Takayama Shin, Arita Ryutaro, Ishii Tadashi
Department of Education and Support for Regional Medicine (General Medicine and Kampo Medicine), Tohoku University Hospital, Sendai, Japan.
Front Pharmacol. 2022 Apr 12;13:870823. doi: 10.3389/fphar.2022.870823. eCollection 2022.
Immune checkpoint inhibitors (ICIs) are indicated for several cancers, including malignant melanoma. Anorexia and nausea resulting in malnutrition are side effects of ICIs. In such cases, conventional drugs are used for symptom relief, but the symptoms may persist. We report a case of advanced malignant melanoma with prolonged anorexia and nausea, which occurred after nivolumab administration, and was successfully treated using Kampo medicines. A 75-year-old man with nasal bleeding visited our hospital. A nasal scope revealed an obstructive tumor in the left nasal concha. Tissue biopsy showed malignant melanoma, and computed tomography showed metastasis to the liver and bone. Thus, the patient was diagnosed with stage IV malignant melanoma. He received radiotherapy (30 Gy) and nivolumab with ipilimumab four times, followed by nivolumab administration alone. During the administration of nivolumab, he complained of severe anorexia and nausea, with a numeric rating scale (no symptoms, 0; severe symptoms, 10) score of 10. He could not consume food because of these symptoms, even after nivolumab administration was discontinued. His blood pressure was 92/59 mmHg, his performance status (PS; no fatigue, 0; bedridden or disabled, 4) was 4, and his body weight gradually decreased from 60 to 39 kg in a month. The patient showed malnutrition and dehydration and experienced anxiety and depression. Nivolumab was terminated, and conventional symptomatic drugs were prescribed, but the symptoms persisted. We then prescribed 9.0 g/day of ninjin'yoeito (TJ-108, Tsumura and Co.) to allow recovery from anorexia and subsequently added bukuryoingohangekobokuto (TJ-116, Tsumura and Co.) to treat the persistent nausea. After treatment with these two Kampo medicines, the patient's appetite gradually recovered. Along with the recovery of nutritional status, his PS improved to 0, his anxiety and depressive state improved, and his body weight increased to 60 kg. The patient remained in good condition without cancer recurrence. The patient's clinical course shows the usefulness of Kampo medicine as supportive care for symptom relief and maintenance of nutritional and mental status during cancer treatment.
免疫检查点抑制剂（ICIs）适用于包括恶性黑色素瘤在内的多种癌症。导致营养不良的厌食和恶心是ICIs的副作用。在这种情况下，使用传统药物缓解症状，但症状可能持续存在。我们报告一例晚期恶性黑色素瘤患者，在使用纳武单抗后出现长期厌食和恶心，并使用中药成功治愈。一名75岁鼻出血男性患者前来我院就诊。鼻内镜检查发现左侧鼻甲有阻塞性肿瘤。组织活检显示为恶性黑色素瘤，计算机断层扫描显示肝和骨转移。因此，该患者被诊断为IV期恶性黑色素瘤。他接受了放疗（30 Gy），并使用纳武单抗联合伊匹木单抗治疗4次，随后单独使用纳武单抗。在使用纳武单抗期间，他抱怨严重厌食和恶心，数字评分量表（无症状为0分；症状严重为10分）评分为10分。由于这些症状，即使停用纳武单抗后，他也无法进食。他的血压为92/59 mmHg，体能状态（PS；无疲劳为0分；卧床或残疾为4分）为4分，体重在一个月内从60 kg逐渐降至到39 kg。患者出现营养不良和脱水，并伴有焦虑和抑郁。停用纳武单抗，并开具了传统的对症药物，但症状持续存在。然后我们开具了每日9.0 g的人参养荣汤（TJ - 108，津村制药株式会社）以促进食欲恢复，随后加用茯苓饮（TJ - 116，津村制药株式会社）治疗持续的恶心。使用这两种中药治疗后，患者的食欲逐渐恢复。随着营养状况的恢复，他的PS改善至0分，焦虑和抑郁状态改善，体重增加到60 kg。患者状况良好，无癌症复发。患者的临床病程表明，中药在癌症治疗期间作为缓解症状以及维持营养和精神状态的支持性治疗方面具有有效性。
