[A case of an elderly patient with gastric cancer successfully treated with TS-1 considering impaired renal function caused by aging].
A 75-year-old female patient with impaired renal function caused by aging was treated with TS 1 for gastric cancer with extensive multiple liver metastases. TS-1 contains CDHP, which inhibits DPD activity and maintains a high blood concentration of 5-FU. Because CDHP is excreted from the kidney, a careful TS-1 administration is necessary for patients with impaired renal function considering an occurrence of severe adverse events. Based on the result previously reported by us about pharmacokinetic study and recommended administration dosage of TS-1 for patients with impaired renal function, we administered 50 mg/day of TS-1 for four weeks followed by two weeks rest per one course for this patient. The patient's creatinine clearance calculated by the Cockcroft-Gault method was 38 ml/min, and we reduced the administration dosage in consideration of her impaired renal function, although normal dosage of TS-1 calculated from body surface area for this patient was 100 mg/day. As this patient underwent TS-1 treatment, sizes of multiple liver metastases and the blood concentration level of CEA were gradually reduced, and the reductive rate of the former was more than 90% and the level of the latter fell to a normal range after 12 courses of TS 1 treatment. Through all the treatment courses, relative drug intensity was 100% and the performance status of this patient was kept 0 without any grade 3 or more adverse events under ambulatory treatment. A successful treatment for this patient might indicate that it was important to consider the appropriate reduction of the dosage of TS-1 administration for elderly patients with gastric cancer, because there is a reverse correlation between aging and renal function. To clarify this problem, a multicenter prospective phase II study about TS-1 reductive administration depending on the renal function for elderly patients with gastric cancer (OGSG0404) is ongoing in our clinical study group (OGSG; Osaka Gastrointestinal Chemotherapy Study Group).
Kishimoto
Tomono
T
Dept. of Surgery, Sakai Municipal Hospital.
Imamura
Hiroshi
H
Furukawa
Hiroshi
H
Yamamoto
Kazuyoshi
K
Miyazaki
Yasuhiro
Y
Ohshiro
Ryouta
R
Ohta
Katsuya
K
Nakata
Yasuyuki
Y
Kamigaki
Shunji
S
Kondo
Motoi
M
Takemoto
Hiroyoshi
H
Fujimi
Satoshi
S
Nakayama
Takahiro
T
Fukunaga
Mutsumi
M
Ohsato
Hiroki
H
Tatsuta
Masayuki
M
D000368:Aged; D000375:Aging / Q000502:physiology; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D003404:Creatinine / Q000378:metabolism; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D013274:Stomach Neoplasms / Q000188:drug therapy*; D005641:Tegafur / Q000008:administration & dosage*
D000964:Antimetabolites, Antineoplastic; D005641:Tegafur; D003404:Creatinine