低用量カルボプラチン投与に関する文献二報など 2015年3月7日




Lower-Dose Chemo for SCLC: Comparable Results in Low PS Patients


June 1, 2004

Abstract & Commentary

Synopsis: In a phase II trial, the combination of low-dose carboplatin and paclitaxel was shown to be well tolerated by elderly and, or frail (ECOG performance status 2) patients with advanced small cell lung cancer. Response rates and survival were comparable to those published for other combinations.


Source: Neubauer M, et al. J Clin Oncol. 2004;22: 1872-1877.

Extensive small-cell lung cancer (esclc) accounts for approximately 20-25% of all lung cancer diagnoses.1 Between 50-75% of all patients with small-cell lung cancer (SCLC) have extensive disease. Despite significant improvements in diagnosis and therapy for the past 10 years, the prognosis for patients with ESCLC remains poor. Currently, the standard treatment for patients with ESCLC is combination chemotherapy with cisplatinum (or carboplatin) plus etoposide. However, previous studies have demonstrated high levels of toxicity with this treatment regimen, most notably in older patients or those who have a compromised performance status (PS). Since this is primarily a disease of older individuals, alternative combinations and dosing schemes need to be assessed.


Neubauer and colleagues from the Kansas City Cancer Center examined 77 eligible patients with ESCLC (50.6% male, 9.4% white, 44.2% with a PS of 2, median age 74 years) between July 2000 and December 2001 with the goal of evaluating the effects of lower doses of carboplatin and paclitaxel (AUC = 2 and 80 mg/m2, respectively) within a shorter treatment time frame (administered on days 1, 8, and 15 of each 4 week cycle, continuing for up to 6 cycles). They were specifically interested in a group of patients that were considered relatively frail either due to advanced age or a compromised performance status. Participating patients were analyzed for 1-year survival, response rate (RR), time to progression (TTP) and safety of weekly paclitaxel plus carboplatin.

カンサスがんセンターのNeubauerらは、77人のESCLC(男性50,6%、白人9.4%、PS2=44,2%、平均年齢74才)患者に対して低用量カルボプラチンとパクリタキセル併用療法(AUC = 2 and 80 mg/m2, respectively)を投与した。(投与日はday1, 8,15、4週1サイクル、6サイクルまで続行)

Sixty six of the 77 participants were assessable for response. Of these, 25 responded to treatment (one complete response and 24 partial responses), leading to a response rate of 38%. The estimated 1-year survival rate was 30% and the median survival was 7.2 months (range, < 1 to 24.4 months). The median TTP was 3.5 months (range, < 1 to 21.2 months) and the estimated progression-free survival rate was 8%. Neutropenia and fatigue were the most common grades 3 and 4 toxicities, occurring in 22.1% and 8.6% of participants, respectively.


Comment by William B. Ershler, MD

The current trial offers a new treatment regimen for older or frailer patients with extended disease small cell lung cancer. The regimen offers a relatively simple schedule, easily manageable in a community oncology office and the toxicities, although present, were considered less than more aggressive regimens (eg, cisplatin and etoposide). Yet, 36 of the evaluable patients had dose reductions on at least one occasion.

One concern regarding weekly paclitaxel in older patients is the common practice of using dexamethasone in relatively high doses (20 mg prior to each injection). The consequences of this have yet to be evaluated with regard to the immune and metabolic effects over the treatment course. With reduced dose paclitaxel and in elderly patients who are more likely to be immunocompromised, it is possible that lower doses of steroid would be required to prevent the hypersensitivity for which it is prescribed.


1. Ihde DC, et al. Cancer: Principles and Practice of Oncology (ed 5) 1997; 911-945.

William B. Ershler, MD INOVA Fairfax Hospital Cancer Center, Fairfax, VA; Director, Institute for Advanced Studies in Aging, Washington, DC, is Editor for Clinical Oncology Alert.


Favorable response obtained by low dose chemotherapy in an elderly patient with extensive small cell lung cancer and renal dysfunction [in Japanese]

低 用 量 化 学 療 法 が 奏 効 し た 腎 機 能 障 害 を 伴 っ た 高 齢 者 小 細 胞 肺 癌 の1例


藤本 勝洋 Fujimoto Katsunada
原田 泰志 Harada Taishi
渡辺 憲太朗 Watanabe Kentaro

An 82-year-old man with extensive small cell lung cancer was treated with 2 courses of low dose CPT-11 (40mg/body, day 1, 8 and 15) and carboplatin (100mg/body, day 1). The reduction in tumor sizes evaluated by two-direction measurement was 88%. His creatinin clearance rates before and after chemotherapy were 20 and 28ml/min, respectively. Temporary leukopenia (900/μl) during the second course of chemotherapy was quickly reversed by the administration of G-CSF, without any episode of infection. Low dose CPT-11 and carboplatin seems to be a promising regimen for elderly patients with small cell lung cancer and renal dysfunction. Cancer tends to increase in old age groups. We consider that it is necessary to examine ideal low dose chemotherapies that can be effective yet preserve quality of life.

<要 約> 症例 は82歳 男性. 進展型小細 胞肺癌 で あ り, 低 用量 の irrinotecan hydrochoride (40mg/body,day 1, 8 and 15) と carboplatin (100mg/body, day 1) に よ り治療が 開始 された. 治療 開始前 のク レアチニ ンク リア ラ ンス は20ml/minで あ り終 了 後 は28ml/minで あ った. 2方 向測 定 に よる縮 小 率 は88%で
あ った. 副作用 と して2コ ース 目の治療 中に一時 的 な白血球減 少 (900/μl) を認め たが, 感染 症等 の重篤
な合 併症 もな くG-CSFに よ り正常 化 した. 低 用量 のCPT-11とCBDCAに よる治 療 は腎機 能の低下 した高齢者 にも使用 可能 な選択肢 の ひ とつ と考 え られた. 今後, 高齢化 とともに担癌 患者 は増加 す る傾 向 にあ り,Quality of Life を保 つ低用量化 学療法 のあ り方 を検討 す る必要が ある と考 え られた.
Key words: 高齢者, 低用量化学療法, カルボプラチ ン, イリノテカン, 小細胞肺癌
(日老医誌 2005; 42: 453-456)

Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics 42(4), 453-456, 2005
The Japan Geriatrics Society


AUC = 2 や 100mg/bodyなどの大幅減量では、AUC=4〜6と同等とは行かないが、それなりの効果がある。





減量段階    アブラキサン  カルボプラチン
通常投与量   100mg/m2    AUC6
1段階減量    75mg/m2    AUC4.5
2段階減量    50mg/m2    AUC3



@医師のブログ がん治療の虚実より


A患者さんのブログ 完治をめざしてより





にほんブログ村 病気ブログへ

小細胞肺がん 進展型 肺がん患者 余命日記

posted by SR400 at 16:20| Comment(0) | 抗ガン剤 | このブログの読者になる | 更新情報をチェックする




認証コード: [必須入力]