福島医学雑誌 59 巻 3 号 2009
〔症例報告〕
分子標的治療薬Bevacizumabを投与した
抗がん剤抵抗性の卵巣癌の1症例
森村 豊1)，橋本 歳洋1)，坂本 且一1)，羽生 忠義1)，西山 浩2)
藤森 敬也2)，山田 秀和2)，佐藤 章2)
1)慈山会医学研究所付属坪井病院婦人科，2)福島県立医科大学医学部産科婦人科学講座
（受付2009年1月27日 受理2009年5月14日）
A Case of Chemo-resistant Ovarian Cancer Treated by
Bevacizumab as Molecular Targeted Agent
YUTAKA MORIMURA1), TOSHIHIRO HASHIMOTO1), KATSUICHI SAKAMOTO1),
TADAYOSHI HANYU1), HIROSHI NISHIYAMA2), KEIYA FUJIMORI2),
HIDEKAZU YAMADA2) and AKIRA SATO2)
1)Department of Gynecology, Jisannkai Medical Institute, Tsuboi Hospital, Kohriyama, 963-0197, Japan, 2)Department of Obstetrics and Gynecology, School of Medicine, Fukushima Medical University, Fukushima, 960-1295, Japan
要旨: 血管内皮増殖因子（vascular endothelial growth factor, VEGF）は卵巣癌の進展に深く関与していると考えられる。VEGF阻害剤であるbevacizumabは分子標的治療薬として，卵巣癌への治療効果が期待できる。抗癌剤抵抗性卵巣癌例に対しbevacizumab の投与を試みた。症例は53歳，進行期IIIc期の漿液性腺癌例で，術後22月にわたる一〜四次化学療法（paclitaxel, PTX, docetaxel, DTX, carboplatin, CBDCA, cisplatin, CDDP, irinotecan, CPT-11, gemcitabineなどの薬剤を含む）に抵抗性を示し，両側胸水と大量腹水貯留，肝脾臓転移を呈していた。bvacizumab 10 mg/kg，day 1, 15+ paclitaxel 60 mg/m2，day 1, 8, 15のレジメを6コース行ったところ，転移巣は腫瘍径で15% 縮小，胸腹水の一部が消失した。RECIST (Response Evaluation Criteria in Solid Tumors）基準に準じればstable diseaseを維持できた。消化管穿孔等の重篤な副作用は認められなかった。分子標的治療薬bevacizumabは，抗癌剤抵抗性の卵巣癌に対する腫瘍増殖の抑制効果や副作用が軽微な点が期待される。適切なレジメの確立や保険適応の拡大が望まれる。
索引用語: bevacizumab，分子標的治療，卵巣癌，抗がん剤抵抗性
Abstracts: Vascular endothelial growth factor (VEGF) seems to be a promoter of tumor progression for ovarian cancer. In molecular targeted strategy, bezacizumab as anti-VEGF monoclonal antibody is expected to prevent tumor growth in relapsed and chemo-refractory ovarian cancer. We experienced a case of chemo-resistant ovarian cancer who received bevacizumab therapy. Although 53-year-old female with stage IIIc ovarian cancer has received first to forth line chemotherapy (containing PTX, DTX, CBDCA, CDDP, CPT-11 and gemcitabine) after surgery during 22 months, her tumor resisted to these chemotherapy and revealed metastatic hepatic and splenic tumor and bilateral pleural effusion and massive ascites. After 6 course of bevacizumab (10 mg/kg, day 1, 15) and PTX (60 mg/m2, day 1, 8, 15), her tumor reduced 15% in diameter and left pleural effusion and ascites disappeared. According to RECIST (Response Evaluation Criteria in Solid Tumors), evaluation of this bevacizumab therapy was stable disease. No severe adverse effect containing bowel perforatin was recognized. Bevacizumab as molecular targeted therapy seems to be active to patients with recurrent and chemo-refractory ovarian cancer and well tolerant. Further study for the establishment of adequate regimen is necessary. The expansion of indication to ovarian cancer is expected.
Key words: bevacizumab, molecular targeted therapy, ovarian cancer, chemo-refractory