M0 カストレーション抵抗性前立腺がんの高齢患者におけるダロルタミドによる心不全:症例報告
Yoshiyuki Miyaji1,2, Shinjiro Shimizu1,2, Michihiro Sato3
1Department of Urology Kawasaki Medical School Kurashiki Japan.
IJU case reports
|September 5, 2025
まとめ
アンドロゲン受容体シグナル伝達阻害剤 (ARSIs) は,高齢の前立腺がん患者の心血管リスクを増大させる可能性があります. 癌治療と心臓の安全性のバランスをとるには,ARSIsの注意深いモニタリングと投与量調整が不可欠です.
科学分野:
- 腫瘍学
- 心臓病科
- 高齢者医療
背景:
- アンドロゲン受容体シグナリング阻害剤 (ARSIs) は前立腺がんの治療に不可欠です.
- 高齢者,特に心疾患のある患者は,ARSIの使用で心血管疾患のリスクが増加します.
研究 の 目的:
- 複数の併発性疾患を有する高齢患者におけるARSI使用に関連する心血管リスクを強調する.
- 心臓機能に対するARSI治療の潜在的な影響と,注意深い管理の必要性を説明する.
主な方法:
- 94歳の男性で 転移した前立腺がんと 重度の心血管疾患
- アンドロゲン欠乏療法 (ADT) に対する患者の反応の詳細な観察と,その後のダロルタミドの開始.
- 前立腺特異抗原 (PSA) レベル,心臓症状,B型ナトリウレチンペプチド (BNP) レベルのモニタリング.
主要な成果:
- 初期症状の改善にもかかわらず,患者さんはダロルタミドを投与開始後,BNP値が上昇した心不全を発症しました.
- ダロルタミドの投与を中止すると,BNPは減少したが,PSAは増加した.
- 低用量ダロルタミド (300 mg/日) は,心臓の損傷なしにPSAレベルを安定させました.
結論:
- ARSIを投与されている心疾患の高齢患者には,心血管の厳密なモニタリングが不可欠です.
- 腫瘍学的有効性を維持しながら心臓のリスクを軽減する有効な戦略である.
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