Hoshino Hiroki, Ishii Yoshiyuki, Hasegawa Hirotoshi, Endo Takashi, Ochiai Hiroki, Hoshino Yoshinori, Matsunaga Atsushi, Shigeta Kohei, Seo Yuki, Hoshino Go, Kitagawa Yuko
Dept. of Surgery, Keio University School of Medicine.
Gan To Kagaku Ryoho. 2012 Jun;39(6):983-6.
As pharmacokinetics in patients undergoing haemodialysis is different from patients with normal renal function, it remains unclear whether chemotherapy can be performed safely for patients with haemodialysis as well as those who have normal renal function. Here, we report a case with recurrence of rectal cancer who received FOLFIRI with bevacizumab chemotherapy under haemodialysis, and obtained good tumor control. A 47-year-old woman had undergone haemodialysis for 10 years due to chronic renal failure. At 45 years of age, she received abdominoperineal resection due to rectal cancer (pStage II). Four months after the surgery, liver metastasis was found, for which partial resection of the liver and adjuvant chemotherapy [UFT (400 mg/body)/UZEL (75 mg/body)] were performed. Eighteen months after the liver resection, multiple lung metastases were found. Therefore, intensive chemotherapy using FOLFIRI (CPT-11: 90 mg/m2) with bevacizumab (2.5 mg/m2) was performed. Severe neutropenia (grade 3, 4), but not non-hematologic adverse events such as diarrhea and bevacizumab-specific adverse events, was observed. As she did not recover easily from neutropenia in spite of treatment with G-CSF, a dose reduction of the FOLFIRI regimen was gradually performed. Although chemotherapy was conducted approximately monthly, the tumor response reflected a stable disease 8 months after 8 courses of chemotherapy. We suggest that it is important to investigate the pharmacokinetics of toxic agents such as CPT-11, (SN38) for dose modification, and for the safe and continuous chemotherapy of patients receiving haemodialysis.
由于接受血液透析的患者的药代动力学与肾功能正常的患者不同，对于接受血液透析的患者以及肾功能正常的患者是否能够安全地进行化疗仍不清楚。在此，我们报告一例直肠癌复发患者，该患者在血液透析情况下接受了含贝伐单抗的FOLFIRI化疗，并获得了良好的肿瘤控制。一名47岁女性因慢性肾衰竭已接受血液透析10年。45岁时，她因直肠癌（pII期）接受了腹会阴联合切除术。术后4个月，发现肝转移，为此进行了肝部分切除术及辅助化疗[优福定（400mg/体）/尿嘧啶替加氟（75mg/体）]。肝切除术后18个月，发现多处肺转移。因此，进行了使用FOLFIRI（伊立替康：90mg/m²）联合贝伐单抗（2.5mg/m²）的强化化疗。观察到严重的中性粒细胞减少（3级、4级），但未观察到腹泻等非血液学不良事件以及贝伐单抗特异性不良事件。尽管使用粒细胞集落刺激因子治疗，但她的中性粒细胞减少仍不易恢复，因此逐渐减少FOLFIRI方案的剂量。尽管化疗大约每月进行一次，但在8个疗程的化疗后8个月，肿瘤反应显示疾病稳定。我们建议，对于接受血液透析的患者，为了进行剂量调整以及安全持续地化疗，研究伊立替康（SN38）等毒性药物的药代动力学很重要。
