한약치료와표적항암요법 ( 아피니토 ) 을병행하여부분관해된신세포암간전이환자 1 례 Abstract Sung-Hwan Chang 1, Ji-Hye Park 1,2, Hwa Seung Yoo,2*

https://doi.org/10.15432/jkto.2017.22.2.013 한약치료와표적항암요법 ( 아피니토 ) 을병행하여부분관해된신세포암간전이환자 1 례 Abstract Sung-Hwan Chang 1, Ji-Hye Park 1,2, Hwa Seung Yoo,2* 1 JangDeuk Integrative Medical Center, Korean Medicine Hospital 2 East West Cancer Center, Dunsan Korean Medicine Hospital of Daejeon University Received 10 December 2017, accepted 22 December 2017 Objectives: The purpose of this study is to report the effect of Korean Herbal Medicine (KHM) on a Renal Cell Carcinoma with multiple liver metastases patient. Methods: One renal cell carcinoma with multiple liver metastases patient was treated by KHM in conjunction with targeted anticancer agent (Afinitor). The effect of KHM was measured by scanning with Computed Tomography (CT), Blood Test, Visual Analogue Scale (VAS) and Eastern Cooperative Oncology Group scale. Results: Multiple hepatic tumors were reduced after the treatment during 5 months (Partial Remission, PR). As treatment was performed, complications induced by targeted anticancer agent (Afinitor) were alleviated. Conclusions: This case provides us a possibility that Korean Herbal Medicine offers potential : 176 75 Tel: 042-470-9132, Fax: 042-470-9006, E-mail: altyhs@dju.kr

14 2017;22(2):13-24 benefits for renal cell carcinoma with multiple liver metastases patient. Key words: Renal Cell Carcinoma, Afinitor, Integrative Medicine, Herbal medicine. 18.,,, 5 1). sorafenib, sunitinib, temsirolimus, bevacizumab, everolimus 2). Caki-1 3), 4). 5, (Afinitor (everolimus)),, AbdominoPelvic Computed Tomography (PR: Partial Remission). O O, 59, 2017/07/20-2017/12/06 (140 ) - 2001/02 chromophobe type (Renal cell carcinoma) Stage (,, 6, 10, 11, 7 ) 2017 7 17 CT,,, supportive care

15 (Total Bilirubin 3.2 mg/dl).,. 4 (Targin) 2 10. 2001 2 4 2002 2 (Lt. radical nephrectomy), 2003 11 (Rt. common iliac lymph node dissection), 2005 1-2 -α, 2005 3 2 (Transcatheter arterial chemoembolization, TACE), 2005 11 T11~12, 2008 6 ~ 2016 1 Sutene (sunitinib) (SD: Stable Disease) (PD: Progressive Disease), 2011 7 20 T5~6, 2015 4 16 TORISEL (Temsirolimus) SD (urology sepsis). Pazopanib 2017 5 3 CT liver, spleen, pancreas tail LNs meatstasis 2017 7 17, supportive care..,,,,,,,....,., ( 4 ).,,. 10 15 3 5,

16 2017;22(2):13-24. 10 15 ( 3 ), 5 (Table 1). (Afinitor), 2017 8 3 2017 12 6 90. 10mg 1 30 14.., aspartate aminotransferase (ALT), alanine aminotransferase (AST), alkaline phosphatase (ALP), Total Bilirubin (TB), c-reactive protein (CRP), white blood cell (WBC) 7 20 12 6. 2017 8 2 9 14 CT, 2017 8 2 9 14, 10 25 CT. Table 1. Prescription of Herbal Decoction Date(YYYY/MM/DD) Prescription (Dose, g) 2017/07/20~2017/07/26 2017/07/27~2017/08/06 2017/08/07~2017/09/06 2017/09/07~2017/09/13 2017/09/14~2017/09/20 2017/10/10~2017/10/20 2017/10/21~2017/10/26 2017/11/11~2017/11/28 16, 8 20, 8,, 4 20, 8, 6, 4, 3.5, 4, 3 8,,, 4,,, 3.5 20, 8, 6, 4, 3.5, 4, 3 20, 8 8 15,,,, 6,,,, 4,, 8,,,,,,,,,,, 5, 3, 2, 3 8 15,,,, 6,,,, 4,, 8

17 10cm. 7 20 12 6. 0~5 ECOG 7 20 12 6. 1) 7 20 ECOG 3,, 3 2, (Targin) 40 mg 2, IR codon prn, 3 3. 2) 7 21 (TB) 2.89 (hyperbilirubinemia) (BUN: blood urea nitrogen) 32.5 [6.0~23.0] (azotemia) (cholangitis) 5 (Table 2). 3) 7 22 (Targin) 20 mg 2 3 4. 4) 7 23 25 /h. 5) 7 25, AST(SGOT) 170 65 ALT(SGPT) 71 43, CRP 24.86 8.63, TB 2.89 1.55, WBC 20.08 13.54 (Table 2). 6) 7 26,,, (= ) 10 3 5 7 25 /h. 7) 8 2 50% ECOG 1. 8) 8 3 ( 8g) 10 3 5. 2 10mg 1 30. 9) 8 9 CRP 8.83 0.54 ALT 43

18 2017;22(2):13-24 21 WBC 13.54 5.31 Albumin (ALB) 2.6 3.9 TB 1.55 0.83 (Table 2). 10) 8 7 8 2 X-ray CT (pleural effusion) (Figure 1(A)).,, 4g 10 3 5, 1. 11) 8 9 AST 65 40 ALB 2.6 3.9 (Table 2). 12) 9 1, 10 3 5. 13) 9 3 3. 14) 9 14 CT (Figure 1(B)), (PR) (Figure 1(D)). 15) 9 14,, (= : 10, 8g) 10 3 5. 16) 10 10 ECOG 1, 10) (VAS 4) 1.5 8g 5. 17) 10 18 1.5, (VAS 2). 18) 10 13 (brown) Blood 4 positive(++++), RBC 30-40, WBC 1-3, proteins 2 positive(++) 10 20 Blood 3 positive(+++), RBC Many, WBC 1-2, proteins 2 positive(++) (Hematuria). 19) 10 21, 1.5 10 3 5. 20) 10 25 CT (PR) (Figure 1(E)). 21) 11 2 Blood negative, RBC 0-1, WBC 0-1, Proteins negative.

19 (A) Chest CT (2017/08/02) (B) Chest CT (2017/09/14) (C) Abdominal CT (2017/08/02) (D) Abdominal CT (2017/09/14) (E) Abdominal CT (2017/10/25) Figure 1. Chest and Abdominal CT Follow up. Minimal decreased amount of right pleural effusion and partial remission of multiple hepatic mass were shown.

20 2017;22(2):13-24 Table 2. Changes of Blood Test YY/MM/DD Blood Test AST(SGOT) (U/L) ALT(SGPT) (U/L) ALP (U/L) CRP (mg/dl) T.B (mg/dl) ALB (g/dl) WBC (10*3/uL) Antibiotics 17/07/17 17/07/20 17/07/25 17/08/09 17/08/17 17/09/11 17/09/18 17/10/06 17/12/06 Normal range 213 170 65 65 40 46 33 48 41 [~40] 90 71 43 21 23 22 16 29 28 [~41] 415 485 603 327 253 253 273 223 34.26 24.86 8.63 0.54 0.12 0.98 0.77 0.12 0.47 40~12 9 [0.0~0.5] 3.2 2.89 1.55 0.73 0.57 0.58 0.38 0.48 0.36 [~1.2] 2.9 2.6 3.9 3.9 4.1 3.7 4.5 4.6 18.8 20.08 13.5 5.31 7.04 6.35 9.37 5.38 6.02 TC KHM Antibiotics : Levofloxacin Inj 17.07.21~17.08.01, Metronidazole Inj 17.07.26~17.08.01 TC : Targeted Chemotherapy (Afinitor) 17.08.03 ~ 17.12.06: 3cycle KHM : Korean Herbal Medicine 17.07.21~17.12.01 3.97~ 4.94 [4.00~ 10.00] AST: aspartate aminotransferase; SGOT: serum glutamic oxaloacetic transaminase; ALT: alanine aminotransferase; SGPT: serum glutamic-pyruvic transaminaes; ALP: alkaline phosphatase; CRP: c-reactive protein; T.B: Total Bilirubin; WBC: white blood cell counts 22) 11 11 ECOG 1 1.5, 8g 10. 23) 12 3 8 3 10mg 1 30 2 1cycle 3cycle. 24) 12 6 ECOG 1, LFT (ALP: alkaline phosphatase) 415 U/L(7 20 ) 223 U/L(12 6 ) (Table 2).

21 3%,.,.. 3,, 3 10~15% 2). 2001 2, chromophobe type 4 2015 4 16,, 2017 5 3 AbdominoPelvic Computed Tomography liver, spleen, pancreas tail LNs meatstasis 2017 7 17,, 1~2. 2017 7 20., (,, ) 5,7), ( ), IL-1β, IL-6 8). 2017 7 26,,, (= ) 10 3 5 7 8 2 50% ECOG 1, CRP ALT WBC ALB T.B.. (Cholangitis),, 7 ( )., 5). Zhang ALT, AST, TNF-α, IL-10 CD(8+) T cell 6), ALT, AST, ALP, TB, CRP. 2017 8 3 2 (Afinitor) 10mg 1 30,

22 2017;22(2):13-24. Qi, 12). Ruan,,,, 13).., mtor, VEGF (Vascular endothelial growth factor) Sutene(sunitinib) 10). 3,049 (everolimus),, 2, (median overall survival) 17 (95% confidence interval [CI] 14.5-19.5 months) 11). 17. 2017 8 2 X-ray CT (pleural effusion),, 4g 10 3 5, 1. 9 14 CT, (PR).,. 10 13 (brown) (Hematuria). 4, 2, 10).,,,, 9), (- )+ (- )+,,,,, 14). 3 5 11 2

23 Blood negative, RBC 0-1, WBC 0-1, Proteins negative,.,,. 2017 11 11 1.5, 8g 10 VAS 4~5 VAS 2,.,,,, 15). 5 2 CT, 12 6 ECOG 1, LFT, (ALP) 415 U/L(7 20 ) 223 U/L(12 6 ), VAS 2,.,.. 1. Sathianathen NJ, etc. The current status of immunobased therapies for metastatic renal-cell carcinoma. Immunotargets Ther. 6:83-93, 2017. 2.,. p.175-180, 2011. 3.,,, Kim J, Choi Y, Hwang W.. 29(1):42-66, 2008. 4.,,,,, Jeong U, et al. 1. 29(2):529-534, 2008. 5.. 30,. p.104-113, 2010. 6. Zhang, Shing etc, Aqueous extract of Bai Hu Tang, a clasical chinese herb formula, prevents excessive immune response and liver injury induced by LPS in rabbits, J Ethnopharmacol. 149(1):321-327, 2013. 7. Kurosawa, S, et al. Gastroenterology 118, p.a221, 2000. 8.,,, p.365-371, 2010. 9.,,. 27(1):59-68, 2013. 10., 10mg

24 2017;22(2):13-24 http://terms.naver.com/entry.nhn?docid=21 23783&cid=51000&categoryId=51000 11. Lakomy R, etc. Utilization and efficacy of second-line targeted therapy in metastatic renal cell carcinoma: data from a national registry. BMC Cancer. 17(1):880, 2017. 12. Qi F, etc. The advantages of using traditional Chinese medicine as an adjunctive therapy in the whole course of cancer treatment instead of only terminal stage of cancer. Biosci Trends. 9(1):16-34, 2015. 13. Ruan WJ, etc. Anticancer effects of Chinese herbal medicine, science or myth? J Zhejiang Univ Sci B. 7(12):1006-1014, 2006. 14.. 3.. p343-344, 2006. 15.. 101.. p726-727, 2004.