진행성 위암에 대한 1차 요법으로 Docetaxel, Cisplatin, 5-FU 복합화학요법의 효과와 안전성
Docetaxel, Cisplatin, 5-FU Combination Chemotherapy as a First-Line Treatment in Patients with Advanced Gastric Cancer
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목적:전이성 위암 환자들에서 1차 치료로서 투여된 docetaxel, cisplatin, 5-FU 복합화학요법의 효과와 안전성에 대하여 분석하였다. 방법:2006년 4월부터 2009년 8월까지 조직학적으로 확진하고 절제가 불가능한 진행, 전이성 위암 환자 48명을 대상으로 의무기록을 통하여 후향적으로 조사하였다. 5-FU는 제1일부터 5일까지 750 mg/m2으로 24시간 동안 지속적으로 정주하였고, 제2일째 docetaxel은 75 mg/m2의 용량으로 1시간 동안, cisplatin은 75 mg/m2의 용량으로 1시간 30분 동안 정주하였고, 이상을 3주마다 반복하였다. 반응률은 2내지 3주기의 항암요법 시행 후 평가하였고, 부작용은 NCI CTC ver. 2.0을 기준으로 평가하였다. 결과:총 48명의 환자들의 총 생존기간의 중앙값은 346일(235-457일)이었고 반응지속기간의 중앙값은 164일(149-179일)이었다. 총 48명의 환자 중 6명은 첫 반응률 평가 시행 전에 사망하거나 약제를 변경하거나 치료를 중단하여 치료반응 평가에서 제외되었다. 48명의 환자 중 완전 관해는 없었고 부분관해 27예(56%), 불변 10예(21%), 진행 5예(10%)로, 반응률은 56%였다. 전체 항암요법 292회 중 G3 이상의 빈혈 6회(2%), G4의 백혈구 감소증은 15회(5%), G4의 호중구 감소증은 154회(52.7%), G3 이상의 혈소판 감소증은 13회(4.4%)였다. 호중구 감소증에 의한 발열은 33회(11.3%)였고 부작용으로 인한 용량감소는 165회(56.5%), 약제변경은 5회(1.7%)였으나 부작용으로 인한 사망은 없었다. 결론:Docetaxel, cisplatin, 5-FU의 복합화학요법은 수술을 할 수 없는 진행성 위암 환자들에 대한 1차 요법으로, 호중구 감소증 등의 부작용의 빈도가 비교적 높으나 높은 반응률을 보이는 치료법이다. 부작용을 최소화하면서 반응률은 유지할 수 있는 가장 적절한 용량과 용법에 대한 합의를 도출해낸다면 진행성 위암 환자들에 대한 1차 요법으로서의 그 가치는 더욱 높아질 것으로 생각한다.
Abstract
Background/Aims:This study investigated the efficacy and safety of docetaxel/cisplatin/5-fluorouracil (DCF) combination chemotherapy as a first‐line treatment in patients with advanced gastric cancer. Methods:The study enrolled 48 patients diagnosed with unresectable pathologically proven gastric cancer who received DCF combination chemotherapy between April 2006 and August 2009. The dose administered was docetaxel 75 mg/m2 for 1 h and cisplatin 75 mg/m2 for 90 min on day 2, and 5-FU 750 mg/m2 for 24 h on days 1-5, every 3 weeks. The response was assessed every three cycles. The toxicity was evaluated for every chemotherapy course according to the National Cancer Institute (NCI) toxicity criteria ver. 2.0. Results:The median age of the patients was 58 years (range 31-78 years). The median overall survival was 11.5 months (2.3-28.2 months) and the median time to progression was 5.5 months (0.3-18.9 months). No complete remission occurred. Of the patients, 56% achieved a partial response, 21% stable disease, and 10% progressive disease. The overall response rate was 56%. During a total 292 cycles, anemia worse than NCI toxicity grade 3 occurred in 2%, leukopenia in 33.1%, neutropenia in 67.1%, and thrombocytopenia in 4.4%. Neutropenic fever occurred in 33 cycles (11.3%), dose reduction due to side effects in 165 cycles (56.5%), and a regimen change due to side effect in five cycles (1.7%). Conclusions:Combination chemotherapy with docetaxel, cisplatin, and 5-FU is efficacious, but has relatively high toxicity. A DCF protocol that maximizes its efficiency, while minimizing toxicity, would be more useful as a first-line treatment in patients with advanced gastric cancer. (Korean J Med 2011;80:680-686)
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