Combined chemotherapy with carboplatin plus irinotecan showed favorable efficacy in a patient with relapsed small cell carcinoma of the prostate complicated with meningeal carcinomatosis.
We report the case of a 65-year-old man with recurrent prostate cancer who presented with meningeal carcinomatosis. In September 2007, he had been diagnosed with mixed type small cell carcinoma and adenocarcinoma at clinical stage T4N1M1 (primary prostate tumor with multiple bone, liver, and lymph node metastases) and hormonal therapy had been administered. Following an increase in the level of pro-gastrin-releasing peptide (ProGRP), combined chemotherapy with cisplatin plus etoposide was implemented and showed efficacy in targeting the small cell carcinoma. In March 2008, he presented with signs of meningeal irritation; his condition deteriorated quickly and multiple brain metastases were confirmed by magnetic resonance imaging (MRI). A sample of cerebrospinal fluid collected by lumbar puncture showed cancer cells and an elevated level of ProGRP. Small cell carcinoma of the prostate complicated with meningeal carcinomatosis was diagnosed. A different chemotherapy regimen was then administered, consisting of a combination of carboplatin plus irinotecan, which is one of the most common first-line treatments for extensive-stage small cell lung carcinoma. From day 20 after the initiation of this therapy, he gradually recovered from the signs of meningeal irritation, and brain MRI showed nearly normal findings; also, the serum level of ProGRP was reduced. In conclusion, we report the efficacy of combined treatment with carboplatin plus irinotecan for small cell carcinoma of the prostate complicated with meningeal carcinomatosis. Because this clinical condition is extremely rare, a gold standard treatment has yet to be established.
Kanazawa University Hospital Cancer Center, Kanazawa, Japan. tadaakiy@med.kanazawa-u.ac.jp
Tadaaki
T
Yamada
Koushiro
K
Ohtsubo
Hisatsugu
H
Mouri
Kaname
K
Yamashita
Kazuo
K
Yasumoto
Kouji
K
Izumi
Yoh
Y
Zen
Hiroyuki
H
Watanabe
Seiji
S
Yano
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D016190:Carboplatin / Q000008:administration & dosage; D018288:Carcinoma, Small Cell / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000378:metabolism / Q000556:secondary; D006801:Humans; D000077146:Irinotecan; D008279:Magnetic Resonance Imaging; D008297:Male; D055756:Meningeal Carcinomatosis / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000378:metabolism / Q000556:secondary; D009364:Neoplasm Recurrence, Local; D010446:Peptide Fragments / Q000097:blood; D011471:Prostatic Neoplasms / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D011994:Recombinant Proteins / Q000097:blood; D013129:Spinal Puncture; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D010446:Peptide Fragments; D011994:Recombinant Proteins; C087079:pro-gastrin-releasing peptide (31-98); D000077146:Irinotecan; D016190:Carboplatin; D002166:Camptothecin