title: Metronomic maintenance chemotherapy in patients presenting with paraneoplastic autoimmune hepatitis with recurrent thymic carcinoma.
abstract: Autoimmune hepatitis is a rarely seen autoimmune paraneoplastic syndrome of thymic carcinoma. Chemotherapy may be an effective choice in the treatment of primary tumor and paraneoplastic disorder. In this case, we report a 32-year-old man presented with increased liver enzymes and cholestasis with a history of thymoma surgically removed four years ago. Liver biopsy showed chronic active autoimmune hepatitis. Computed tomography scan showed pulmonary metastases and pleural mass as a recurrence of thymic carcinoma, proven by biopsy. After four cycles of cisplatin plus adriamycin plus cyclophosphamide plus vincristine and six cycles of paclitaxel plus gemcitabine, maintenance metronomic cyclophosphamide plus etoposide regimen was offered to the patient. Complete biological signs of hepatitis without need for steroids or immune suppressors and complete radiologic response in primary tumor were achieved. Maintenance metronomic chemotherapy regimens may be an alternative to the current treatment options in patients with thymic carcinomas.
authors.affiliation: Department of Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey deryakivrak@gmail.com.
authors.forename: Derya
authors.initials: D
authors.lastname: Kivrak Salim
authors.affiliation: Department of Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Mutlu
authors.affiliation: Department of Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey.
authors.forename: Melek
authors.initials: M
authors.lastname: Karakurt Eryilmaz
authors.affiliation: Department of Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Yalçin Musri
authors.affiliation: Department of Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Tural
authors.affiliation: Department of Medical Oncology, Akdeniz University School of Medicine, Antalya, Turkey.
authors.forename: Hasan Şenol
authors.initials: HŞ
authors.lastname: Coşkun
mesh_terms: D059250:Administration, Metronomic; D000328:Adult; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D060046:Maintenance Chemotherapy / Q000379:methods*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013945:Thymoma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013953:Thymus Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
keywords: Metronomic therapy; maintenance therapy; paraneoplastic autoimmune hepatitis; thymic carcinoma