Neoadjuvant Chemotherapy with Reduced-Dose Carboplatin and Gemcitabine for Non-small Cell Lung Cancer in a Patient with Fanconi Anemia

Abstract

Fanconi anemia (FA) is characterized by pancytopenia, congenital malformations, and susceptibility to malignancies. We describe a 31-year-old man with FA, who had undergone bone marrow transplantation and whole body irradiation at the age 17 years for FA. Fourteen years later, he presented with squamous cell carcinoma of the bronchus intermedius in the right lung. The tumor was located next to the main pulmonary artery and between the superior and inferior pulmonary veins. Two cycles of neoadjuvant therapy were given in an attempt to decrease tumor size and avoid a potential right pneumonectomy. Treatment consisted of a 21-day cycle with carboplatin (area under the curve 3) given on day 1 and gemcitabine (1250 mg/m) on day 1 and 8. Because FA cells are hypersensitive to DNA crosslinking agents, we reduced the carboplatin dose to minimize treatment-related toxicity. The tumor regressed sufficiently to permit performance of a right middle and lower lobectomy. In our case, neoadjuvant therapy with gemcitabine and low-dose carboplatin exhibited antitumor activity with manageable side-effects, suggesting that this chemotherapy regimen can be safely and effectively used in the treatment of NSCLC in FA patients who have achieved hematopoietic reconstitution after bone marrow transplantation.

Medical anticancer treatment of lung cancer associated with comorbidities: A review

“…A case of a patient with Fanconi anemia treated by bone marrow transplantation and whole body irradiation at the age of 17 years, presented 14 years later with a squamous cell lung cancer [26]. A neoadjuvant chemotherapy consisting of 21-day cycles with carboplatin (area under the curve 3) given on day 1 and gemcitabine (1250 mg/m 2 ) on days 1 and 8 was successfully followed by radical lobectomy.…”

Three Cases of Esophageal Cancer Related to Fanconi Anemia

“…There have been several reports on chemotherapy techniques for solid tumors associated with FA, such as a reduced carboplatin dose for non-small cell lung cancer ( 32 ) and low-dose 5-FU/CDDP for esophageal cancer ( 15 ). In addition, postoperative radiotherapy was reported for 12 cases of SCC of the head and neck, but treatment was terminated due to severe adverse effects ( 33 ).…”

Serial Cancer Development Three Times in a Patient with Fanconi Anemia

“…Clinical information about these cases was not available. However, we found 2 additional case reports of lung cancer developing in FA patients [ 12 , 13 ]; both were male, in their 30 s, with 10-pack year smoking history, and no history of previous cancers. The histological type was squamous cell lung cancer.…”

“…Thus, limited information was available about therapeutic strategies and outcomes in cases of solid tumors developing in FA. Recently, Dudek et al [ 13 ] reported a well-tolerated neoadjuvant chemotherapy with a reduced dose of carboplatin and gemcitabine in a patient with nonsmall cell lung cancer. Hosoya et al [ 11 ] also reported successful treatment outcome in a case of esophageal carcinoma treated with a low dose of cisplatin and 5-fluorouracil plus radiotherapy (30 Gy).…”

“…Several case series report described synchronous and/or chronological second SCCs following head and neck cancer in patients with FA, such as esophageal and anogenital cancers [ 4 , 5 , 9 , 10 , 11 ]. However, the development of second lung cancer is extremely rare [ 2 , 3 , 12 , 13 ] and the occurrence of over second primary malignancies has not been elucidated because of the rarity of FA.…”