Successful treatment of doxorubicin and cisplatin resistant hepatoblastoma in a child with Beckwith-Wiedemann syndrome with high dose acetaminophen and N-acetylcysteine rescue.
High dose acetaminophen (HDAC) with N-acetylcysteine (NAC) has been effective in adults with advanced malignancies. We report HDAC with NAC in a child with progressive hepatoblastoma, confirmed at biopsy of an unresectable hepatic mass. Alpha-fetoprotein (AFP) increased despite four courses of doxorubicin and one course of cisplatin, 5-flurouracil, and vincristine. Following HDAC with NAC, AFP markedly decreased. A continued response without toxicity was observed during four subsequent courses of HDAC with NAC and cisplatin. The residual necrotic tumor was resected. The child is now over 8 years disease free. HDAC and NAC are effective and well tolerated for progressive hepatoblastoma.
Kobrinsky
Nathan L
NL
Roger Maris Cancer Center, MeritCare Health System, Fargo, North Dakota 58122, USA. nathankobrinsky@meritcare.com
Sjolander
Diane E
DE
Goldenberg
Jacob A
JA
Ortmeier
Thomas C
TC
D000082:Acetaminophen / Q000008:administration & dosage*; D000111:Acetylcysteine / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology / Q000627:therapeutic use; D001506:Beckwith-Wiedemann Syndrome / Q000150:complications; D002945:Cisplatin / Q000008:administration & dosage / Q000494:pharmacology; D004317:Doxorubicin / Q000494:pharmacology; D019008:Drug Resistance, Neoplasm; D004359:Drug Therapy, Combination; D005260:Female; D018197:Hepatoblastoma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology
D000970:Antineoplastic Agents; D000082:Acetaminophen; D004317:Doxorubicin; D002945:Cisplatin; D000111:Acetylcysteine