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分子標的薬であるエベロリムスの関与が疑われた 抜歯1か月後に生じた後出血の1例

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Title: 分子標的薬であるエベロリムスの関与が疑われた 抜歯1か月後に生じた後出血の1例
Authors: 格口, 渉 Browse this author
鈴木, 豊典 Browse this author
藤田, 温志 Browse this author →KAKEN DB
松田, 光平 Browse this author
Keywords: everolimus
post-extraction hemorrhage
mTOR (mammalian target of rapamycin)
VEGF (Vascular endothelial growth factor)
angiogenesis inhibitor
エベロリムス
抜歯後出血
哺乳類ラパマイシン標的タンパク(mTOR)
血管内皮増殖因子(VEGF)
血管新生阻害
Issue Date: Sep-2014
Publisher: 北海道歯学会
Journal Title: 北海道歯学雑誌
Volume: 35
Issue: 1
Start Page: 42
End Page: 47
Abstract: エベロリムスは,哺乳類ラパマイシン標的タンパク(mTOR)を標的とする分子標的薬である.mTORはがん細胞およびT細胞などの正常細胞の細胞増殖や血管新生に関わっているため,エベロリムスは抗癌剤や免疫抑制剤として使用されている.一方で,血管新生阻害作用や細胞増殖抑制作用は,創傷治癒不全や術後出血を引き起こす.症例は74歳男性で,左側腎細胞癌および肺多発転移でスニチニブを内服していた.スニチニブ内服休薬後,近歯科医院にて右側下顎犬歯・小臼歯を抜歯された.抜歯22日後,エベロリムス内服を開始した.抜歯31日後,食事後に右側下顎犬歯・小臼歯部から出血を認め,近歯科医院では止血ができなかったため,当科を紹介され受診した.当科初診時,口腔内は凝血塊で充満しており,同部から静脈性の出血を認めた.抜歯窩を掻爬し,止血処置を行った.抜歯窩の治癒が悪かったため,止血処置5日後エベロリムス内服を休薬し,止血処置33日後抜歯窩が上皮化したことを確認し終診とした.エベロリムス使用者に対する外科処置では,創傷治癒不全による突然の術後出血が起こる可能性があり,上皮化が得られるまでは,注意深く経過観察することが必要と思われた.
Everolimus is a molecularly targeted drug for mammalian target of rapamycin (mTOR). mTOR is related angiogenesis, the proliferation of normal cells include T-cells and cancer cells. Everolimus is treated with anti-cancer and immunosuppressive drugs. However, it triggers wound healing failure and post-surgery hemorrhage because of anti-angiogenesis and inhibition of cell proliferation. A 74-year-old male patient diagnosed with left renal cell carcinoma and multiple pulmonary metastases was treated with sunitinib. His right lower cuspid and first premolar had been extracted by a dental practitioner after the discontinuation of sunitinib. Everolimus started 22 days after the extraction. Hemorrhage from right lower cuspid and first premolar sockets occurred after a meal 31 days after the extraction. He was referred to our hospital because the hemorrhage continued. Initial examination revealed a lot of clots in his mouth and venous hemorrhage from the sockets. We performed curettage of the sockets and hemostatic treatment to stop the hemorrhage, and then we achieved hemostasis. Because wound healing was delayed, Everolimus was discontinued 5 days after the curettage and hemostatic treatment. The sockets were epithelialized within 33 days after the curettage and hemostatic treatment. We suggest that patients treated with Everolimus require attention to sudden post-operation hemorrhage due to wound healing failure until the wound is epithelialized.
Type: article
URI: http://hdl.handle.net/2115/57098
Appears in Collections:北海道歯学雑誌 = Hokkaido Journal of Dental Science > 第35巻 第1号

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