Sagawa Tamotsu, Sato Yasushi, Takayama Tetsuji, Kuroda Hiroyuki, Hirakawa Masahiro, Abe Seiichiro, Iyama Satoshi, Sakamaki Sumio, Kato Junji, Niitsu Yoshiro
Fourth Department of Internal Medicine, Sapporo Medical University School of Medicine.
Gan To Kagaku Ryoho. 2007 Sep;34(9):1467-71.
According to the National Comprehensive Cancer Network (NCCN) clinical practice guideline for gastric cancer (2006, the first edition), 5-FU/Leucovorin (LV), 5-FU-based, cisplatin (CDDP)-based, oxaliplatin (L-OHP)-based, taxane-based, and irinotecan (CPT-11)-based, ECF are recommended. We used modified FOLFOX 6 (mFOLFOX 6) for pretreatment, that is oxaliplatin-based chemotherapy, for a patient who had received 5-FU-based, CDDPbased, taxane-based, and CPT-11-based treatment for an unresectable gastric cancer case responding to mFOLFOX 6. A 73-year-old male admitted to our hospital for treatment of advanced gastric cancer was diagnosed to be inoperable. A combination chemotherapy docetaxel and CDDP and S-1 as first-line treatment, CPT-11 and CDDP as second-line treatment, weekly paclitaxel treatment as third-line treatment, and MTX and 5-FU as fourth-line treatment were performed. He had progressed after 5-FU-based, CDDP-based, taxane-based, and CPT-11-based chemotherapy. There are no effective approved drugs for gastric cancer in Japan. Oxaliplatin was reportedly effective for metastatic gastric cancer, but it is still non-approved in Japan. After receiving an explanation of oxaliplatin-based therapy, he gave informed consent. Oxaliplatin-based therapy for this patient was then evaluated and approved under an institutional review board of Higashi Sapporo Hospital. mFOLFOX 6 used for the oxaliplatin-based therapy. After 2 courses of mFOLFOX 6, he showed a partial response. Oxaliplatin-based treatment was thought to be promising for previously CDDP-treated patients with unresectable gastric cancers.
根据美国国立综合癌症网络（NCCN）胃癌临床实践指南（2006年第一版），推荐使用5-氟尿嘧啶/亚叶酸（LV）、基于5-氟尿嘧啶的、基于顺铂（CDDP）的、基于奥沙利铂（L-OHP）的、基于紫杉烷的、基于伊立替康（CPT-11）的以及ECF方案。对于一例不可切除的胃癌患者，该患者之前接受过基于5-氟尿嘧啶、顺铂、紫杉烷和伊立替康的治疗，我们采用改良FOLFOX 6（mFOLFOX 6）进行预处理，即基于奥沙利铂的化疗。一名因晚期胃癌入院治疗的73岁男性被诊断为无法手术。进行了多西他赛联合顺铂和S-1作为一线治疗、伊立替康联合顺铂作为二线治疗、每周紫杉醇治疗作为三线治疗以及甲氨蝶呤和5-氟尿嘧啶作为四线治疗。他在接受基于5-氟尿嘧啶、顺铂、紫杉烷和伊立替康的化疗后病情进展。在日本，尚无获批的有效胃癌药物。据报道奥沙利铂对转移性胃癌有效，但在日本仍未获批。在向他解释了基于奥沙利铂的治疗方案后，他签署了知情同意书。然后，在札幌东医院机构审查委员会的评估和批准下，对该患者进行了基于奥沙利铂的治疗。基于奥沙利铂的治疗采用mFOLFOX 6方案。经过2个疗程的mFOLFOX 6治疗后，他出现了部分缓解。基于奥沙利铂的治疗被认为对之前接受过顺铂治疗的不可切除胃癌患者有前景。
