乳癌患者接受化學治療合併靜脈注射甘草甜素之個案報告

A Patient with Breast Cancer Treated with Chemotherapy and Intravenous Glycyrrhizin-a case report

現今乳癌治療方法以手術、局部放射療法、全身性化療及賀爾蒙療法為主。對於轉移性乳癌的化療而言，多種藥物合併的治療效果比單一藥物為佳，但許多藥物都必須經由肝臟代謝，因此病患的肝臟功能是否健全則是其能否接受進ㄧ步的全身性化療的重要關鍵。本文將介紹一位因接受化療（Taxotere 合併5FU 及Taxol 合併Gemzar）導致肝功能異常因而中斷治療的43 歲轉移性乳癌患者。她於化療（Taxotere合併5FU）期間，因肝功能異常而增加合併靜脈注射甘草甜素（Glycyrrhizini 簡稱GL）治療（每次化療前兩天及化療後一天，各施打一次GL 80mg）。雖然肝功能獲得改善，但因腫瘤指標（CA15-3） 攀升及肺部轉移而更改化療藥物（Taxol 合併Gemzar）。第一次注射Taxol 合併Gemzar 後，原本恢復正常的肝功能再度異常，因此，她重新接受靜脈注射甘草甜素的合併治療，但GL 施打方式改為每次化療前後各注射一次，每次120mg。更改此種注射方式之後，她的肝功能又逐漸恢復正常，並且維持平穩至整個療程結束（總共4 個月）。此期間化療持續沒有中斷，且未出現任何不良反應。因持續化療的關係，其腫瘤指標CA15-3 穩定下降。另一方面，2005 年11月胸部電腦斷層顯示，肺部腫瘤完全消失。此結果顯示，靜脈注射甘草甜素似乎可以減輕及預防化療引起的肝功能障礙。甘草甜素之減輕及預防化療引起肝功能障礙的療效值得進一步大規模臨床試驗探討。

The standard treatments of breast cancer are operation, local radiotherapy, systemic chemotherapy and hormone therapy. Regarding chemotherapy for metastatic breast cancer, combination chemotherapy is more effective than single agent. However, most of the drugs used for chemotherapy are metabolized by the liver. Therefore, whether the liver function is tolerable or not becomes the key point for patients receiving systemic chemotherapy. In this report, we present a case of a 43 year old female patient with metastatic breast cancer. She suffered from intolerable liver dysfunction following chemotherapy with intravenous injection of Taxotere and 5FU. Liver function gradually recovered after chemotherapy combined with intravenous injection of glycyrrhiznin (GL) at a dosage of 80mg/day for 2 days pre-chemotherapy and 80mg/day post-chemotherapy. Although liver function improved, the regimen of chemotherapy was changed to another regimen with Taxol and Gemzar due to the findings of increased serum tumor marker (CA15-3) and lung metastasis. Following the first injection of Taxol and Gemzar, her liver function once again became abnormal. She received intravenous injection of GL again. However, the dosage of GL was changed to 120mg (IVD) before and immediately afterchemotherapy. After the regimen of GL changed, her liver function recovered again and remained normal until the completion of the whole chemotherapy schedule (total of 4 months). During this period, chemotherapy was performed continuously and no significant side-effects appeared. Due to persistent chemotherapy, the tumor marker (CA15-3) decreased gradually, and the metastatic lung tumors, noted by chest CT scan, disappeared completely in Nov. 2005. The above results suggest intravenous GL may attenuate or prevent liver dysfunction induced by chemotherapy. It is worthwhile evaluating the preventive and therapeutic effects of intravenous GL on liver dysfunction induced by chemotherapy with a large clinical trial in the future.