Antineoplastics

Abstract

Various toxicities: case report A 72-year-old man developed gastrointestinal toxicity following off-label treatment with carboplatin and etoposide. He also developed thrombocytopenia, neutropenia and diarrhoea following off-label treatment with nedaplatin and irinotecan for primary small cell neuroendocrine carcinoma (SCNEC) [not all routes stated]. The man presented with right flank pain and gross haematuria. He underwent numerous laboratory and imaging tests, which showed moderate right hydroureterosis. Therefore, a laparoscopic right nephroureterectomy was performed. Following the procedure, microscopic and immunohistochemical tests were performed, which confirmed the diagnosis of ureteral SCNEC, pT3N0M0. He then received off label treatment with 4 cycles of infusion of carboplatin 4 mg/mL/min on day 1 and infusion of etoposide at 100 mg/m2 on days 1–3, every 21 days. However, he experienced grade 1 gastrointestinal toxicity during treatment. After the completion of chemotherapy, at 7.5 months, the disease progression was noted. Repeat CT scan showed mass infiltrating bladder wall without clear margins to the surrounding tissues. Left inguinal lymphadenopathy was suspicious for metastasis. Hence, a percutaneous biopsy of the lymph node was performed which confirmed the diagnosis of metastatic SCNEC. Therefore, he received off label treatment with nedaplatin 80 mg/m2 on day 1 and irinotecan 65 mg/m2 on days 1 and 8, every 21 days for 4 courses. However, after the first cycle of chemotherapy, he experienced grade 3 neutropenia, grade 3 thrombocytopenia and grade 2 diarrhoea. The man was recovered from symptomatic treatment, and his chemotherapy was delayed by 1 week. He had continuous diseases progression. Hence, he received second-line off label treatment with 2 cycles of infusion of durvalumab 10 mg/kg on day 1, every 14 days along with radiotherapy. Thereafter, thigh numbness, pain and gross hematuria were resolved. However, liver bilateral pubic bones, right acetabulum, and liver metastases were noted. Later, even after the condition deterioration, he was moved to hospice service. Eventually, after 2 months he died from extensive metastatic disease [exact time to reaction onset not stated].