切除不能肺癌患者に対するclarithromycinの有効性に関する臨床的・基礎的研究

Abstract

I carried out a randomized study of 100 consecutive patients with unresecta- ble primary lung cancer to ascertain whether clarithromycin (CAM), a 14-membered ring macrolide, can improve the outcome of the patients. A total of 95 complete cases had received prior chemotherapy and/or radiotherapy during admission. They were randomly allocated into two study groups on the first visit to the out-patient clinic after discharge : 49 patients recieved CAM (400 mg/day orally), and 46 patients did not recieve CAM. There was no significant difference in median survival time for small cell lung cancer between the CAM group and the non-CAM group. In contrast, CAM treatment significantly elongated the median survival time for non-small cell lung cancer patients. The underlying mecha- nism explaining such effects of CAM may be postulated ; a long-term treatment of CAM is able to decrease the production of cachexia-inducing cytokin interleukin 6, and increase the production of interleukin 12 and INF-γ in association with increasing NK-cell activity. In mice bearing murine lung cancer, administration of CAM initiated 7 days after the comple- tion of anticancer chemotherapy inhibited the tumor growth to a greater extent, and significantly increased NK-cell activity, compared with the combined use of CAM and anticancer chemotherapy. CAM was especially effective for patients at the early clinical stages and having responded well to prior anticancer therapy, which was confirmed by the study of CAM effect on murine lung cancer.