肺がん治療薬ベバシズマブの代替薬

薬剤併用療法はベバシズマブを使用できない非小細胞肺がん患者の治療選択肢となり得る

Drug combination may provide option for patients with non-small cell lung cancer ineligible for bevacizumab

非小細胞肺がん（NSCLC）患者に対するnab-paclitaxelとカルボプラチン併用療法はベバシズマブを使用できない患者の有望な治療選択肢となり得るとのデータが2012年AACR学会で発表された。研究者らは進行NSCLC患者63人においてカルボプラチンとnab-paclitaxelの併用療法を評価した。76%の患者の組織所見が扁平上皮がんでありそのためベバシズマブの適応外であった。これらの患者におけるベバシズマブの他の禁忌は喀血、血栓および治療目的での抗凝固療法であった。研究者らは患者に300mg/m²/AUC6を21日ごとに投与した。これは後に神経障害が過剰であったため260mg/m²/AUC6に変更された。その結果、評価が可能であった患者53人における全奏効率は41%であった。さらに39%の患者は少なくとも6週間状態が安定した。19%の患者においては進行が認められた。10%を超える患者において、血液毒性、発熱性好中球減少症、感染症、感覚性ニューロパチー、呼吸困難および脱水症などのグレード3～4の毒性が発現した；研究者らはグレード5毒性の死亡4例を報告した。筆者らは、この併用療法は特に他の治療法が限られている扁平上皮がん患者に対する選択肢とすべきである、と述べている。

A combination of nab-paclitaxel and carboplatin for the treatment of non-small cell lung cancer may be a promising option for patients ineligible for treatment with bevacizumab, according to data presented at the AACR Annual Meeting 2012, held in Chicago, March 31 - April 4.

"The combination of carboplatin and nab-paclitaxel demonstrates promising efficacy with tolerable toxicity in patients with non-small cell lung cancer (NSCLC) ineligible for therapy with bevacizumab," said Gregory A. Otterson, M.D., professor of internal medicine, co-director of the thoracic oncology program and associate director of the hematology and medical oncology fellowship program at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus, Ohio.

Otterson and colleagues evaluated the drug combination in 63 patients with advanced NSCLC. Seventy-six percent of patients had squamous histology, making them ineligible for bevacizumab. Other contraindications for bevacizumab among this patient population included hemoptysis, thrombosis and therapeutic anticoagulation. Researchers assigned patients to 300 mg/m²/AUC6, which was later adjusted to 260 mg/m²/AUC6 due to excess neuropathy, every 21 days.

Researchers found an overall response rate of 41 percent among 53 patients available for evaluation. An additional 39 percent of patients had stable disease for at least six weeks. Disease progressed in 19 percent of patients.

"We have been surprised at the durability of response with some patients not requiring further treatment for at least six months," Otterson said.

More than 10 percent of patients had grade 3 to 4 toxicities, including hematologic toxicity, febrile neutropenia, infection, sensory neuropathy, dyspnea and dehydration; researchers reported four deaths as grade 5 toxicities.

"This combination treatment should be an option, particularly for patients with squamous histology who have limited alternative options," Otterson said.