進行肝細胞癌に対するソラフェニブと肝動注化学療法の有効性および治療法選択
Child-Pugh分類Aかつ遠隔転移のない進行肝細胞癌に対して,治療法選択および後治療の有無が予後に影響するか検討した.一次治療としてHAICを施行した83例(HAIC開始群),Sorafenibを施行した53例(Sorafenib開始群),無治療で経過を観察した12例,合計148例を対象とした.HAIC開始群とSorafenib開始群の比較では,奏効率に有意差を認めたが(26.5% vs. 7.5%,P=0.007),腫瘍制御率と生存率には有意差を認めなかった.また,両群とも無治療群と比較して有意に生存期間の延長を認めた.さらに,後治療の有無により両治療群を副グループ化し追加検討した.結果...
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Published in | 肝臓 Vol. 54; no. 4; pp. 233 - 248 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | Japanese |
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一般社団法人 日本肝臓学会
2013
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Online Access | Get full text |
ISSN | 0451-4203 1881-3593 |
DOI | 10.2957/kanzo.54.233 |
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Abstract | Child-Pugh分類Aかつ遠隔転移のない進行肝細胞癌に対して,治療法選択および後治療の有無が予後に影響するか検討した.一次治療としてHAICを施行した83例(HAIC開始群),Sorafenibを施行した53例(Sorafenib開始群),無治療で経過を観察した12例,合計148例を対象とした.HAIC開始群とSorafenib開始群の比較では,奏効率に有意差を認めたが(26.5% vs. 7.5%,P=0.007),腫瘍制御率と生存率には有意差を認めなかった.また,両群とも無治療群と比較して有意に生存期間の延長を認めた.さらに,後治療の有無により両治療群を副グループ化し追加検討した.結果,Sorafenibで治療を開始し後治療が施行された症例は最も生存率が高く,多変量解析でも独立した予後因子であった([HR];0.144,P<0.001).また,Sorafenibから後治療(HAIC)へ移行するためには,Sorafenibの初期体重換算投与量:[13>―≥7(mg/kg/day)]が寄与因子であった.進行肝細胞癌は,体重を指標にSorafenibを先行投与しHAICへ移行することで予後の改善が得られる可能性がある. |
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AbstractList | Child-Pugh分類Aかつ遠隔転移のない進行肝細胞癌に対して,治療法選択および後治療の有無が予後に影響するか検討した.一次治療としてHAICを施行した83例(HAIC開始群),Sorafenibを施行した53例(Sorafenib開始群),無治療で経過を観察した12例,合計148例を対象とした.HAIC開始群とSorafenib開始群の比較では,奏効率に有意差を認めたが(26.5% vs. 7.5%,P=0.007),腫瘍制御率と生存率には有意差を認めなかった.また,両群とも無治療群と比較して有意に生存期間の延長を認めた.さらに,後治療の有無により両治療群を副グループ化し追加検討した.結果,Sorafenibで治療を開始し後治療が施行された症例は最も生存率が高く,多変量解析でも独立した予後因子であった([HR];0.144,P<0.001).また,Sorafenibから後治療(HAIC)へ移行するためには,Sorafenibの初期体重換算投与量:[13>―≥7(mg/kg/day)]が寄与因子であった.進行肝細胞癌は,体重を指標にSorafenibを先行投与しHAICへ移行することで予後の改善が得られる可能性がある. |
Author | 平峯, 靖也 庄, 幸彦 田原, 憲治 今村, 也寸志 坪内, 博仁 鐘撞, 一郎 玉井, 努 馬場, 芳郎 山下, 容雅 樋脇, 卓也 |
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References_xml | – reference: 45) 村上英介. 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(5): 322-324 – reference: 14) 赤座英之, 沖田 極, 飯島正文, 他. 「ネクサバール®適性使用ガイド 2009年版」 第一版, バイエル薬品 – reference: 18) Hansen TF, Christensen RD, Andersen RF, et al. The predictive value of single nucleotide polymorphisms in the VEGF system to the efficacy of first-line treatment with bevacizumab plus chemotherapy in patients with metastatic colorectal cancer: results from the Nordic ACT trial. Int J Colorectal Dis 2012; 27: 715-720 – reference: 21) Ibrahim N. Molecular target therapies for cancer: sorafenib mono-tyerapy and its combination with other therapies (review). Oncol Rep 2012; 27: 1303-1311 – reference: 27) Thomas R, Bernhard A, Philipp S, et al. Sorafenib attenuates the portal hypertensive syndrome in partial portal vein ligated rats. J Hepatol 2009; 51: 865-873 – reference: 49) Toh HC, Chen PJ, Carr BI, et al. Phase 2 trial of linifanib (ABT-869) in patients with unresectable or metastatic hepatocellular carcinoma. Cancer 2012 Jul 25. doi: 10.1002/cncr.27758 – reference: 15) Hiramine Y, Uto H, Imamura Y, et al. Sorafenib and hepatic arterial infusion chemotherapy for unresectable advanced hepatocellular carcinoma: A comparative study. Experimental and Therapeutic Medicine 2011; 2: 433-441 – reference: 4) Zhao JD, Liu J, Ren ZG, et al. Maintenance of Sorafenib following combined therapy of three-dimensional conformal radiation therapy/intensity-modulated radiation therapy and transcatheter arterial chemoembolization in patients with locally advanced hepatocellular carcinoma: a phase I/II study. Radiat Oncol 2010; 5: 12 – reference: 3) 「ネクサバール®錠200 mg 特定使用成績調査 第2回中間報告書(切除不能な肝細胞癌)」 バイエル薬品, 2012 – reference: 22) Kim C, Lee JL, Choi YH, et al. Phase I dose-finding study of sorafenib in combination with capecitabine and cisplatin as a first-line treatment in patients with advanced gastric cancer. Invest New Drugs 2012; 30: 306-315 – reference: 17) Gerger A, El-Khoueiry A, Zhang W, et al. Pharmacogenetic angiogenesis profiling for first-line Bevacizumab plus oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Clin Cancer Res 2011; 17: 5783-5792 – reference: 37) Urabe T, Kaneko S, Matsushita E, et al. Clinical pilot study of intrahepatic arterial chemotherapy with Methotrexate, 5-Fluorouracil, Cisplatin and subcutaneous Interferon-Alpha-2b for patients with locally advanced hepatocellular carcinoma. Oncology 1998; 55: 39-47 – reference: 26) Nagai H, Mukozu T, Matsui D, et al. Sorafenib prevents escape from host immunity in liver cirrhosis patients with advanced hepatocellular carcinoma. Clin Dev Immunol 2012; 2012: 607851 – reference: 38) Kuroda M, Kobayashi Y, Urawa N, et al. Hepatic arterial infusion of 5-Fluorouracil in combination with subcutaneous interferon-alpha for advanced hepatocellular carcinoma. Hepatogastroenterology 2007; 54: 518-521 – reference: 7) Kogure T, Iwasaki T, Ueno Y, et al. Complete remission of a case of hepatocellular carcinoma with tumor invasion in inferior vena cava and with pulmonary metastasis successfully treated with repeated arterial infusion chemotherapy. Hepatogastroenterology 2007; 54: 2113-2116 – reference: 31) Arrondeau J, Mir O, Boudou-Rouquette P, et al. Sorafenib exposure decreases over time in patients with hepatocellular carcinoma. Invest New Drugs 2011 Oct 29. [Epub ahead of print] – reference: 20) Abou-Alfa GK. Doxorubicin plus sorafenib vs doxorubicin alone in patients with advanced hepatocellular carcinoma: a randomized trial. JAMA 2010; 304: 2154-2160 – reference: 39) 平峯靖也, 宇都浩文, 今村也寸志, 他. 高度進行肝細胞癌に対する肝動注化学療法の検討. 日本消化器病学会雑誌 2010; 107: 1127-1138 – reference: 42) Sengupta B, Siddiqi SA. Hepatocellular Carcinoma: Important Biomarkers and their Significance in Molecular Diagnostics and Therapy. Curr Med Chem 2012; 19: 3722-3729 – reference: 46) 小山幸法, 波多野悦郎, 田浦康二郎, 他. 進行肝細胞癌に伴う下大静脈腫瘍栓,門脈腫瘍栓に対する放射線治療の有効性. 肝臓 2012; 53(8): 486-493 – reference: 2) 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: 19) Grothey A, Cutsem EV, Sobrero A, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet 2012 Nov 21. pii: S01406736 (12) 61900-X – reference: 48) Kanai F, Yoshida H, Tateishi R, et al. A phase I/II trial of the oral antiangiogenic agent TSU-68 in patients with advanced hepatocellular carcinoma. Cancer Chemother Pharmacol 2011; 67: 315-324 – reference: 43) Niizeki T, Sumie S, Torimura T, et al. Serum vascular endothelial growth factor as a predictor of response and survival in patients with advanced hepatocellular carcinoma undergoing hepatic arterial infusion chemotherapy. J Gastroenterol 2012; 47: 686-695 – reference: 30) Boudou-Rouquette P, Narjoz C, Golmard JL, et al. Early Sorafenib-Induced Toxicity Is Associated with Drug Exposure and UGTIA9 Genetic Polymorphism in Patients with Solid Tumors: A Preliminary Study. PLoS One 2012; 7: e42875 – reference: 44) Edeline J. Comparison of tumor response by response evaluation criteria in solid tumor (RECIST) and modified RECIST in patients treated with sorafenib for hepatocellular carcinoma. Cancer 2012; 118: 147-156 – reference: 35) Yamasaki T, Sakaida I. Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma and future treatments for the poor responders. Hepatol Res 2012; 42: 340-348 – reference: 11) Eisenhauer EA, Therasse P, Bogaerts J, et al. 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Validation of an HPLC-UV method for sorafenib determination in human plasma and application to cancer patients in routine clinical practice. J Pharm Biomed Anal 2009; 49: 1109-1114 – reference: 8) Ando E, Tanaka M, Yamashita F, et al. Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: analysis of 48 cases. Cancer 2002; 95: 588-595 – reference: 5) 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: 154-166 – reference: 9) Tanioka H, Tsuji A, Morita S, et al. Combinatin chemotherapy with continuous 5-fluorouracil and low-dose cisplatin infusion for advanced hepatocellular carcinoma. Anticancer Res 2003; 23: 1891-1897 – reference: 1) Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. 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SubjectTerms | ソラフェニブ 後治療 治療法選択 肝動注化学療法 進行肝細胞癌 |
Title | 進行肝細胞癌に対するソラフェニブと肝動注化学療法の有効性および治療法選択 |
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