Gao Feng, Cong Xiaofeng, Liu Ziling
Deparment of Oncology, First Affiliated Hospital, Jilin University, Changchun, Jilin, PR China.
Medicine (Baltimore). 2020 Oct 2;99(40):e22637. doi: 10.1097/MD.0000000000022637.
Small cell lung cancer (SCLC) is an aggressive malignancy that progresses rapidly and easily relapses. To the best of our knowledge, advances have been minimal for decades and the first-line treatment is still platinum-etoposide and radiotherapy. However, elderly patients with severe renal failure who suffer from SCLC usually show more serious drug-related side effects. A large proportion of them cannot tolerate the standard treatment, and their prognosis is poorer compared with that of younger patients. Presently, oral etoposide capsules may be accepted as a replaceable option. We report the case of a male patient with SCLC on hemodialysis who was successfully treated with concurrent oral etoposide monotherapy and radiotherapy and achieved excellent outcomes.
PATIENT'S CONCERNS: A 63-year-old man with severe renal failure was diagnosed with SCLC.
SCLC was diagnosed using transbronchial biopsy.
He received concomitant single-agent oral etoposide (6 cycles) and local radiotherapy. Etoposide 100 mg once daily combined with thoracic radiation treatment (2 Gy/f, total DT: 50 Gy/25 f), was subsequently followed by prophylactic cranial irradiation plus anlotinib.
The patient achieved complete response after 1 cycle and the subsequent treatment was effective without any kidney damage and other severe side effects.
Though etoposide capsule is an old drug, its use should be considered in SCLC patients with renal insufficiency undergoing hemodialysis. However, treatment guidelines and research data for such patients are still lacking and further studies are needed. Although recent research focuses mainly on new drugs, some old drugs like etoposide which can bring unexpected positive effects should not be neglected.
小细胞肺癌（SCLC）是一种侵袭性恶性肿瘤，进展迅速且易复发。据我们所知，几十年来进展甚微，一线治疗仍然是铂类-依托泊苷和放疗。然而，患有SCLC的严重肾衰竭老年患者通常会出现更严重的药物相关副作用。他们中的很大一部分人无法耐受标准治疗，与年轻患者相比，其预后更差。目前，口服依托泊苷胶囊可能被视为一种可替代的选择。我们报告了一例接受血液透析的SCLC男性患者，该患者通过口服依托泊苷单药与放疗联合治疗获得成功，并取得了优异的疗效。
一名63岁患有严重肾衰竭的男性被诊断为SCLC。
经支气管活检诊断为SCLC。
他接受了口服依托泊苷单药（6个周期）与局部放疗联合治疗。依托泊苷100mg每日一次，联合胸部放疗（2Gy/次，总剂量：50Gy/25次），随后进行预防性颅脑照射加安罗替尼治疗。
患者在1个周期后达到完全缓解，后续治疗有效，未出现任何肾脏损害及其他严重副作用。
尽管依托泊苷胶囊是一种老药，但对于接受血液透析的肾功能不全的SCLC患者，应考虑使用。然而，此类患者的治疗指南和研究数据仍然缺乏，需要进一步研究。尽管近期研究主要集中在新药上，但一些像依托泊苷这样能带来意外积极效果的老药不应被忽视。
