与3カ月目までは増加傾向を示していたが，4カ月後には減少に転じた．投与9カ月後の現在までソラフェニブ200 mg/日での加療を継続し，RECIST基準にてPRが得られている．本例は投与4カ月後にPDからPRに転じ，少量にても著明な腫瘍縮小効果がみられている. |
| Author | 阿部, 慎太郎 原田, 大 日浦, 政明 大江, 晋司 柴田, 道彦 本間, 雄一 田原, 章成 |
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| References_xml | – reference: 3) Liu L, Cao Y, Chen C, et al. Sorafenib blocks the RAF/MEK/ERK pathway, inhibits tumor angiogenesis, and induces tumor cell apoptosis in hepatocellular carcinoma model PLC/PRF/5. Cancer Res 2006; 66: 11851-11858 – reference: 4) Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008; 359: 378-390 – reference: 16) Kudo M, Imanaka K, Chida N, et al. Phase III study of sorafenib after transarterial chemoembolisation in Japanese and Korean patients with unresectable hepatocellular carcinoma. Eur J Cancer 2011; 47: 2117-2127 – reference: 18) Okuwaki Y, Nakazawa T, Hidaka H, et al. Late-onset benefit in progressive advanced hepatocellular carcinoma with continued sorafenib therapy: a case report. J Med Case Rep 2012; 6: 38 – reference: 20) Naito S, Tsukamoto T, Murai M, et al. Overall survival and good tolerability of long-term use of sorafenib after cytokine treatment: final results of a phase II trial of sorafenib in Japanese patients with metastatic renal cell carcinoma. BJU Int 2011; 108: 1813-1819 – reference: 13) 上嶋一臣, 工藤正俊. PIVKA-IIはSorafenibの治療効果予測因子になりうる. 肝臓 2010; 51: 681-683 – reference: 2) Chang YS, Adnane J, Trail PA, et al. Sorafenib (bay 43-9006) inhibits tumor growth and vascularization and induces tumor apoptosis and hypoxia in RCC xenograft models. Cancer Chemother Pharmacol 2007; 59: 561-574 – reference: 8) Arii S, Sata M, Sakamoto M, et al. Management of hepatocellular carcinoma: Report of Consensus Meeting in the 45th Annual Meeting of the Japan Society of Hepatology (2009). Hepatol Res 2010; 40: 667-685 – reference: 17) Morimoto M, Numata K, Kondo M, et al. Higher discontinuation and lower survival rates are likely in elderly Japanese patients with advanced hepatocellular carcinoma receiving sorafenib. Hepatol Res 2011; 41: 296-302 – reference: 6) Cheng AL, Kang YK, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomized, double-blind, placebo-controlled trial. Lancet Oncol 2009; 10: 25-34 – reference: 5) Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumors: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45: 228-247 – reference: 11) Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53: 1020-1022 – reference: 19) Zhang L, Bhasin M, Schor-Bardach R, et al. Resistance of renal cell carcinoma to sorafenib is mediated by potentially reversible gene expression. PLoS One 2011; 6: e19144 – reference: 14) Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010; 30: 52-60 – reference: 9) 工藤正俊. TACE不応例に対する治療指針. 「肝癌診療マニュアル第2版」 日本肝臓学会編, 医学書院, 東京, 2010, p118-121 – reference: 10) 金子周一, 古瀬純司, 工藤正俊, 他. 肝がんに対する新規抗がん剤使用に関する指針2010年度版. 肝臓 2011; 52: 532-551 – reference: 7) Kudo M. The 2008 Okuda lecture: Management of hepatocellular carcinoma: from surveillance to molecular targeted therapy. J Gastroenterol Hepatol 2010; 25: 439-452 – reference: 15) Kudo M, Ueshima K. Positioning of a molecular-targeted agent, sorafenib, in the treatment algorithm for hepatocellular carcinoma and implication of many complete remission cases in Japan. Oncology 2010; 78: S154-166 – reference: 1) Wilhelm SM, Carter C, Tang L, et al. Bay 43-9006 exhibits broad spectrum oral antitumor activity and targets the RAF/MEK/ERK pathway and receptor tyrosine kinases involved in tumor progression and angiogenesis. Cancer Res 2004; 64: 7099-7109 – reference: 12) 村上英介, 相方 浩, 宮木大輔, 他. 肝細胞癌のソラフェニブ治療効果判定におけるRECIST，modified RECIST，RECICL基準の比較. 肝臓 2011; 52: 322-324 |
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| Snippet | 症例は79歳女性．多発肝細胞癌に対しTACEを繰り返していたが，肝細胞癌の増加増大を認めTACE不応例と判断した．肝予備能がChild-Pugh grade Aであったためソラフェニブ800 mg/日の投与を開始したが，投与開始1週間後にgrade 2の手足症候群，筋肉痛および肝酵素の上昇を認め，400... |
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| StartPage | 564 |
| SubjectTerms | ソラフェニブ 奏効 少量 肝細胞癌 進行 |
| Title | ソラフェニブ投与開始直後は進行（PD）であったが，少量投与にて4カ月以後に著明な抗腫瘍効果を認めた肝細胞癌の1例 |
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