胃と腸38巻1号

2003年01月発行

今月の主題 胃癌―診断と治療の最先端

主題

胃癌化学療法の新たな展開

著者： 土井俊彦¹ 大津敦¹ 目良清美¹ 武藤学¹ 佐野寧¹

所属機関： ¹国立がんセンター東病院消化器内科

ページ範囲：P.89 - P.94

文献概要

　日本においては，切除不能進行胃癌に対する化学療法は，従来はpalliative careとして認識されており，治療法についても，“医者のさじ加減”が優先され，EBMとはほど遠いものであった．近年，切除不能進行胃癌例に対する化学療法は，best supportive careと比べて生存期間の延長が証明され，化学療法の考え方の変化をもたらしてはいるが，効果は不十分であり，5-FU単剤を越える標準的治療法は確立していない．new agentとしてのCPT-11は，CDDPやMMCとの併用により60％前後，経口剤S-1も単剤で45％，CDDPとの併用で76％と従来の併用治療法に比べても非常に高い奏効率を認めている．最終的には，5FU単剤と比較した第III相比較試験(JCOGで進行中)での生存期間での評価が必要である．さらに，胃癌に対しても生物学的・薬物動態的特性に基づいた治療戦略が可能となり始めていると同時に分子生物学的マーカーや分子標的の見地に立った治療法の確立に期待が持たれている．

参考文献

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