臨床外科71巻4号

2016年04月発行

特集 大腸癌肝転移—最新の治療ストラテジー 治療の実際

全身化学療法

著者： 石川敏昭¹ 石黒めぐみ² 植竹宏之¹

所属機関： ¹東京医科歯科大学大学院総合外科学分野 ²東京医科歯科大学大学院応用腫瘍学講座

ページ範囲：P.418 - P.425

【ポイント】
◆切除不能肝転移は全身化学療法の適応である．化学療法後に切除可能になり肝切除を行う（conversion chemotherapy）と生存期間の延長が期待でき，治癒する場合もある．
◆肝転移に対する全身化学療法では，各レジメンの特性を理解して個々の症例に適切なレジメンを選択することが重要である．
◆切除可能肝転移に対する周術期化学療法の有用性は確立されておらず，臨床試験にて検証されている．
◆大腸癌肝転移は集学的治療により治療成績が向上することが期待されており，大腸外科医，腫瘍内科医，肝臓外科医，放射線科医などが密接に連携することが重要である．

参考文献

1）大腸癌研究会（編）：大腸癌治療ガイドライン医師用2014年版，金原出版，2014

2）Adam R, Wicherts DA, de Haas RJ, et al：Patients with initially unresectable colorectal liver metastasis：is there a possibility of cure? J Clin Oncol 27：1829-1838, 2009

3）Folprecht G, Grothey A, Alberts S, et al：Neoadjuvant treatment of unresectable colorectal liver metastases：correlation between tumour response and resection rates. Ann Oncol 16：1311-1319, 2005

4）Saltz LB, Clarke S, Díaz-Rubio E, et al：Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer：a randomized phase III study. J Clin Oncol 26：2013-2019, 2008

5）Wong R, Cunningham D, Barbachano, et al：A multicentre study of capecitabine, oxaliplatin plus bevacizumab as perioperative treatment of patients with poor-risk colorectal liver-only metastases not selected for upfront resection. Ann Oncol 22：2042-2048, 2011

6）Van Cutsem E, Köhne CH, Hitre E, et al：Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med 360：1408-1417, 2009

7）Folprecht G, Gruenberger T, Bechstein WO, et al：Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetaximab：the CELIM randomized phase 2 trial. Lancet Oncol 11：38-47, 2010

8）Douillard JY, Siena S, Cassidy J, et al：Final results from PRIME：randomized phase III study of panitumumab with FOLFOX4 for first-line treatment of metastatic colorectal cancer. Ann Oncol 25：1346-1355, 2014

9）Tournigand C, André T, Achille E, et al：FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer：a randomized GERCOR study. J Clin Oncol 22：229-237, 2004

10）Falcone A, Ricci S, Brunetti I, et al：Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan（FOLFOXIRI）compared with infusional fluorouracil, leucovorin, and irinotecan（FOLFIRI）as first-Line treatment for metastatic colorectal cancer：The Gruppo Oncologico Nord Ovest. J Clin Oncol 25：1670-1676, 2007

11）Klinger M, Tamandl D, Eipeldauer S, et al：Bevacizumab improves pathological response of colorectal cancer liver metastases treated with XELOX/FOLFOX. Ann Surg Oncol 17：2059-2065, 2010

12）Ribero D：Bevacizumab improves pathologic response and protects against hepatic injury in patients treated with oxaliplatin-based chemotherapy for colorectal liver metastases. Cancer 110：2761-2767, 2007

13）Douillard JY, Oliner KS, Siena S, et al：Panitumumab-FOLFOX4 treatment and RAS mutations in colorectal cancer. N Engl J Med 369：1023-1034, 2013

14）Van Cutsem E, Lenz CH, Köhne CH, et al：Fluorauracil, leucovorin, and irinotecan plus cetuximab treatment and RAS mutations in colorectal cancer. J Clin Oncol 33：692-700, 2015

15）Heinemann V, von Weikersthal LF, Decker T, et al：FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer（FIRE-3）：a randomised, open-label, phase 3 trial. Lancet Oncol 15：1065-1075, 2014

16）Venook AP, Niedzwiecki D, Lenz HJ, et al：CALGB/SWOG 80405：phase Ⅲ trial of irinotecan/5-FU/leucovorin（FOLFIRI）or oxaliplatin/5-FU/leucovorin（mFOLFOX6）with bevacizumab（BV）or cetuximab（CET）for patients（pts）with KRAS wild-type（wt）untreated metastatic adenocarcinoma of the colon or rectum（MCRC）. Proc Am Soc Clin Oncol 32（suppl）：LBA3（abstr），2014

17）Heinemann V, Modest D, Fischer von Weikersthal L, et al：Independent radiological evaluation of objective response early tumor shrinkage, and depth of response in FIRE-3（AIO KRK-0306）. Ann Oncol 2014；25（Suppl 2）：ii117., 2014

18）Kliger M, Tamandl D, Eipeldauer S, et al：Bevacizumab improves pathological response of colorectal cancer liver metastases treated with XELOX/FOLFOX. Ann Surg Oncol 17：2059-2065, 2010

19）Ribero D, Wang H, Donadon M, et al：Bevacizumab improves pathological response and protects against hepatic injury in patients treated with oxaliplatin-based chemotherapy for colorectal liver metastases. Cnacer 11：2761-2767, 2007

20）de Gramont A, Figer A, Seymour M, et al：Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18：2938-2947, 2000

21）Kishi Y, Zorzi D, Contreras CM, et al：Extended preoperative chemotherapy does not improve pathologic response and increases postoperative liver insufficiency after hepatic resection for colorectal liver metastases. Ann Surg Oncol 17：2870-2876, 2010

22）Portier G, Elias D, Bouche O, et al：Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases：FFCD ACHBTH AURC 9002 trial. J Clin Oncol 24：4976-4982, 2006

23）Mitry E, Fields AL, Bleiberg H, et al：Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer：a pooled analysis of two randomized trials. J Clin Oncol 26：4906-4911, 2008

24）Nordlinger B, Van Cutsem E, Gruenberger T, et al：Combination of surgery and chemotherapy and the role of targeted agents in the treatment of patients with colorectal liver metastases：recommendations from an expert panel. Ann Oncol 20：985-992, 2009

25）大腸癌研究会（編）：大腸癌取扱い規約第8版．金原出版，2013

26）Kato T, Yasui K, Hirai T, et al：Therapeutic results for hepatic metastasis of colorectal cancer with special reference to effectiveness of hepatectomy；Analysis of prognostic factors for 763 cases recorded at 18 institutions. Dis Colon Rectum 46：S22-31, 2003

27）Nordlinger B, Sorby H, Glimeliuset B, et al：Perioperative FOLFOX4 chemotherapy and surgery versus surgery alone for resectable liver metastases from colorectal cancer（EORTC 40983）：long-term results of a randomized, controlled, phase 3 trial. Lancet Oncol 14：1208-1215, 2013

28）Primrose J, Falk S, Finch-Jones M, et al：Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis：the New EPOC randomised controlled trial. Lancet Oncol 15：601-611, 2014

29）Benoist S, Brouquet A, Penna C, et al：Complete response of colorectal liver metastases after chemotherapy：does it mean cure? J Clin Oncol 24：3939-3945, 2006

30）Elias D, Goere D, Boige V, et al：Outcome of posthepatectomy-missing colorectal liver metastases after complete response to chemotherapy：impact of adjuvant intra-arterial hepatic oxaliplatin. Ann Surg Oncol 14：3188-3194, 2007