小細胞肺癌患者接受口服化療合併高劑量維他命C靜脈注射之個案報告

A Patient With Small Cell Lung Cancer Treated with Oral Chemotherapy and Intravenous High Dose Vitamin C

小細胞肺癌為轉移性高的惡性腫瘤，其治療以靜脈注射組合抗癌化學藥物為主，其中又以靜脈注射VP-16 （etoposide） 合併cisplatin 最為常用。對於無法接受靜脈注射化學治療的高齡小細胞肺癌患者而言，如何控制腫瘤的快速成長及轉移常是令臨床醫師頭痛的問題。本文將介紹一個因接受傳統靜脈注射化學藥物VP-16 （etoposide） 合併cisplatin 導致嚴重副作用的83 歲廣範性小細胞肺癌患者。他於改為接受口服etoposide（ 每日150mg 連續3 週，停1 週） 合併每週靜脈注射高劑量維他命C （50g-60g） 四個月後，腫瘤獲得完全緩解，且未出現明顯副作用。患者雖於終止口服etoposise 五個月後因腫瘤復發而死亡，但在腫瘤復發前生活機能一直維持在良好狀態，而且其存活期（10 個月）仍長於一般單獨接受口服etoposide 之廣泛性小細胞肺癌患者的中位存活期（ 約4.8 個月）。此結果顯示，維他命C 或許可以加強口服Etoposide 的抗癌作用。至於維他命C 如何加強化學藥物的抗癌作用值得更進一步探討。

Small cell lung cancer is a kind of cancer with high metastasis and mortality rate. The current standard treatment for extensive small cell lung cancer is a combination of chemotherapy with etoposide and cisplatin. While the regimen is highly effective, many older patients could not tolerate the associated side effects of this regimen and few alternative and effective treatment exists for management of this population of elderly patients. In this report, we present a case of an 83 year old patient with extensive small cell lung cancer who suffered from serious side effects following chemotherapy with intravenous injection of VP-16 and cisplatin and the treatment was switched to oral etoposide(150mg/day for 3weeks and rest for one week) and intravenous high dose vitamin C (50-60g weekly for 4 months). The tumor responded completely to this regimen and the patient reported no significant side effects. His treatment had continued for 4 months and his performance status had markedly improved and remained stable until 5 months following discontinuation of oral etoposide. His survival period was 10 months, which is significantly longer than the reported median survival of 4.6 months for extensive stage small cell lung cancer treated with oral etoposide alone. The ability to achieve a complete response and prolonged survival in this patient by this combination therapy suggests that highdose vitamin C may potentiate the cytotoxicity of etoposide in small cell lung cancer. Based on this result, we feel that further investigation into the efficacy of intravenous high dose vitamin C in combination with oral etoposide in the treatment of extensive small cell lung cancer is warranted.