Sorafenib治療開始早期より画像所見に著明な変化を呈したが，死亡した進行肝細胞癌の1例
症例は，66歳男性．肝外転移を有する進行肝癌治療目的でsorafenib 800 mg/day投与開始し，治療開始17日目に代謝性脳症で死亡した．治療前および治療後1週に，ソナゾイド造影超音波とMRI拡散強調画像をそれぞれ撮像した．造影超音波では，治療前と比べ治療後1週において，腫瘍部と健常腎実質部に著明な血流低下を認めた．一方，拡散強調画像では，腫瘍部のADCの著明な低下を認めた．sorafenib治療において，腫瘍部に血流低下などの，急激な画像所見の変化が生じる場合，治療効果良好の徴候とも考えられるが，重篤な有害事象の発現の可能性も念頭に置き，厳重な経過観察が必要であると考える．...
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| Published in | 肝臓 Vol. 51; no. 5; pp. 227 - 235 |
|---|---|
| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本肝臓学会
2010
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0451-4203 1881-3593 |
| DOI | 10.2957/kanzo.51.227 |
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| Abstract | 症例は，66歳男性．肝外転移を有する進行肝癌治療目的でsorafenib 800 mg/day投与開始し，治療開始17日目に代謝性脳症で死亡した．治療前および治療後1週に，ソナゾイド造影超音波とMRI拡散強調画像をそれぞれ撮像した．造影超音波では，治療前と比べ治療後1週において，腫瘍部と健常腎実質部に著明な血流低下を認めた．一方，拡散強調画像では，腫瘍部のADCの著明な低下を認めた．sorafenib治療において，腫瘍部に血流低下などの，急激な画像所見の変化が生じる場合，治療効果良好の徴候とも考えられるが，重篤な有害事象の発現の可能性も念頭に置き，厳重な経過観察が必要であると考える． |
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| AbstractList | 症例は，66歳男性．肝外転移を有する進行肝癌治療目的でsorafenib 800 mg/day投与開始し，治療開始17日目に代謝性脳症で死亡した．治療前および治療後1週に，ソナゾイド造影超音波とMRI拡散強調画像をそれぞれ撮像した．造影超音波では，治療前と比べ治療後1週において，腫瘍部と健常腎実質部に著明な血流低下を認めた．一方，拡散強調画像では，腫瘍部のADCの著明な低下を認めた．sorafenib治療において，腫瘍部に血流低下などの，急激な画像所見の変化が生じる場合，治療効果良好の徴候とも考えられるが，重篤な有害事象の発現の可能性も念頭に置き，厳重な経過観察が必要であると考える． |
| Author | 平良, 淳一 山田, 幸太 本定, 三季 村島, 英学 今井, 康晴 古市, 好宏 宮田, 祐樹 齋藤, 和博 森安, 史典 中村, 郁夫 杉本, 勝俊 佐野, 隆友 市村, 茂輝 山田, 昌彦 |
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| References | 10) Schraml C, Schwenzer NF, Martirosian P, et al. Diffusion-weighted MRI of advanced hepatocellular carcinoma during sorafenib treatment: initial results. AJR 2009; 193: W301-W307 8) Takahara T, Imai Y, Yamashita T, et al. Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing STIR and high resolution 3D display. Radiat Med 2004; 22: 275-282 5) Strumberg D, Awada A, Hirte H, et al. Pooled safety analysis of BAY 43-9006 (sorafenib) monotherapy in patients with advanced solid tumors: Is rash associated with treatment outcome? Eur J Cancer 2006; 42: 548-556 12) Richly H, Schultheis B, Adamietz IA, et al. Combination of sorafenib and doxorubicine in patients with advanced hepatocellular carcinoma: results from a phase I extension trial. Eur J Cancer 2009; 45: 579-587 9) Koh DM, Scurr E, Collins D, et al. Predicting response of colorectal hepatic metastasis: value of pretreatment apparent diffusion coefficients. AJR 2007; 188: 1001-1008 15) Huang WS, Yang CH. Sorafenib induced tumor lysis syndrome in an advanced hepatocellular carcinoma patient. World J Gastroenterology 2009; 15: 4464-4466 6) Abou-Alfa GK, Schwartz L, Ricci S, et al. Phase II study of sorafenib in patients with advanced hepatocellular carcinoma. J Clin Oncol 2006; 24: 4293-4300 11) ネクサバール錠200mg安全性情報. 2009 4) Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst 2009; 92: 205-216 2) 本定三季, 杉本勝俊, 宮田祐樹, 他. Sorafenib投与後早期に代謝性脳症を併発し死亡した進行肝細胞癌の1例. 肝臓 2009; 50: 595-597 13) Drug information research, clinical trial, news. Nexavar, Adverse Event Reports. (www.druglib.com/druginfo/nexavar/.htm (accessed 2009 sept 1). 7) Lassau N, Chami L, Benatsou B, et al. Dynamic contrast-enhanced ultrasonography (DCE-US) with quantification of tumor perfusion: a new diagnostic tool to evaluate the early effects of antiangiogenic treatment. Eur Radiol 2007; 17 (Supple 6): F89-98 3) Lassau N, Lamuraglia M, Chami L, et al. Gastrointestinal stromal tumors treated with imatinib: monitoring response with contrast-enhanced sonography. AJR 2006; 187: 1267-1273 16) Mehata J, Jakob C, Singhal S, et al. Bortezomib causes tumor lysis syndrome 1% of patients with myeloma [abstract]. Blood 2003; 102 (supple 2): 386b 1) Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008; 359: 378-390 14) Govindarajan R, Adusumilli J, Baxter DL, et al. Reversible posterior leukoencephalopathy syndrome induced by RAF kinase inhibitor BAY 43-9006. J Clin Oncol 2006; 24: e48 |
| References_xml | – reference: 1) Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008; 359: 378-390 – reference: 2) 本定三季, 杉本勝俊, 宮田祐樹, 他. Sorafenib投与後早期に代謝性脳症を併発し死亡した進行肝細胞癌の1例. 肝臓 2009; 50: 595-597 – reference: 7) Lassau N, Chami L, Benatsou B, et al. Dynamic contrast-enhanced ultrasonography (DCE-US) with quantification of tumor perfusion: a new diagnostic tool to evaluate the early effects of antiangiogenic treatment. Eur Radiol 2007; 17 (Supple 6): F89-98 – reference: 8) Takahara T, Imai Y, Yamashita T, et al. Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing STIR and high resolution 3D display. Radiat Med 2004; 22: 275-282 – reference: 5) Strumberg D, Awada A, Hirte H, et al. Pooled safety analysis of BAY 43-9006 (sorafenib) monotherapy in patients with advanced solid tumors: Is rash associated with treatment outcome? Eur J Cancer 2006; 42: 548-556 – reference: 11) ネクサバール錠200mg安全性情報. 2009 – reference: 10) Schraml C, Schwenzer NF, Martirosian P, et al. Diffusion-weighted MRI of advanced hepatocellular carcinoma during sorafenib treatment: initial results. AJR 2009; 193: W301-W307 – reference: 3) Lassau N, Lamuraglia M, Chami L, et al. Gastrointestinal stromal tumors treated with imatinib: monitoring response with contrast-enhanced sonography. AJR 2006; 187: 1267-1273 – reference: 6) Abou-Alfa GK, Schwartz L, Ricci S, et al. Phase II study of sorafenib in patients with advanced hepatocellular carcinoma. J Clin Oncol 2006; 24: 4293-4300 – reference: 12) Richly H, Schultheis B, Adamietz IA, et al. Combination of sorafenib and doxorubicine in patients with advanced hepatocellular carcinoma: results from a phase I extension trial. Eur J Cancer 2009; 45: 579-587 – reference: 4) Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst 2009; 92: 205-216 – reference: 14) Govindarajan R, Adusumilli J, Baxter DL, et al. Reversible posterior leukoencephalopathy syndrome induced by RAF kinase inhibitor BAY 43-9006. J Clin Oncol 2006; 24: e48 – reference: 13) Drug information research, clinical trial, news. Nexavar, Adverse Event Reports. (www.druglib.com/druginfo/nexavar/.htm (accessed 2009 sept 1).) – reference: 16) Mehata J, Jakob C, Singhal S, et al. Bortezomib causes tumor lysis syndrome 1% of patients with myeloma [abstract]. Blood 2003; 102 (supple 2): 386b – reference: 9) Koh DM, Scurr E, Collins D, et al. Predicting response of colorectal hepatic metastasis: value of pretreatment apparent diffusion coefficients. AJR 2007; 188: 1001-1008 – reference: 15) Huang WS, Yang CH. Sorafenib induced tumor lysis syndrome in an advanced hepatocellular carcinoma patient. World J Gastroenterology 2009; 15: 4464-4466 |
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| Title | Sorafenib治療開始早期より画像所見に著明な変化を呈したが，死亡した進行肝細胞癌の1例 |
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