臨牀消化器内科 Vol.33 No.9(12)


特集名 膵神経内分泌腫瘍 update
題名 膵神経内分泌腫瘍の化学療法
発刊年月 2018年 08月
著者 古瀬 純司 杏林大学医学部腫瘍内科学
【 要旨 】 神経内分泌腫瘍(NETs)は高分化腫瘍と低分化がん(NEC)に分けられ,薬物療法はそれぞれ大きく異なる.高分化NETsに対する薬物療法はソマトスタチンアナログ,分子標的薬,殺細胞性抗がん剤(化学療法薬)が増殖速度(悪性度)や腫瘍量を考慮して使い分けられる.化学療法薬は一般にソマトスタチンアナログや分子標的薬に比べ高い腫瘍縮小効果が得られるが,比較試験に基づくエビデンスに乏しい.現在ストレプトゾシンのみが保険診療上使用可能であり,単独あるいはフルオロウラシルとの併用で用いられる.海外ではテモゾロミドやカペシタビンが使用されており,日本でも適応承認が期待される.一方,NECに対する薬物療法は通常小細胞肺がんに準じてシスプラチンとイリノテカンあるいはエトポシドとの併用療法が行われている.
Theme Update on Pancreatic Neuroendocrine Tumors
Title Chemotherapy for Pancreatic Neuroendocrine Tumor
Author Junji Furuse Department of Medical Oncology, Kyorin University Faculty of Medicine
[ Summary ] Neuroendocrine tumors (NETs) is classified into well differentiated tumor and poorly differentiated carcinoma, and chemotherapy is differently applied according to these histological grades. Somatostatin analogs, molecular targeted agents, and chemotherapeutic agents are used to treat well differentiated tumors such as NETs. Chemotherapeutic agents generally show higher anti-tumor effect than that of somatostatin analogs and molecular targeted agents. Streptozocin is only approved for the treatment of NETs and used as monotherapy or in combination with fluorouracil. Temozolomide and capecitabine demonstrate promising anti-tumor effects, and the approval for its use to treat NETs is expected. On the contrary, cisplatin-based chemotherapy combined with irinotecan or etoposide, which is a standard regimen to treat small cell lung cancer, is applied to neuroendocrine carcinoma.
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