胃と腸40巻7号

2005年06月発行

今月の主題 胃癌化学療法の進歩と課題 主題

胃癌化学療法の考え方―欧米とわが国の比較

著者： 滝内比呂也¹ 後藤昌弘¹ 川部伸一郎¹ 太田俊輔¹ 紀貴之¹ 田中俊充¹ 桑門心¹ 西谷仁¹ 平田一郎¹ 勝健一¹

所属機関： ¹大阪医科大学第2内科

ページ範囲：P.977 - P.985

要旨　20世紀に行われた無作為化比較試験において，奏効率および無増悪生存期間で5-FU単剤を上回る成績を示した多剤併用療法はいくつも存在する．しかし全生存期間において5-FU単剤を凌駕した多剤併用療法はいまだ出現していない．この事実は，胃癌化学療法の考え方を語るうえで無視できない事実である．しかし欧米では，5-FU単剤を無視した多剤併用療法同士の無作為化比較試験が繰り返し行われている．一方わが国においては，日本臨床腫瘍研究グループ（JCOG）が5-FU単剤をreference armとした無作為化比較試験を展開している．特に現在行われているJCOG9912は，5-FU単剤と欧米で好んで使われているCPT-11＋CDDPを比較する試験である．近い将来その結果が明らかにされたときに，欧米とわが国の胃癌化学療法に対する考え方に接点が生まれ，それが礎となって胃癌化学療法の新たな展開が始まるものと思われる．

参考文献

1）Pyrhonen S, Kuitunen T, Nyandoto P, et al. Randomized comparison of fluorouracil, epidoxorubicin and methotrexate（FEMTX）plus supportive care with best supportive care alone in patients with non-resectable gastric cancer. Br J Cancer 71 : 587-591, 1995

2）Murad A, Santiago FF, Petroianu A, et al. Modified therapy with 5-FU, doxorubicin and methotrexate in advanced gastric cancer. Cancer 72 : 37-41, 1993

3）Grimelius B, Hoffman K, Haglund U, et al. Initial or delayed chemotherapy with best supportive care in advanced gastric cancer. Ann Oncol 5 : 189-190, 1994

4）Cullinan SA, Moertel CG, Fleming TR, et al. A comparison of three chemotherapeutic regimens in the treatment of advanced pancreatic and gastric carcinoma : fluorouracil versus fluorouracil and doxorubicin versus fluorouracil, doxorubicin and mitomycin. JAMA 253 : 2061-2067, 1985

5）Kim NK, Park YS, Heo DS, et al. A phase III randomized study of 5-fluorouracil and cisplatin versus 5-fluorouracil, doxorubicin, and mitomycin C versus 5-fluorouracil alone in the treatment of advanced gastric cancer. Cancer 71 : 3813-3818, 1993

6）Cullinan SA, Moertel CG, Wieand H, et al. Controlled evaluation of three drugs combination regimen versus fluorouracil alone in the therapy of advanced gastric cancer. J Clinl Oncol 12 : 412-416, 1994

7）Wils JA, Klein HO, Wagener DJT, et al. Sequential high-dose methotrexate and fluorouracil combined with doxorubicin―a step ahead in the treatment of advanced gastric cancer : a trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. J Clin Oncol 9 : 827-831, 1991

8）Vanhoefer U, Rougier P, Wilke H, et al. Final results of a randomized phase III trial of sequential high-dose Methotrexate, fluorouracil, and doxorubicin versus infusional fluorouracil and cisplatin in advanced gastric cancer : a trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group. J Clin Oncol 18 : 2648-2657, 2000

9）Kelsen D, Atiq O, Saltz L, et al. FAMTX versus etoposide, doxorubicin, and cisplatin : a random assignment trial in gastric cancer. J Clin Oncol 10 : 541-548, 1992

10）O’Connell MJ. Etoposide, doxorubicin, and cisplatin chemotherapy for advanced gastric cancer : An old lesson revisited. J Clin Oncol 10 : 515-516, 1992

11）Ohtsu A, Shimada Y, Shirao K, et al. Randomized phase III trial of fluorouracil alone versus fluorouracil plus cisplatin versus uracil and tegafur plus mitomycin in patients with advanced gastric cancer : JCOG study 9205. J Clin Oncol 21 : 54-59, 2003

12）Grothey A, Sargent D, Goldberg RM, et al. Survival of patients with advanced colorectal cancer improves with the availability of fluorouracil-leucovorin, irinotecan, and oxaliplatin in the course of treatment. J Clin Oncol 22 : 1209-1214, 2004

13）Ajani JA, Cutsem EV, Moiseyenko, et al. Docetaxel, cisplatin, 5-fluorouracil compare to cisplatin and 5-fluorouracil for chemotherapy-naive patients with metastatic or locally recurrent, unresectable gastric carcinoma : Interim results of a randomized phase III trial（V325）. Proc Am Soci Clin Oncol 22 # : 999, 2003

14）Boku N, Ohtsu A, Shirao K, et al. Phase II study of a combination of irinotecan and cisplatin against metastatic gastric cancer. J Clin Oncol 17 : 319-323, 1999

15）Koizumi W, Tanabe S, Saigenji K, et al. Phase I/II study of S-1 combined with cisplatin in patients with advanced gastric cancer : Br J Cancer 89 : 2207-2212, 2003

16）Narahara H, Takiuchi H, Tsujinaka T, et al. Phase I study of CPT-11 plus S-1 in patients with metastatic gastric cancer. Proc ASCO 21 : 170a, #677, 2002

17）円谷彰，長晴彦，小西和男，他．進行再発胃癌に対する2nd lineとしてのweekly paclitaxel（WP）．日本癌治療学会誌 37 : 310, 2002