透析患者に発症した肺小細胞癌に対して塩酸アムルビシンを投与した1例

Amrubicin Hydrochloride Chemotherapy for Small Lung Cell Carcinoma with Chronic Renal Failure Undergoing Hemodialysis

要旨　患者は79歳，男性．慢性腎不全に対して血液透析中，胸部異常陰影を指摘され紹介受診．精査の結果，肺小細胞癌と診断された．従来どおり血液透析を行いながら肝代謝・胆汁排泄型薬剤である塩酸アムルビシン(AMR)を開始した．4コース終了した時点で原発巣の著明な縮小を認めたため，化学療法を6コースまで継続した．副作用に関してはGrade 1の悪心を認めたものの骨髄抑制は軽微であり，G-CSF製剤や輸血を要しなかった．透析患者に発症した肺小細胞癌の化学療法としてエトポシドや塩酸イリノテカンの報告例が散見されるが，AMRの報告例は少ない．透析患者における肺癌の発生頻度は増加傾向にあり，治療方針決定に苦慮することが少なくない．AMRを含め化学療法の有効性・安全性を確立していくため，今後症例を蓄積していくことが重要と考えられた．

　A 79-year old man who had undergone hemodialysis for 4 years visited our hospital because of pulmonary abnormal shadow. He was diagnosed as having extensive small cell lung carcinoma based on further examination and treated with Amrubicin hydrochloride on day 1 to 3 of each 28 day therapy course. Four courses of chemotherapy resulted in remarkable reduction of the tumor. Finally he completed 6 courses of Amrubicin. No severe side effects were observed except grade 2 of anemia. He did not receive G-CSF and blood transfusion. It has been reported that Etoposide and Irinotecan were effective for small cell lung carcinoma complicated with chronic renal failure undergoing hemodialysis, but there have been few reports on Amrubicin. Although further research will be needed, Amrubicin may be effective for small lung cell carcinoma with chronic renal failure undergoing hemodialysis.