중등도 혹은 고도의 악성 림프종 환자에서 ProMACE-CytaBOM 복합화학요법의 치료 효과

손창학,주영돈,정준용 인제대학교 1997 仁濟醫學 Vol.18 No.3

비호지킨 악성 림프종은 면역체계에 발생하는 종양으로 표준항암화학 요법으로 40-70%에서 완치를 기대할 수 있다. 화학요법은 1970년대 이후 제1세대, 제2세대, 제3세대로 발전되어 왔으며, 제3세대의 경우 80-85%의 완전 관해율과 60-65%의 장기 생존율이 보고되었다. 이에 저자들은 제3세대인 proMACE-cytaBOM 복합화학요법을 1991년부터 1993년까지 3년간 중등도 이상의 비호지킨 악성 림프종 환자 25예에 적용하여 완전관해율, 생존을, 부작용 등을 검토하여 본 교실에서 1991년 대한암학회지에 발표한 Modified COP-BLAM과 비교하여 보고 하고자 한다. Between July 1991 and December 1993, 25 patients of intermediated or high grade Non-Hodgkins lymphoma were treated with ProMACE-CytaBOM (Cyclophosphamide 650mg/m2 IV day 1, Doxorubicin 25mg/m2 IV day 1, Etoposide 120mg/m2 IV day 1, Cytarabine 300mg/m2 IV day 8, Bleomycine 5mg/m2 IV day 8, Vincristine 1.4 mg/m2 IV day 8, Methotrexate 120mg/m2 IV day 8, Prednisone 40mg/m2 PO day 1-14, Cotrimoxazole 2mg/m2 PO day 1-14). The median age was 39(range 16-67) and M : F ratio was 2.6 : 1. The most common histologic type was diffuse large cell(52%). Of the 25 patients, 7(28%) had clinical stage II ; 10(40%) stage III, 8(32%) swage IV according to Ann Anbor criteria. 9(36%) patients had B symptoms. Bulky disease was found in 9(32%) patients. Overall complete remission(CR) was 60% and median duration of CR was 13 months (range 2-34+). The 2-year relapse free survival ramie was 47% and overall 2-years survival rate was 34%. there was not a significant difference between the result of ProMACE-Cyto-BOM chemotherapy and the result of Modified COP-BLAM chemotheraphy, which were performed between January 1987 and July 1990 in Pusan Paik Hospital.

진행성 비소세포폐암에서 Vinorelbine Ifosfamide, Cisplatin (VIP) 복합항암화학요법의 효과

손창학,윤보영 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Objectives: This study designed to evaluate the efficacy and toxicity of vinorelbine, ifosfamide, and cisplatin (VIP) combination chemotherapy in patients with advanced non-small-cell lung cancer(NSCLC), retrospectively. Methods and Materials: From March 1997 through March 2000, ninety-one untreated patients with inoperable stage Ⅲ-Ⅳ were included. The median age was 60 years (range 37-76) : stage ⅢA/ⅢB/Ⅳ 12/34/45. The regimen consisted of vinorelbine (25㎎/㎡ day 1 and 8), ifosfamide (3,000 ㎎/㎡ day 1 with uroprotective mesna), cisplatin (60 ㎎/㎡ day 1) every 4 weeks. Results: Ninety-one patients and total 228 cycles of chemotherapy were evaluable for toxicity and seventy-seven for response. Toxicity was mainly hematologic: grade 3-4 leukopenia (23.7%), thrombocytopenia (1.3%), and anemia(13.2%). Overall response rate was 32.5% with 25 patial responders. The median survival was 13.6 months and the mean survival 9.3±.5 months(SE). One-year survival was 54.2%. There was significant difference in survival according to the performance status (EGOG 1/2-3 8.8±.5 months/6.9±.0 months. p=0.001), which suggested that it was significant prognostic factor in this study. Responder show significant improvements in mean survival compared with non-responder (responder/non-responder 9.5±.5 months/8.3±.7 months. p=0.008). Conclusions: The combination of vinorelbine, ifosfamide and cisplatin chemotherapy(VIP) produced acceptable efficacy and tolerance in patients with advanced NSCLC.

Multiple Myeloma

손창학 대한조혈모세포이식학회 1999 대한조혈모세포이식학회지 Vol.4 No.1

항암화학요법의 치료 원칙

손창학 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

성인 급성 림프구성 백혈병의 화학요법 효과

손창학,구대식,조기정,이성근 大韓血液學會 1993 大韓血液學會誌 Vol.28 No.1

진행성 비소세포폐암에 대한 Mitomycin-C, Ifosfamide, Cisplatin 복합화학 요법

손창학,주영돈 인제대학교 1999 仁濟醫學 Vol.20 No.2

Objectives: To evaluate the response rate, survival and toxicity of combination chemotherapy including mitomycin-C, ifosfamide, cislpatin for the previously untreated patients with clinical stage III or IV non-small cell lung cancer. Materials and Methods: 49 patients with clinical stage III or IV non-small cell lung cancer who had no prior systemic chemotherapy were treated with combined mitomycin-C (6 mg/m2 by intravenous infusion on day 1), ifosfamide (3,000 mg/m2 plus mesna 1,000 mg/m2 by intravenous infusion on day 1 and mesna 400 mg/m2 by intravenous infusion every 3 hours for 4 times on day 2), cisplatin (60 mg/m2 by intravenous infusion on day 1). We evaluated the response rate, survival and toxicities of these patients. Results: The objective response rate was 32%(CR; 1/47, 2%, PR; 14/47, 30%) for 47 evaluable patients. The median survival of all these patients were 48 weeks (6 ∼116+weeks) : the responding patients survived longer than the non-responders (median survival; 81 weeks vs 33 weeks, p<0.05). The toxicity were acceptable without treatment related toxic death. Conclusion: MIC chemotherapy is relatively effective and safe in advanced nonsmall cell lung cancer with acceptable toxicities.

진행성 비소세포 폐암에서 면역조직화학염색법에 의한 p35 단백질의 발현과 항암화학요법 효과와의 관계

손창학 인제대학교 1997 仁濟醫學 Vol.18 No.4

p53 종양억제유전자의 비활성화는 암종에서 가장 흔히 발견되는 유전자 변화로서, 최근 p53 유전자의 비활성화에 의한 세포 소멸(apoptosis)의 결함이 화학요법제 혹은 방사선치료에 대한 내성과 밀접한 관계가 있음이 알려지고 있다. 본 연구는 진행성(병기 III 및 IV 기) 비소세포 폐암환자 53예에서, 단클론성 p53 항체로써 면역조직화학염색을 시행하여, p53 단백의 발현 양상을 관찰하고 임상적 소견과 항암화학요법의 치료 반응 효과와의 관계를 분석하였다. 전체 비소세포 폐암환자 53예 중 39예인 74%에서 p53 단백의 발현율을 보였으며. 음성군(<5%)은 14예로서 26%였고, 다시 양성 반응군 39예를 5% 이상에서 50% 미만 사이의 종양 세포에서 양성 반응을 보이는 저양성군과 50% 이상의 세포에서 양성 반응을 보이는 고양성군으로 나누면 각각 15예와 24예로 고양성군이 많았다. 폐암의 조직형에 따른 p53 단백의 발현은 편평상피암 30예 중 23예(77%), 선암 20예 중 13예(75%), 그리고 대세포암은 3예(100%) 모두에서 나타내어 조직형과 p53 단백의 발현과는 상관 관계가 없었다(p>0.05). 병기별로는 IIIA기 5예 중 2예(40%), IIIB기 24예 중 16예(67%) 그리고 IV기 24예 중 21예(88%)에서 p53 단백의 발현을 보여 병기가 진행될수록 발현율이 상승되는 경향을 보였다(p=0.043). p53 단백질의 발현과 항암화학요법에 대한 반응율과의 관계에서 화학요법 후 평가 가능한 43예에서 p53 단백 음성군 12예 중 6예(50%), 저양성군 15예 중 7예(47%)에서는 화학요법후 종괴의 50% 이상이 감소되는 치료 반응을 나타내었으나, 고양성군 16예에서는 단지 2예(13%)만이 치료 반응을 보여 p53 단백의 발현 정도와 화학 요법의 효과 사이에 유의한 차이를 나타내었다(p=0.045). 이상의 결과는 p53 유전자 이상이 비소세포 폐암 환자에서 화학 요법에 대한 종양의 내성과 치료 반응의 중요한 인자중의 하나인 것으로 시사된다. Alteration or inactivation of p53 seems to be the most common genetic change in human cancers. Mutation of the p53 gene is one of the most common genetic abnormalities found in non-small cell lung cancer(NSCLC). But little is known about which of the molecular events is involved in lung carcinogenesis and progression. In NSCLC, prognostic significances of p53 have yielded conflicting results. And defects in apoptosis caused by the inactivation of p53 can produce treatment-resistant tumors and may he an important determinant of tumor response to chemotherapy or radiation. We studied 53 cases of inoperable primary NSCLCS by the immunohistochemical staining technique, using p53 monoclonal antibody (DO-7, Dako, Denmark) and analyzed the relationship between the expression of p53 protein and clinical parameters including the efficacy of chemotherapy. Overall, 39(74%) of 53 cases of NSCLCS expressed p53 protein in more than 5% of tumor cells and can be divided into three groups, as follows: p53-negative(<5%, n=14), low p53 expression(5 to 50%, n=15), and high p53 expression(≥50%, n=24). By histologic type, they showed 77% positivity of p53 expression in squamous cell carcinoma, 65% in adenocarcinoma, and 100% in large cell carcinoma of lung(p>0.05). p53 protein was positive in 40% of stage IIIA, 67% of stage IIIB, and 88% of stage IV of NSCLCS(p=0.043). Response rates to chemotherapy of 43 treated patients were 50% in the p53-negative group, 47% in low p53 group, and 13% in high p53 group, which is significantly correlated with p53 status (p = 0.045). These findings indicate that alteration of p53 gene is frequent in advanced NSCLCS, is associated with a poor chemotherapeutic response and may be useful as a prognostic indicator for drug resistance.

급성 골수성 백혈병의 완전관해유도 효과

손창학 大韓血液學會 1991 大韓血液學會誌 Vol.26 No.2

담배성공사례

손창학 충북대학교 농과대학 1996 농업생산 Vol.1 No.-

-본문참고-

급성 골수성 백혈병에서 Etoposide, Cytarabine 및 Daunorubicin의 복합 화학 요법 효과

손창학,주영돈,이원식 인제대학교 1998 仁濟醫學 Vol.19 No.2

1991년 9월부터 1994년 8월까지 인제의대 부산백병원 내과에 입원했던 16세에서 63세까지의(중앙값: 34세) 성인 급성 골수성 백혈병의 치료 대상 환자 23명에서 etoposide, cytarabine 및 daunorubicin 복합 화학 요법을 시행한 결과 완전 관해율(CR)은 65.2%(15/23)였고, 완전 관해를 얻은 환자의 관해 지속 기간(중앙치)은 9.5개월(4∼21개월이상), 완전 관해의 2년 관해 지속율(2-year RFS)은 26%였다. Between Sep. 1991 and Aug. 1994. 23 patients of acute myeloid leukemia (AML) were treated with etoposide, cytarabine and daunorubicin regimen (cytarabine arabinoside 100mg/m2 IV emery 12hr on days 1-7, daunorubicin 50mg/m2 IV on days 1-3, Etoposide(VP-16) 120mg/m2 IV on day 1,3,5) as remission induction followed by postremission therapy. Median age was 34 years(16-63) and M:F ratio was 1.3:1. AML-M2 was most common type. Overall complete remission (CR) ramie was 65.2% (15/23). Median duration of CR was 9.5months(range 4-more than 21). And in complete responders, 2-year relapse-free survival rate was 26% by Kaplan Meier method. Combination therapy of etoposide, cytarabine and daunorubicin may be useful as a remission induction in acute myeloid leukemia, but did not improve therapeutic response compared to TAD as previous control at our hospital.