Takao Motoshi, Inoue Kentarou, Watanabe Fumiaki, Onoda Koji, Shimono Takatsugu, Shimpo Hideto, Yada Isao
Department of Thoracic Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
World J Surg Oncol. 2003 Jul 1;1(1):8. doi: 10.1186/1477-7819-1-8.
Bronchorrhea is one of late complaints in patients with bronchioloalveolar carcinoma (BAC) and hampers their quality of life. Although an effective treatment for bronchorrhea in these patients has not been established, recently we have treated effectively one case of persistent bronchorrhea associated with clinical recurrent BAC with gefitinib (ZD1839, 'Iressa trade mark '; AstraZeneca Japan; Osaka, Japan). CASE PRESENTATION: A 63-year-old Japanese female had undergone left pneumonectomy with radical lymph node dissection (ND2a) for diffuse type bronchioloalveolar carcinoma originated in left lower lobe. Multiple pulmonary metastases in right lung were found one year after operation. Pulmonary metastatic lesion has grown and she complained of progressive symptoms of massive watery sputum and dyspnea, four years after operation. Although her symptom was getting worse in spite of routine treatment, it completely disappeared within 2 weeks of starting oral gefitinib. Thereafter, she has been symptom-free and shows good partial response on repeat scan after 9 months of oral gefitinib. CONCLUSIONS: The dramatic remission of persistent bronchorrhea by gefitinib in the presented case suggests that gefitinib might be a promising option for bronchioloalveolar carcinoma, particularly in cases with severe bronchorrhea. Although it is not possible to comment on whether the improvement came from tumor cell death itself or suppressive effect of mucin synthesis by the epidermal growth factor receptor-tyrosine kinase inhibitory action.
支气管黏液溢是细支气管肺泡癌（BAC）患者的晚期症状之一，会影响患者的生活质量。尽管尚未确立针对此类患者支气管黏液溢的有效治疗方法，但最近我们成功地用吉非替尼（ZD1839，“易瑞沙”商标；阿斯利康日本公司；日本大阪）治疗了一例与临床复发性BAC相关的持续性支气管黏液溢患者。病例报告：一名63岁日本女性因起源于左下叶的弥漫型细支气管肺泡癌接受了左肺切除术及根治性淋巴结清扫术（ND2a）。术后一年发现右肺多发肺转移。术后四年，肺转移病灶增大，她出现大量水样痰和呼吸困难的进行性症状。尽管常规治疗后症状仍在加重，但口服吉非替尼2周内症状完全消失。此后，她一直无症状，口服吉非替尼9个月后的复查扫描显示有良好的部分缓解。结论：该病例中吉非替尼使持续性支气管黏液溢显著缓解，提示吉非替尼可能是细支气管肺泡癌的一个有前景的选择，尤其是对于有严重支气管黏液溢的病例。尽管无法评论症状改善是源于肿瘤细胞自身死亡还是表皮生长因子受体 - 酪氨酸激酶抑制作用对黏蛋白合成的抑制效果。
