Yamaguchi Teppei, Isogai Sumito, Okamura Takuya, Uozu Sakurako, Mieno Yuki, Hoshino Tami, Goto Yasuhiro, Hayashi Masamichi, Nakanishi Toru, Imaizumi Kazuyoshi
Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan.
Case Rep Oncol. 2015 Feb 11;8(1):78-82. doi: 10.1159/000375485. eCollection 2015 Jan-Apr.
A 72-year-old man undergoing continuous ambulatory peritoneal dialysis (CAPD) for chronic renal failure and who had undergone right upper lobectomy for lung adenocarcinoma (pT2aN0M0) 2 years ago was admitted for recurrence of lung cancer presenting as multiple brain metastases. An epidermal growth factor receptor mutation analysis of his lung cancer revealed a deletion of 15 nucleotides (E746-A750) in exon 19. After whole-brain radiotherapy, we started daily administration of 250 mg gefitinib under the continuation of CAPD and performed a pharmacokinetic analysis. We speculated that the plasma concentration of gefitinib reached the steady state at least by day 16 after the start of gefitinib (626.6 ng/ml at trough level). On day 46, the plasma concentration was 538.4 ng/ml at trough level and the concentration in the peritoneal dialysis fluid was 34.6 ng/ml, suggesting that CAPD appeared to have little effect on the pharmacokinetics of gefitinib. During gefitinib therapy, there were no significant adverse events except for grade 2 diarrhea. Gefitinib could be safely administered to a patient undergoing CAPD.
一名72岁男性，因慢性肾衰竭接受持续非卧床腹膜透析（CAPD）治疗，2年前因肺腺癌（pT2aN0M0）接受了右上叶切除术，现因肺癌复发伴多发脑转移入院。对其肺癌进行的表皮生长因子受体突变分析显示，第19外显子有15个核苷酸缺失（E746 - A750）。全脑放疗后，在继续进行CAPD的情况下，我们开始每日给予250 mg吉非替尼，并进行了药代动力学分析。我们推测，至少在开始使用吉非替尼后的第16天，吉非替尼的血浆浓度达到了稳态（谷浓度为626.6 ng/ml）。在第46天，谷浓度时血浆浓度为538.4 ng/ml，腹膜透析液中的浓度为34.6 ng/ml，这表明CAPD似乎对吉非替尼的药代动力学影响不大。在吉非替尼治疗期间，除了2级腹泻外，没有明显的不良事件。吉非替尼可以安全地给予接受CAPD治疗的患者。
