臨床泌尿器科63巻5号

2009年04月発行

特集 泌尿器科の癌薬物療法―ここが聞きたい

精巣腫瘍―“poor risk”の標準的導入化学療法はBEPか？

著者： 中村晃和¹ 三木恒治¹

所属機関： ¹京都府立医科大学大学院医学研究科泌尿器外科学

ページ範囲：P.353 - P.357

文献概要

要旨　IGCC分類が報告されて以来，この分類に基づいて，転移を有する進行性精巣腫瘍の治療方針が考えられるようになった。Good prognosis群では，BEP療法3コースまたはEP療法4コースが標準的導入化学療法であるのに対し，poor prognosis群では，BEP療法を4コース行うことが標準である。肺機能低下の疑われる症例では，VIP療法を導入化学療法として行ってもよい。導入化学療法としての大量化学療法は，RCTが行われた結果，その有用性が証明されず，現在のところ標準的な導入化学療法とはいえない。

参考文献

1）IGCCCG：International Germ cell consensus classification：a prognostic factor-based staging system for metastatic germ cell cancer. J Clin Oncol 15：594-603, 1997

, testicular cancer, 2008, USA

3）Krege S, Beyer J, Souchon R, et al：European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer：a report of the second meeting of the European Germ Cell Cancer Consensus Group（EGCCCG）：Part Ⅱ. Eur Urol 53：497-513, 2008

4）Einhorn LH and Donohue JP：Cis-diamminedichloroplatinum, vinblastine, and bleomycin combination chemotherapy in disseminated testicular cancer. Ann Intern Med 87：293-298, 1977

5）Williams SD, Birch R, Einhorn LH, et al：Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med 316：1435-1440, 1987

6）Saxman SB, Finch D, Gonin R, et al：Long-term follow-up of a phase Ⅲ study of three versus four cycles of bleomycin, etoposide, and cisplatin in favorable-prognosis germ-cell tumors：the Indiana University experience. J Clin Oncol 16：702-706, 1998

7）Xiao H, Mazumdar M, Bajorin D, et al：Long-term follow-up of patients with good-risk germ cell tumors treated with etoposide and cisplatin. J Clin Oncol 15：2553-2558, 1997

8）Loehrer PJ Sr, Johnson D, Elson P, et al：Importance of bleomycin in favorable-prognosis disseminated germ cell tumors：an Eastern Cooperative Oncology Group Trial. J Clin Oncol 13：470-476, 1995

9）Nichols CR, Williams SD, Loehrer PJ, et al：Randomized study of cisplatin dose intensity in poor-risk germ cell tumors：a Southeastern Cancer Study Group and Southwest Oncology Group protocol. J Clin Oncol 9：1163-1172, 1991

10）Motzer RJ, Mazumdar M, Bajorin DF, et al：High-dose carboplatin, etoposide, and cyclophosphamide with autologous bone marrow transplantation in first-line therapy for patients with poor-risk germ cell tumors. J Clin Oncol 15：2546-2552, 1997

11）Motzer RJ, Mazumdar M, Gulati SC, et al：Phase Ⅱ trial of high-dose carboplatin and etoposide with autologous bone marrow transplantation in first-line therapy for patients with poor-risk germ cell tumors. J Natl Cancer Inst 85：1828-1835, 1993

12）Bokemeyer C, Kollmannsberger C, Meisner C, et al：First-line high-dose chemotherapy comapred with standard-dose PEB/VIP chemotherapy in patients with advanced germ cell tumors：a multivariate and matched-pair analysis. J Clin Oncol 17：3450-3456, 1999

13）Motzer RJ, Nichols CJ, Margolin KA, et al：Phase Ⅲ randomized trial of conventional-dose chemotherapy with or without high-dose chemotherapy and autologous hematopoietic stem-cell rescue as first-line treatment for patients with poor-prognosis metastatic germ cell tumors. J Clin Oncol 25：247-256, 2007

14）Kaye SB, Mead GM, Fossa S, et al：Intensive induction-sequential chemotherapy with BOP/VIP-B compared with treatment with BEP/EP for poor-prognosis metastatic nonseminomatous germ cell tumors：a randomized Medical Research Council/European Organization for Rsearch and Treatment of Cancer study. J Clin Oncol 16：692-701, 1998

15）Nichols CR, Catalano PJ, Crawford ED, et al：Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumors：an Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol 16：1287-1293, 1998

16）Hinton S, Catalano PJ, Einhorn LH, et al：Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors：final analysis of an intergroup trial. Cancer 97：1869-1875, 2003

17）Culine S, Andrew KA, Théodore C, et al：Randomized trial comparing bleomycin/etoposide/cisplatin with alternating cisplatin/cyclophosphamide/doxorubicin and vinblastine/bleomycin regimens of chemotherapy for patients with intermediate-and poor-risk metastatic nonseminomatous germ cell tumors：Genito-Urinary Group of the French Federation of Cancer Centers Trial T93MP. J Clin Oncol 26：421-427, 2008

18）van Dijk MR, Steyerberg EW and Habbema JD：Survival of non-seminomatous germ cell cancer patients according to the IGCC classification：an update based on meta-analysis. Eur J Cancer 42：820-826, 2006

19）Shintaku I, Satoh M, Okajima E, et al：Survival of metastatic germ cell cancer patients assessed by international germ cell consensus classification in Japan. Jpn J Clin Oncol 38：281-287, 2008

20）van Dijk MR, Steyerberg EW, Stenning SP, et al：Survival of patients with nonseminomatous germ cell cancer：a review of the IGCC classification by Cox regression and recursive partitioning. Br J Cancer 90：1176-1183, 2004

21）Kollmannsberger C, Nichols C, Meisner C, et al：Identification of prognostic subgroups among patients with metastatic‘IGCCCG poor-prognosis’germ-cell cancer：an explorative analysis using cart modeling. Ann Oncol 11：1115-1120, 2000