Chemotherapy plus atezolizumab for a patient with small cell lung cancer undergoing haemodialysis: a case report and review of literature

Abstract

Little is known about the safety of chemotherapy plus atezolizumab for patients with extensive‐stage small cell lung cancer (ES‐SCLC) undergoing haemodialysis (HD). An 80‐year‐old male received carboplatin [area under the concentration‐time curve (AUC) = 5 on day 1], etoposide (40 mg/m 2 on days 1, 2, and 3), and atezolizumab (1200 mg/body on day 1) as the first‐line therapy for ES‐SCLC. He was undergoing HD thrice a week for seven years. HD was provided 16 h after carboplatin administration. During the first cycle, grade 4 neutropenia (neutrophil count: 74/μL) and leukopenia (white blood cell count: 680/μL) occurred. Therefore, chemotherapy was administered with a reduced dose of carboplatin (AUC = 4) and etoposide (30 mg/m 2 ) from the second to fourth cycles. After four cycles, no severe non‐haematological adverse events occurred, showing a remarkable response. We conclude that the carboplatin, etoposide, and atezolizumab combination can be safely administered to cancer patients undergoing HD.

A 75-Year-Old Female Smoker with Advanced Small-Cell Lung Cancer and Eastern Cooperative Oncology Group Performance Status 2 who Responded to Combination Immunochemotherapy with Atezolizumab, Etoposide, and Carboplatin

“…The sparse case reports in the literature show that an elderly patient undergoing hemodialysis safely received this kind of treatment [ 13 ] and describe a good response in a patient with poorer PS scores and indicate that there is a lack of research in this group [ 14 ].…”

“…Most case reports in the literature refer to the immunochemotherapy in NSCLC. There are reports of using chemotherapy with atezolizumab in an 80-year-old male patient with extensive-stage SCLC undergoing hemodialysis [ 13 ]. Authors of another case report also suggested that SCLC patients outside of clinical trials are typically in a poor ECOG state but could also benefit from immunotherapy [ 14 ].…”

Tolerability and efficacy of IMpower133 regimen modified for dialysis patients with extensive‐stage small cell lung cancer: Two case reports

“…Additionally, the dose and the administration schedule of CBDCA/VP‐16 were modified according to the previous reports analyzing the pharmacokinetics of these cytotoxic drugs in ES‐SCLC patients on dialysis 2,3 . Although the dose of CBDCA/VP‐16 and the timing of dialysis were different, Imaji et al 5 reported that atezolizumab/VP‐16 (40 mg/m 2 on dayd 1, 2, and 3)/CBDCA (area under the concentration‐time curve = 5 on day 1) could be administered to dialysis patients with ES‐SCLC, as seen in this report. Therefore, the modified IMpower133 regimen can be a treatment option in patients with ES‐SCLC on dialysis.…”