Kaneko Takashi, Sugimori Kazuya, Tozuka Yuichiro, Fukushima Taito, Okada Kazuya, Oka Hiroyuki, Okazaki Hiroshi, Maeda Shin
Department of Gastroenterology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuurahigasi, Kanazawa-ku, Yokohama, 2360037, Japan.
Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
Clin J Gastroenterol. 2019 Oct;12(5):484-489. doi: 10.1007/s12328-019-00976-w. Epub 2019 Apr 16.
In cancer patients, impairment of kidney function is not uncommon. Recently, the efficacy of the combination of gemcitabine and nab-paclitaxel for pancreatic ductal adenocarcinoma (PDAC) patients has been reported, however, there is no recommendation for dose and administration to patients undergoing hemodialysis (HD). A 66-year-old man began receiving HD for chronic renal failure 4 years previously. He suffered from diarrhea, back pain, and loss of appetite, and his weight gradually decreased. Abdominal dynamic computed tomography showed a 45-mm hypodense mass in the pancreatic body and a 30-mm hypodense mass in the liver. The patient was diagnosed with metastatic PDAC. He started combination chemotherapy of gemcitabine and nab-paclitaxel without dose modification. He developed pneumonia and neutropenia in the first and second courses, so we modified to a 60% dose of gemcitabine and nab-paclitaxel on day 1 every 2 weeks. After dose modification, he continued combination chemotherapy for over 7 months without severe adverse events or tumor progression. Combination chemotherapy using gemcitabine and nab-paclitaxel was effective in a PDAC patient undergoing HD. While it is possible to originally administer these drugs with no dose modification, early dose modification was needed for our patient because of severe adverse events.
在癌症患者中，肾功能损害并不罕见。最近，已有关于吉西他滨与纳米白蛋白结合型紫杉醇联合用药对胰腺导管腺癌（PDAC）患者疗效的报道，然而，对于接受血液透析（HD）的患者，尚无关于剂量和给药方式的推荐。一名66岁男性4年前开始因慢性肾衰竭接受血液透析。他出现腹泻、背痛和食欲不振，体重逐渐下降。腹部动态计算机断层扫描显示胰体有一个45毫米的低密度肿块，肝脏有一个30毫米的低密度肿块。该患者被诊断为转移性PDAC。他开始接受吉西他滨与纳米白蛋白结合型紫杉醇的联合化疗，未调整剂量。他在第一个疗程和第二个疗程中出现肺炎和中性粒细胞减少，因此我们将吉西他滨和纳米白蛋白结合型紫杉醇的剂量调整为每2周第1天剂量的60%。剂量调整后，他继续联合化疗超过7个月，未出现严重不良事件或肿瘤进展。吉西他滨与纳米白蛋白结合型紫杉醇联合化疗对一名接受血液透析的PDAC患者有效。虽然最初有可能不调整剂量给药，但由于严重不良事件，我们的患者需要早期调整剂量。
