胃と腸55巻7号

2020年06月発行

今月の主題 薬剤関連消化管病変のトピックス 主題

—薬剤関連消化管病変の臨床的特徴—免疫チェックポイント阻害薬を除く抗悪性腫瘍薬による消化管傷害—S-1による消化管傷害を中心に

著者： 迎美幸¹ 小林清典² 川岸加奈¹ 別當朋広¹ 横山薫¹ 佐田美和¹ 小泉和三郎¹

所属機関： ¹北里大学医学部消化器内科学 ²北里大学医学部新世紀医療開発センター

ページ範囲：P.900 - P.907

要旨●免疫チェックポイント阻害薬を除く抗悪性腫瘍薬による消化管傷害について解説した．フルオロウラシル誘導体であるS-1の投与に起因する腸炎では下痢が主症状であるが，腸管浮腫に伴う腸閉塞を合併することがある．内視鏡所見では主として終末回腸に，浅い潰瘍やびらんを認める．トポイソメラーゼ阻害薬であるイリノテカンは，その活性代謝物であるSN-38の消化管細胞毒性により，下痢を主症状とする消化管傷害を引き起こす．タキサン系薬剤は大腸の穿孔を合併し，投与開始後2週間以内に穿孔を発症することが多い．分子標的薬の中ではベバシズマブの投与も大腸穿孔発生の報告がある．クリゾチニブは食道潰瘍を生じ，胸部中部食道が潰瘍の好発部位である．抗悪性腫瘍薬を投与する際には，薬剤により消化管傷害の発生部位や発症様式が異なることを理解しておく必要がある．

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