周術期にニンテダニブからピルフェニドンへ薬剤変更した特発性肺線維症合併肺癌の一切除例
背景．抗線維化薬であるニンテダニブとピルフェニドンは特発性肺線維症の治療に重要である．また，特発性肺線維症合併肺癌の手術は，急性増悪の危険性があり慎重な対応を要する．症例．68歳，男性．5年5ヵ月前に特発性肺線維症合併肺癌に対し右下葉切除および右上葉楔状切除術を施行し，切除肺に病理学的に通常型間質性肺炎所見を認めた．術後5年頃に特発性肺線維症が進行しニンテダニブによる治療を開始，同時期に左肺下葉異時性重複肺癌を疑う病変を認め手術の方針となった．特発性肺線維症に対しては周術期も抗線維化薬の継続が望ましいと判断したが，ニンテダニブは創傷治癒遅延の可能性があり周術期の安全性は確立されていないため，周...
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| Published in | 日本呼吸器外科学会雑誌 Vol. 38; no. 5; pp. 446 - 452 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本呼吸器外科学会
15.07.2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0919-0945 1881-4158 |
| DOI | 10.2995/jacsurg.38.446 |
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| Abstract | 背景．抗線維化薬であるニンテダニブとピルフェニドンは特発性肺線維症の治療に重要である．また，特発性肺線維症合併肺癌の手術は，急性増悪の危険性があり慎重な対応を要する．症例．68歳，男性．5年5ヵ月前に特発性肺線維症合併肺癌に対し右下葉切除および右上葉楔状切除術を施行し，切除肺に病理学的に通常型間質性肺炎所見を認めた．術後5年頃に特発性肺線維症が進行しニンテダニブによる治療を開始，同時期に左肺下葉異時性重複肺癌を疑う病変を認め手術の方針となった．特発性肺線維症に対しては周術期も抗線維化薬の継続が望ましいと判断したが，ニンテダニブは創傷治癒遅延の可能性があり周術期の安全性は確立されていないため，周術期に使用可能なピルフェニドンに薬剤を変更した．その後左下葉楔状切除術を施行し，術後経過は良好だった．結論．術前にニンテダニブからピルフェニドンへ薬剤変更した特発性肺線維症合併肺癌の症例を経験した． |
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| AbstractList | 背景．抗線維化薬であるニンテダニブとピルフェニドンは特発性肺線維症の治療に重要である．また，特発性肺線維症合併肺癌の手術は，急性増悪の危険性があり慎重な対応を要する．症例．68歳，男性．5年5ヵ月前に特発性肺線維症合併肺癌に対し右下葉切除および右上葉楔状切除術を施行し，切除肺に病理学的に通常型間質性肺炎所見を認めた．術後5年頃に特発性肺線維症が進行しニンテダニブによる治療を開始，同時期に左肺下葉異時性重複肺癌を疑う病変を認め手術の方針となった．特発性肺線維症に対しては周術期も抗線維化薬の継続が望ましいと判断したが，ニンテダニブは創傷治癒遅延の可能性があり周術期の安全性は確立されていないため，周術期に使用可能なピルフェニドンに薬剤を変更した．その後左下葉楔状切除術を施行し，術後経過は良好だった．結論．術前にニンテダニブからピルフェニドンへ薬剤変更した特発性肺線維症合併肺癌の症例を経験した． |
| Author | 安部, 光洋 岩田, 剛和 小野里, 優希 松井, 由紀子 植松, 靖文 山本, 高義 |
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| References | 3. Maher TM, Strek ME. Antifibrotic therapy for idiopathic pulmonary fibrosis: time to treat. Respir Res 2019; 20: 205. 8. Iwata T, Yoshino I, Yoshida S, Ikeda N, Tsuboi M, Asato Y, et al. A phase II trial evaluating the efficacy and safety of perioperative pirfenidone for prevention of acute exacerbation of idiopathic pulmonary fibrosis in lung cancer patients undergoing pulmonary resection: West Japan Oncology Group 6711L (PEOPLE Study). Respir Res 2016; 17: 90. 13. Natsuizaka M, Chiba H, Kuronuma K, Otsuka M, Kudo K, Mori M, et al. Epidemiologic survey of Japanese patients with idiopathic pulmonary fibrosis and investigation of ethnic differences. Am J Respir Crit Care Med 2014; 190: 773-9. 21. Vancheri C, Kreuter M, Richeldi L, Ryerson CJ, Valeyre D, Grutters JC, et al. Nintedanib with add-on pirfenidone in idiopathic pulmonary fibrosis. Results of the INJOURNEY trial. Am J Respir Crit Care Med 2018; 197: 356-63. 11. 伊達洋至, 佐藤寿彦, 渡辺 敦, 近藤晴彦. 肺癌の背景に見られる間質性肺炎をどう診断しマネージするか-外科的立場から-. 肺癌 2015; 55: 900-4. 2. King TE Jr, Bradford WZ, Castro-Bernardini S, Fagan EA, Glaspole I, Glassberg MK, et al. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med 2014; 370: 2083-92. 19. Tanaka K, Tsutani Y, Wakabayashi M, Mizutani T, Aokage K, Miyata Y, et al. Sublobar resection versus lobectomy for patients with resectable stage I non-small cell lung cancer with idiopathic pulmonary fibrosis: a phase III study evaluating survival (JCOG1708, SURPRISE). Jpn J Clin Oncol 2020; 50: 1076-9. 9. Iwata T, Yoshida S, Fujiwara T, Wada H, Nakajima T, Suzuki H, et al. Effect of perioperative pirfenidone treatment in lung cancer patients with idiopathic pulmonary fibrosis. Ann Thorac Surg 2016; 102: 1905-10. 15. Watanabe N, Taniguchi H, Kondoh Y, Kimura T, Kataoka K, Nishiyama O, et al. Efficacy of chemotherapy for advanced non-small cell lung cancer with idiopathic pulmonary fibrosis. Respiration 2013; 85: 326-31. 17. Sato T, Watanabe A, Kondo H, Kanzaki M, Okubo K, Yokoi K, et al. Long-term results and predictors of survival after surgical resection of patients with lung cancer and interstitial lung diseases. J Thorac Cardiovasc Surg 2015; 149: 64-70.e1-2. 10. Sato T, Kondo H, Watanabe A, Nakajima J, Niwa H, Horio H, et al. A simple risk scoring system for predicting acute exacerbation of interstitial pneumonia after pulmonary resection in lung cancer patients. Gen Thorac Cardiovasc Surg 2015; 63: 164-72. 16. Sato T, Teramukai S, Kondo H, Watanabe A, Ebina M, Kishi K, et al. Impact and predictors of acute exacerbation of interstitial lung diseases after pulmonary resection for lung cancer. J Thorac Cardiovasc Surg 2014; 147: 1604-11. 5. Omori T, Tajiri M, Baba T, Ogura T, Iwasawa T, Okudela K, et al. Pulmonary resection for lung cancer in patients with idiopathic interstitial pneumonia. Ann Thorac Surg 2015; 100: 954-60. 7. Sato S, Shimizu Y, Goto T, Kitahara A, Koike T, Ishikawa H, et al. Survival after repeated surgery for lung cancer with idiopathic pulmonary fibrosis: a retrospective study. BMC Pulm Med 2018; 18: 134. 20. Sakairi Y, Yoshino I, Iwata T, Yosihda S, Kuwano K, Azuma A, et al. A randomized controlled phase III trial protocol: perioperative pirfenidone therapy in patients with non-small cell lung cancer combined with idiopathic pulmonary fibrosis to confirm the preventative effect against postoperative acute exacerbation: the PIII-PEOPLE study (NEJ034). J Thorac Dis 2023; 15: 1486-93. 12. 「特発性肺線維症の治療ガイドライン」作成委員会編. 日本呼吸器学会, 厚生労働科学研究費補助金難治性疾患政策研究事業「びまん性肺疾患に関する調査研究」班監修. 特発性肺線維症の治療ガイドライン2023. 改訂第2版. 東京: 南江堂; 2023. 4. Moor CC, Mostard RLM, Grutters JC, Bresser P, Aerts JGJV, Dirksen CD, et al. Patient expectations, experiences and satisfaction with nintedanib and pirfenidone in idiopathic pulmonary fibrosis: a quantitative study. Respir Res 2020; 21: 196. 18. Tsutani Y, Mimura T, Kai Y, Ito M, Misumi K, Miyata Y, et al. Outcomes after lobar versus sublobar resection for clinical stage I non-small cell lung cancer in patients with interstitial lung disease. J Thorac Cardiovasc Surg 2017; 154: 1089-96. 1. Richeldi L, du Bois RM, Raghu G, Azuma A, Brown KK, Costabel U, et al. Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med 2014; 370: 2071-82. 14. Lee YH, Kim YS, Lee SN, Lee HC, Oh SJ, Kim SJ, et al. Interstitial Lung Change in Pre-radiation Therapy Computed Tomography Is a Risk Factor for Severe Radiation Pneumonitis. Cancer Res Treat 2015; 47: 676-86. 6. Saito Y, Kawai Y, Takahashi N, Ikeya T, Murai K, Kawabata Y, et al. Survival after surgery for pathologic stage IA non-small cell lung cancer associated with idiopathic pulmonary fibrosis. Ann Thorac Surg 2011; 92: 1812-7. |
| References_xml | – reference: 8. Iwata T, Yoshino I, Yoshida S, Ikeda N, Tsuboi M, Asato Y, et al. A phase II trial evaluating the efficacy and safety of perioperative pirfenidone for prevention of acute exacerbation of idiopathic pulmonary fibrosis in lung cancer patients undergoing pulmonary resection: West Japan Oncology Group 6711L (PEOPLE Study). Respir Res 2016; 17: 90. – reference: 13. Natsuizaka M, Chiba H, Kuronuma K, Otsuka M, Kudo K, Mori M, et al. Epidemiologic survey of Japanese patients with idiopathic pulmonary fibrosis and investigation of ethnic differences. Am J Respir Crit Care Med 2014; 190: 773-9. – reference: 11. 伊達洋至, 佐藤寿彦, 渡辺 敦, 近藤晴彦. 肺癌の背景に見られる間質性肺炎をどう診断しマネージするか-外科的立場から-. 肺癌 2015; 55: 900-4. – reference: 9. Iwata T, Yoshida S, Fujiwara T, Wada H, Nakajima T, Suzuki H, et al. Effect of perioperative pirfenidone treatment in lung cancer patients with idiopathic pulmonary fibrosis. Ann Thorac Surg 2016; 102: 1905-10. – reference: 6. Saito Y, Kawai Y, Takahashi N, Ikeya T, Murai K, Kawabata Y, et al. Survival after surgery for pathologic stage IA non-small cell lung cancer associated with idiopathic pulmonary fibrosis. Ann Thorac Surg 2011; 92: 1812-7. – reference: 12. 「特発性肺線維症の治療ガイドライン」作成委員会編. 日本呼吸器学会, 厚生労働科学研究費補助金難治性疾患政策研究事業「びまん性肺疾患に関する調査研究」班監修. 特発性肺線維症の治療ガイドライン2023. 改訂第2版. 東京: 南江堂; 2023. – reference: 1. Richeldi L, du Bois RM, Raghu G, Azuma A, Brown KK, Costabel U, et al. Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med 2014; 370: 2071-82. – reference: 5. Omori T, Tajiri M, Baba T, Ogura T, Iwasawa T, Okudela K, et al. Pulmonary resection for lung cancer in patients with idiopathic interstitial pneumonia. Ann Thorac Surg 2015; 100: 954-60. – reference: 14. Lee YH, Kim YS, Lee SN, Lee HC, Oh SJ, Kim SJ, et al. Interstitial Lung Change in Pre-radiation Therapy Computed Tomography Is a Risk Factor for Severe Radiation Pneumonitis. Cancer Res Treat 2015; 47: 676-86. – reference: 21. Vancheri C, Kreuter M, Richeldi L, Ryerson CJ, Valeyre D, Grutters JC, et al. Nintedanib with add-on pirfenidone in idiopathic pulmonary fibrosis. Results of the INJOURNEY trial. Am J Respir Crit Care Med 2018; 197: 356-63. – reference: 17. Sato T, Watanabe A, Kondo H, Kanzaki M, Okubo K, Yokoi K, et al. Long-term results and predictors of survival after surgical resection of patients with lung cancer and interstitial lung diseases. J Thorac Cardiovasc Surg 2015; 149: 64-70.e1-2. – reference: 16. Sato T, Teramukai S, Kondo H, Watanabe A, Ebina M, Kishi K, et al. Impact and predictors of acute exacerbation of interstitial lung diseases after pulmonary resection for lung cancer. J Thorac Cardiovasc Surg 2014; 147: 1604-11. – reference: 19. Tanaka K, Tsutani Y, Wakabayashi M, Mizutani T, Aokage K, Miyata Y, et al. Sublobar resection versus lobectomy for patients with resectable stage I non-small cell lung cancer with idiopathic pulmonary fibrosis: a phase III study evaluating survival (JCOG1708, SURPRISE). Jpn J Clin Oncol 2020; 50: 1076-9. – reference: 20. Sakairi Y, Yoshino I, Iwata T, Yosihda S, Kuwano K, Azuma A, et al. A randomized controlled phase III trial protocol: perioperative pirfenidone therapy in patients with non-small cell lung cancer combined with idiopathic pulmonary fibrosis to confirm the preventative effect against postoperative acute exacerbation: the PIII-PEOPLE study (NEJ034). J Thorac Dis 2023; 15: 1486-93. – reference: 7. Sato S, Shimizu Y, Goto T, Kitahara A, Koike T, Ishikawa H, et al. Survival after repeated surgery for lung cancer with idiopathic pulmonary fibrosis: a retrospective study. BMC Pulm Med 2018; 18: 134. – reference: 15. Watanabe N, Taniguchi H, Kondoh Y, Kimura T, Kataoka K, Nishiyama O, et al. Efficacy of chemotherapy for advanced non-small cell lung cancer with idiopathic pulmonary fibrosis. Respiration 2013; 85: 326-31. – reference: 18. Tsutani Y, Mimura T, Kai Y, Ito M, Misumi K, Miyata Y, et al. Outcomes after lobar versus sublobar resection for clinical stage I non-small cell lung cancer in patients with interstitial lung disease. J Thorac Cardiovasc Surg 2017; 154: 1089-96. – reference: 4. Moor CC, Mostard RLM, Grutters JC, Bresser P, Aerts JGJV, Dirksen CD, et al. Patient expectations, experiences and satisfaction with nintedanib and pirfenidone in idiopathic pulmonary fibrosis: a quantitative study. Respir Res 2020; 21: 196. – reference: 10. Sato T, Kondo H, Watanabe A, Nakajima J, Niwa H, Horio H, et al. A simple risk scoring system for predicting acute exacerbation of interstitial pneumonia after pulmonary resection in lung cancer patients. Gen Thorac Cardiovasc Surg 2015; 63: 164-72. – reference: 2. King TE Jr, Bradford WZ, Castro-Bernardini S, Fagan EA, Glaspole I, Glassberg MK, et al. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med 2014; 370: 2083-92. – reference: 3. Maher TM, Strek ME. Antifibrotic therapy for idiopathic pulmonary fibrosis: time to treat. Respir Res 2019; 20: 205. |
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| SubjectTerms | ニンテダニブ ピルフェニドン 特発性肺線維症 肺癌 術後急性増悪 |
| Title | 周術期にニンテダニブからピルフェニドンへ薬剤変更した特発性肺線維症合併肺癌の一切除例 |
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