胃と腸44巻12号

2009年11月発行

今月の主題 消化管癌の化学・放射線療法の効果判定と問題点 主題

消化管癌の化学・放射線療法の現状と展望

著者： 高張大亮¹ 室圭¹

所属機関： ¹愛知県がんセンター中央病院薬物療法部

ページ範囲：P.1805 - P.1815

要旨　食道癌ではJCOG9907試験において術前化学療法の有用性が報告されるなど，化学療法はほぼすべてのStageにおいて必要となってきており，食道癌全体の治療成績向上に必須となっている．胃癌においては最近，本邦から重要な臨床研究結果が相次いで発表された．すなわちACTS-GCおよびJCOG9912，SPIRITSという3つの第III相試験である．これらにより，本邦における胃癌治療の標準化の流れは一気に加速した．今後はHER2陽性胃癌におけるtrastuzumabを端緒とした分子標的治療薬の臨床導入が期待される．大腸癌に対する化学療法は，5-FU，irinotecan，oxaliplatinの3つの抗癌剤に加えて，bevacizumab，cetuximabに代表される分子標的治療薬の有用性が示され，その生存期間は無治療の6～8か月から今や2年を超える時代となった．そして，KRAS遺伝子変異例ではcetuximabやpanitumumabといった抗EGFR抗体薬の効果が期待できないことが明らかとなり，個別化治療が実践され始めた状況である．

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