Niikura Ryota, Serizawa Takako, Yamada Atsuo, Yoshida Shuntaro, Tanaka Mariko, Hirata Yoshihiro, Koike Kazuhiko
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
Case Rep Gastroenterol. 2016 May 19;10(1):17-23. doi: 10.1159/000443267. eCollection 2016 Jan-Apr.
The number of cancer patients undergoing dialysis has been increasing, and the number of these patients on chemotherapy is also increasing. Imatinib is an effective and safe therapy for KIT-positive gastrointestinal stromal tumors (GIST), but the efficacy and safety of imatinib in dialysis patients remain unclear. Because clinical trials have not been conducted in this population, more investigations are required. We report on a 75-year-old Japanese man undergoing dialysis who presented with massive tarry stool from a duodenal GIST. The duodenal GIST was 14 cm in diameter with multiple liver and bone metastases. The patient underwent an urgent pancreaticoduodenectomy to achieve hemostasis. After surgery, he was administered imatinib 400 mg/day. No severe adverse event including myelosuppression, congestive heart failure, liver functional impairment, intestinal pneumonia, or Steven-Johnson syndrome occurred, and the liver metastasis remained stable for 4 months. During chemotherapy, hemodialysis continued three times per week without adverse events. We suggest that regular-dose imatinib is an effective and safe treatment in patients with GIST undergoing dialysis. In addition, we present a literature review of the effectiveness and safety of imatinib treatment in dialysis patients.
接受透析的癌症患者数量一直在增加，且接受化疗的此类患者数量也在增加。伊马替尼是治疗KIT阳性胃肠道间质瘤（GIST）的一种有效且安全的疗法，但伊马替尼在透析患者中的疗效和安全性仍不明确。由于尚未在该人群中开展临床试验，因此需要进行更多研究。我们报告了一名75岁接受透析的日本男性，他因十二指肠GIST出现大量柏油样便。十二指肠GIST直径为14 cm，伴有多发肝转移和骨转移。患者接受了紧急胰十二指肠切除术以实现止血。术后，给予他伊马替尼400 mg/天。未发生包括骨髓抑制、充血性心力衰竭、肝功能损害、坠积性肺炎或史蒂文斯-约翰逊综合征在内的严重不良事件，肝转移在4个月内保持稳定。化疗期间，每周继续进行三次血液透析，未出现不良事件。我们认为常规剂量伊马替尼对接受透析的GIST患者是一种有效且安全的治疗方法。此外，我们还对伊马替尼治疗透析患者的有效性和安全性进行了文献综述。
