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 主題研究

薬剤感受性による胃癌化学療法の選択―現状と問題点

著者： 久保田哲朗¹

所属機関： ¹慶應義塾大学医学部外科学教室

ページ範囲：P.1023 - P.1026

要旨　本邦における抗癌剤感受性試験の正診率は74％である（第30回制癌剤適応研究会）．われわれは胃癌術後に適応抗癌剤を投与すれば症例の生存期間の延長が図れるのではないかとの仮説をたて，補助化学療法選択における抗癌剤感受性試験の有用性を明らかにしてきた．胃癌補助化学療法については生存期間延長のメリットを受ける適応群とメリットを受けない耐性群が存在し，小規模なRCTによる補助化学療法有用性の証明は困難であり，適応群と耐性群の弁別には現在のところ抗癌剤感受性試験が最も有用と考えられる．抗癌剤感受性試験は標準的治療群を対象としたRCTにより評価される必要があり，現在2つのstudyが検討中である．

参考文献

1）Kondo T, Kubota T, Tanimura T, et al. Cumulative results of chemosensitivity tests for antitumor agents in Japan. Anticancer Res 20 : 2389-2392, 2000

2）Saikawa Y, Kubota T, Furukawa T, et al. Single-cell suspension assay with an MTT endpoint is useful for evaluating the optimal adjuvant chemotherapy for advanced gastric cancer. Jpn J Cancer Res 85 : 762-765, 1994

3）Kobayashi H, Higashiyama M, Minamigawa K, et al. Examination of in vitro chemosensitivity test using collagen gel droplet culture method with colorimetric endpoint quantification. Jpn J Cancer Res 92 : 203-210, 2001

4）Furukawa T, Kubota T, Hoffman RM. Clinical application of histoculture drug response assay. Clin Cancer Res 1 : 305-311, 1995

5）Kubota T, Sasano N, Abe O, et al. The potential of the histoculture drug response assay to contribute to cancer patient survival. Clin Cancer Res 1 : 1537-1543, 1995

6）Fujita K, Kubota T, Matsuzaki SW, et al. Further evidence for the value of the chemosensitivity test in deciding appropriate chemotherapy for advanced gastric cancer. Anticancer Res 18 : 1973-1978, 1998

7）Abe S, Kubota T, Matsuzaki SW, et al. Chemosensitivity test is useful in evaluating the appropriate adjuvant cancer chemotherapy for Stage III non-scirrhous gastric cancer. Anticancer Res 19 : 4581-4586, 1999

8）Kubota T, Egawa T, Otani Y, et al. Cancer chemotherapy chemosensitivity testing is useful in evaluating the appropriate adjuvant cancer chemotherapy for Stages III/IV gastric cancer without peritoneal dissemination. Anticancer Res 23 : 583-588, 2003

9）日本胃癌学会（編）．胃癌治療ガイドライン医師用2004年4月改訂．金原出版，2004

10）Hermans J, Bonenkamp JJ, Boon MC, et al. Adjuvant therapy after curative resection for gastric cancer : Meta-analysis of randomized trials. J Clin Oncol 11 : 1441-1447, 1993

11）Nakajima T, Ohta K, Ohyama S, et al. Meta-analysis of adjuvant chemotherapy trials for gastric cancer at the Cancer Institute Hospital, Tokyo. Nakajima T, Yamaguchi T(eds). Multimodality therapy for gastric cancer, pp 27-21, Springer-Verlag, Tokyo, 1999

12）Earle CC, Maroun JA. Adjuvant chemotherapy after curative resection for gastric cancer in no-Asian patients : Revisiting a meta-analysis of randomized trials. Eur J Cancer 35 : 1059-1064, 1999

13）Mari E, Floriani I, Tinazzi A, et al. Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a meta-analysis of published randomised trials. A study of the GISCAD（Gruppo Italiano per lo Studio dei Carcinomi dell’Apparato Digerente）. Ann Oncol 11 : 837-843, 2000

14）Janunger KG, Hafstroem L, Nygren P, et al. A systemic overview of chemotherapy effects in gastric cancer. Acta Oncol 40 : 309-326, 2001

15）Panzini I, Gianni L, Fattori PP, et al. Adjuvant chemotherapy in gastric cancer : A meta-analysis of randomized trials and a comparison with previous meta-analyses. Tumori 88 : 21-27, 2002

16）Samson DJ, Seidenfeld J, Ziegler K, et al. Chemotherapy sensitivity and resistance assays : A systematic review. J Clin Oncol 22 : 3618-3630, 2004

17）Schrag D, Garewal HS, Burstein HJ, et al. American Society of Clinical Oncology Technology Assessment : Chemotherapy sensitivity and resistance assays. J Clin Oncol 22 : 3631-3638, 2004