Neoadjuvant chemotherapy with reduced-dose carboplatin and gemcitabine for non-small cell lung cancer in a patient with Fanconi anemia.
Fanconi anemia (FA) is characterized by pancytopenia, congenital malformations, and susceptibility to malignancies. We describe a 31-year-old man with FA, who had undergone bone marrow transplantation and whole body irradiation at the age 17 years for FA. Fourteen years later, he presented with squamous cell carcinoma of the bronchus intermedius in the right lung. The tumor was located next to the main pulmonary artery and between the superior and inferior pulmonary veins. Two cycles of neoadjuvant therapy were given in an attempt to decrease tumor size and avoid a potential right pneumonectomy. Treatment consisted of a 21-day cycle with carboplatin (area under the curve 3) given on day 1 and gemcitabine (1250 mg/m) on day 1 and 8. Because FA cells are hypersensitive to DNA crosslinking agents, we reduced the carboplatin dose to minimize treatment-related toxicity. The tumor regressed sufficiently to permit performance of a right middle and lower lobectomy. In our case, neoadjuvant therapy with gemcitabine and low-dose carboplatin exhibited antitumor activity with manageable side-effects, suggesting that this chemotherapy regimen can be safely and effectively used in the treatment of NSCLC in FA patients who have achieved hematopoietic reconstitution after bone marrow transplantation.
Dudek
Arkadiusz Z
AZ
Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota Medical School, MMC 480, 420 Delaware St. S. E., Minneapolis, MN 55455, USA. dudek002@umn.edu
Chereddy
Subhadra
S
Nguyen
Sheila
S
Wagner
John E
JE
Maddaus
Michael
M
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D001984:Bronchial Neoplasms / Q000188:drug therapy / Q000209:etiology; D001999:Bronchoscopy; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000209:etiology; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005199:Fanconi Anemia / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000209:etiology; D008297:Male; D020360:Neoadjuvant Therapy; D011651:Pulmonary Artery / Q000473:pathology / Q000528:radiation effects; D014916:Whole-Body Irradiation; D000093542:Gemcitabine
D003841:Deoxycytidine; D016190:Carboplatin; D000093542:Gemcitabine