진행된 위암 및 대장암에서의 Doxifluridine의 치료 효과

Study on Efficacy and Safety of 5'-Deoxy-5-Fluorouridine for Advanced Gastric and Colorectal Cancer

1992년 1월부터 1992년 11월사이 서울대학교병원 내과에 내원하였던 진행위암 14명, 진행 대장암 10명을 대상으로 5'-dFUR 경구 화학요법을 시행한 결과 완전관해는 한 예도 없었고 위암에서 부분관해 3/12(25%), 불변 1/12(8%), 진행 8/12(67%)였고, 대장암에서는 부분관해 1/10(10%), 불변 5/10(50%), 진행 4/10(40%)였다. 관해군에서의 관해지속기간은 위암환자 3예중 2예에서 각각 13주, 20주였고 1예에서는 관해후 추적이 안되어 관해지속기간을 알 수 없었으나 11월 30일 현재까지 30+주 이상 생존해있고 대장암 환자 1예에서 관해지속기간은 12주였다. 24명 환자의 5'-dFUR 경구 화학요법중 부작용으로 오심 및 구토가 4예 (grade 1 : 3예 , grade 2 : 1예), 점막염이 4예(grade 1 : 3, grade 2 : 1) 발생되었으나 투약을 중단할만한 부작용은 없었으며, 혈액학적인 부작용인 백혈구감소나 혈소판감소는 관찰되지 않았다. 본 연구 결과 5'-dFUR 경구 화학요법은 고령이거나 운동능력이 저하된 위암 및 대장암 환자에게 비교적 안전하게 투여해 볼만한 약제로 사료된다.

Background : 5-Fluorouracil(5-FU) has been widely used in the treatment of gastric and colorectal cancer. However the response rate was less than 20% with only minimal impact on survival. 5'-deoxy-5-fluorouridine(5'-dFUR), an analogue of 5-FU, has been shown to have superior antitumor effect to 5-FU and the therapeutic index was $10{\sim}15$ times higher than those of 5-FU and other fluorourimidines. Methods : Fourteen patients with advanced gastric cancer and ten patients with advanced colorectal cancer were treated with 5'-dFUR by oral administration at a dose of 100mg/5kg/day. Results : Among 12 evaluable patients with gasrtic cancer, 3(25%) achieved partial response : among 10 patients with colorectal cancer 1(10% ) had a partial response. The duration of remission of three patients in stomach cancer were 13 weeks and 20 weeks, however one case could not evaluated for remission duration due to lost of follow up. The duration of remission of one responder in colorectal cancer was 12 weeks. Myelosuppression was minimal. and non-hematologic toxicities were less common and generally mild and well tolerated. Conclusion : Oral administration of 5'-dFUR at a dose of 100mg/5kg/day seems to be safe for elderly or poor performance status patients with advanced gastric and colorectal cancer.