80歳以上の高齢者非小細胞肺癌へのゲフィチニブ(イレッサ®)投与に関する臨床的検討

A Retrospective Study of Gefitinib(Iressa®) for Non-small Cell Lung Cancer(NSCLC) in Patients Aged Eighty Years or Older

要旨　【目的】80歳以上の高齢者非小細胞肺癌に対するゲフィチニブ投与の安全性や有効性について評価する．【方法】ゲフィチニブが投与された80歳以上の非小細胞肺癌患者17例を集積し後ろ向きに検討した．【結果】患者の平均年齢85.8歳(80～95歳)，大部分が女性，腺癌，非喫煙者，全身状態も良好で，間質性肺炎など重篤基礎疾患のない症例であり，また13例(76.5%)で1st line therapyとして導入されていた．開始時の投与量が250mg連日とされた15例中8例(53.3%)で有害事象のため薬剤の減量や休薬，あるいは中止が必要であった．奏効率は41.2%，disease control rateは64.7%であった．【考察】80歳以上の高齢者へのゲフィチニブ投与は有害事象の発生頻度が比較的高く投与量の調整が望ましいと思われるが，適切な症例の選択により，1st line therapyとしての使用も考慮しうると考えられた．

　【Objective】 A retrospective clinical study was conducted to evaluate the safety and efficacy of Gefitinib treatment for elderly patients with non-small cell lung cancer(NSCLC). 【Methods】 A retrospective chart review was performed of seventeen patients with NSCLC aged eighty years or older administered Gefitinib. 【Results】 The mean patient age was 85.8 years(range 80 to 95 years). Fourteen of the patients were women, fourteen were non-smokers, sixteen had adenocarcinoma, and fifteen had a good performance status(ECOG Performance Status of 0 to 1). None of the patients had serious pre-existing diseases such as interstitial pneumonia. Gefitinib was administered for thirteen patients(76.5%)as a first-line chemotherapy. Although daily 250mg of Gefitinib is routine treatment, eight patients out of fifteen(53.3%) were forced to reduce or withdraw or quit the dose because of its deleterious side effects. The response rate and the disease control rate were 41.2% and 64.7%, respectively. 【Conclusions】 Daily administration of Gefitinib for elderly patients with NSCLC seems to have a relatively high morbidity rate. Although dose reduction of Gefitinib is preferable in elderly patients with NSCLC, Gefitinib can be used as a first-line chemotherapy for elderly patients with NSCLC if the case-selection and dose are appropriate.