Mizota Ayako, Shitara Kohei, Kondo Chihiro, Nomura Motoo, Yokota Tomoya, Takahari Daisuke, Ura Takashi, Muro Kei
Dept. of Clinical Oncology, Aichi Cancer Center Hospital, Japan.
Gan To Kagaku Ryoho. 2011 Jul;38(7):1205-8.
The prognosis of patients with advanced colorectal cancer with icterus is dismally poor, and adequate chemotherapy for these patients has not been established yet. A 59-year-old male with fatigue, anorexia and icterus with serum total bilirubin 9.7 mg/dL was referred to our institution. He was diagnosed with advanced sigmoid colon cancer with multiple liver metastases. A biopsy specimen of the primary tumor showed well-differentiated adenocarcinoma without KRAS mutation. Since biliary drainage was impossible due to diffuse liver metastases, we initiated combination chemotherapy with 5-fluorouracil, Leucovorin, oxaliplatin (modified FOLFOX6) and cetuximab. The doses of 5-fluorouracil and oxaliplatin were reduced, but cetuximab was administered at the standard dosage. After 3 courses of chemotherapy, total bilirubin dropped to 0.8 mg/dL. No significant toxicity other than grade-2 skin toxicity and neuropathy was observed, and the patient has continued chemotherapy on an outpatient basis. Combination chemotherapy with mFOLFOX6 plus cetuximab was effective and feasible in this case of metastatic colon cancer with icterus due to diffuse liver metastasis.
晚期结直肠癌伴黄疸患者的预后极差，目前尚未确立针对这些患者的充分化疗方案。一名59岁男性因疲劳、厌食及黄疸就诊于我院，血清总胆红素为9.7mg/dL。他被诊断为晚期乙状结肠癌伴多发肝转移。原发肿瘤活检标本显示为高分化腺癌，无KRAS突变。由于弥漫性肝转移无法进行胆道引流，我们开始使用5-氟尿嘧啶、亚叶酸钙、奥沙利铂（改良FOLFOX6）和西妥昔单抗进行联合化疗。5-氟尿嘧啶和奥沙利铂的剂量减少，但西妥昔单抗按标准剂量给药。3个疗程化疗后，总胆红素降至0.8mg/dL。除2级皮肤毒性和神经病变外，未观察到明显毒性，患者已在门诊继续化疗。在本例因弥漫性肝转移导致黄疸的转移性结肠癌中，mFOLFOX6联合西妥昔单抗的联合化疗有效且可行。
