サン調剤薬局

滋賀県守山市にある『サン調剤薬局』のブログ

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ジャンル : 日記

滋賀県守山市サン調剤薬局西川でございます。
滋賀も寒くなってきました。

今年夏に行った局内研修会を報告させてもらいます。

研修日時   平成29年8月8日
研修タイトル 乳がん補助療法
研修要旨
1、乳がんはエストロゲンにより成長するため、治療はホルモン療法となる。
2、乳がんのホルモン療法の変遷は以下の通りである。
  1960年(昭和35年) エストロゲン受容体の発見
  1981年(昭和56年) 抗エストロゲン剤:タモキシフェン(ノルバデックス)の承認
  1994年(平成6年)  LH-RHアゴニスト:ゴセレリン(ゾラデックス)の承認
  1996年(平成8年)  LH-RHアゴニスト:リュープロレリン(リュープリン)の承認
  2000年(平成12年) アロマターゼ阻害薬:アナストロゾール(アリミデックス)の承認
  2011年(平成23年) SERD:フルベストラント(フェソロデックス)の承認
3、各ホルモン療法剤の投与方法と対象は以下の通りである。
  LH-RHアゴニスト製剤 投与方法:皮下注射(4週に1回、12週に1回)
                  対象:閉経前
  アロマターゼ阻害薬 投与方法:内服(毎日服用)
                対象:閉経後
  抗エストロゲン剤 投与方法:内服(毎日服用)
              対象:閉経前、閉経後
  治療後、卵巣機能を回復させたい(妊娠を希望している)ときはLH-RHアゴニストを投与してはいけない。
4、タモキシフェンはSERMの第一世代で、乳腺・中枢神経には抗エストロゲン作用を示し、子宮・骨・脂質代謝・
  抗凝固能にはエストロゲン作用を示す。投与期間は術後5年から10年であり、5年投与より10年投与の方が
  対側乳がん(手術した乳房とは反対の乳房に乳がんが発生すること)の発生リスクが低い。さらに、再発リスク
  や死亡リスクも10年投与の方が低いことが確認させている。
5、アナストロゾールは閉経後乳がんにおける第一選択薬で、投与期間は5年投与である。タモキシフェン5年投与
  よりアナストロゾール5年投与の方が効果が高く、リスクが軽減されることがわかっており、アナストロゾールの
  術後5年投与はガイドラインの推奨グレードAである。また、術後タモキシフェンを2~3年投与した後にアナスト
  ロゾールを3年投与する方が、再発率や死亡率、対側乳がん発生リスクが低くなることがわかっており、この
  方法はガイドラインで推奨グレードAとなっている。なお、アリミデックス投与後に月経が戻る方もいる。
6、フェソロデックスは乳房のエストロゲン受容体数だけを減少させる働きがあり、SERMのように骨や子宮に対し
  ては影響がないため、子宮がんや骨折のリスクは無い。

前回研修会報告 DI変更 http://blog.cabrain.net/CN112049/article/id/103612.html
局内研修会履歴 http://www.myph.jp/sun_pharm/pc/free2.html
薬局HP http://www.myph.jp/sun_pharm/pc/index.html
薬局スマホサイト http://sun-ph.jp/sumaho/

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