대장암의 보조항암화학요법
Adjuvant Chemotherapy in Colon Cancer
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참고문헌
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초록
대장암 수술 후 재발을 줄이려고 하는 노력은 계속되고 있으며, 이러한 결과 고위험 II기 및 III기 환자들을 대상으로5-FU와 LV 또는 capecitabine을 근간으로 한 oxaliplatin 병용요법을 6개월 시행하는 것을 보조요법의 표준치료로 권고하고 있다. IV기 대장암 환자에서 좋은 결과를 보인 irinotecan 그리고 bevacizumab, cetuximab과 같은 표적치료제는 아직 보조요법에서 유효성을 평가받지 못하여 실제 임상에서 사용되지 않고 있다. Oxaliplatin 병용요법이 기존 5-FU/LV 보조요법에 비해 더 나은 결과를 보이면서 신경학적 독성 및 고령에서의 독성 발현빈도가 높음을 고려할 때 보조요법의 기간에 대한 재평가가 이루어져야 할 것이다. 또한 조기 대장암 뿐만 아니라 IV기 대장암에서 수술적 절제 전후에 시행되는 보조항암요법은 전이 병소의 완전절제율을 향상시키고, 재발률을 감소시킬 수 있으므로 이를 바탕으로 한 활발한 다학제적 접근을 통한 적극적인 치료가 필요하다. 아직까지는 병기 중심적인 보조요법의 적응증에 의존하고 있지만 향 후 항암치료와 연관된 예측인자 및 예후인자에 대한 좋은 연구 결과가 나와 유효한 대상 환자를 선택하여 그에 맞는 효과적인 보조항암요법을 선택할 수 있는 새로운 권고안이 제시될 수 있기를 기대해본다.
Abstract
Colorectal cancer represents a major public health problem in worldwide including Korea. According to the National Cancer Registry, colon cancer is the third most common cancer and the forth leading cause of cancer death. The surgery is a main treatment option for cure. Despite curative surgery in those presenting early, the risk of relapse is significantly high. To improve the survival, huge advances have been made in the treatment of colon cancer over the last decade. Especially, the median overall survival time for stage IV colon cancer has been reached from 6-9 months to over 20 months. Based on these results, drugs such as irinotecan, oxaliplatin and oral fluoropyrimidine have been used to evaluate the efficacy in adjuvant setting. Oxaliplatin based chemotherapy is now emerging as the standard of care in adjuvant treatment of stage III colon cancer. Targeted agents, which have shown promise in the metastatic setting, are currently being examined in the adjuvant setting, although results have been disappointing until now. Even though adjuvant treatment is recommended for ‘high risk’ stage II, the endeavor to answer for question-who should be treated by what-is needed. (Korean J Med 2012;83:297-304)
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