The use of everolimus in a patient with metastatic atypical bronchial carcinoid undergoing haemodialysis: a single-centre experience with one case
Abstract
Background. The treatment of lung neuroendocrine tumours is still a challenge due to their rare occurrence and the lack of prospective randomised studies. We present the case of patient with metastatic atypical lung carcinoid treated with everolimus undergoing haemodialysis due to end-stage renal failure as a result of renal cirrhosis. Methods. A 68-year-old man was followed up in our hospital for an atypical lung carcinoid diagnosed in 2006. The patient initially underwent left upper lobectomy for a well-differentiated tumour — atypical carcinoid. Pathology stage was pT3N0M0PL0 (Ki67 3%). Nine years later, the evaluation revealed a progressive disease (metastases in the liver, bones, and spleen). Hepatic metastasectomy was performed and progression of carcinoid (Ki67 1%) was confirmed. In the same year end-stage renal failure as a result of renal cirrhosis was diagnosed and the patient required dialysis three times a week. The patient was qualified to start the treatment with somatostatin analogues by multidisciplinary team. In February 2017, new liver metastases occurred. Due to clinical symptoms (flush, diarrhoea) associated with hormonal activity (serotonin, chromogranin A), the decision to use molecular-targeted therapy with everolimus was made. In February 2017, everolimus therapy at the full dose of 10 mg daily was initiated. Results. The evaluation of treatment effects after 12 weeks of everolimus administration revealed the decrease of chromogranin A and serotonin levels with stabilisation of the hepatic metastases on computed tomography scans — stable disease according to RECIST criteria was found. At the time of publication, the patient was receiving everolimus, somatostatin analogues, and dialysis therapy. Conclusions. Targeted therapy with everolimus seems to be very promising for patients with lung carcinoid and renal failure, but further trials need to be conducted.
Keywords: bronchial carcinoideverolimusrenal failurehaemodialysis
References
- Travis WD, Brambilla E, Nicholson AG, et al. WHO Panel. The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol. 2015; 10(9): 1243–1260.
- Caplin ME, Baudin E, Ferolla P, et al. ENETS consensus conference participants. Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor Society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids. Ann Oncol. 2015; 26(8): 1604–1620.
- Pelosi G, Sonzogni A, Harari S, et al. Classification of pulmonary neuroendocrine tumors: new insights. Transl Lung Cancer Res. 2017; 6(5): 513–529.
- Merola E, Panzuto F, Delle Fave G. Antiproliferative effect of somatostatin analogs in advanced gastro-entero-pancreatic neuroendocrine tumors: a systematic review and meta-analysis. Oncotarget. 2017; 8(28): 46624–46634.
- Yao J, Fazio N, Singh S, et al. Everolimus for the treatment of advanced, non-functional neuroendocrine tumours of the lung or gastrointestinal tract (RADIANT-4): a randomised, placebo-controlled, phase 3 study. The Lancet. 2016; 387(10022): 968–977.
- Saksena R, Wong ST. Clinical evidence of the efficacy of everolimus and its potential in the treatment of breast cancer. Breast Cancer (Dove Med Press). 2013; 5: 27–35.
- Afinitor EMEA Summary of Product Characteristics.
- Thiery-Vuillemin A, Curtit E, Maurina T, et al. Hemodialysis does not affect everolimus pharmacokinetics: two cases of patients with metastatic renal cell cancer. Ann Oncol. 2012; 23(11): 2992–2993.
- Czarnecka AM, Kawecki M, Lian F, et al. Feasibility, efficacy and safety of tyrosine kinase inhibitor treatment in hemodialyzed patients with renal cell cancer: 10 years of experience. Future Oncol. 2015; 11(16): 2267–2282.
- Brizzi MP, La Salvia A, Tampellini M, et al. Efficacy and safety of everolimus treatment in a hemodialysis patient with metastatic atypical bronchial carcinoid: case report and literature review. BMC Cancer. 2018; 18(1): 311.
- Thiery-Vuillemin A, Curtit E, Maurina T, et al. Hemodialysis does not affect everolimus pharmacokinetics: two cases of patients with metastatic renal cell cancer. Ann Oncol. 2012; 23(11): 2992–2993.
- Syrios J, Kechagias G, Tsavaris N. Treatment of patients with metastatic renal cell carcinoma undergoing hemodialysis: case report of two patients and short literature review. BMC Nephrol. 2013; 14: 84.
- White DA, Camus P, Endo M, et al. Noninfectious pneumonitis after everolimus therapy for advanced renal cell carcinoma. Am J Respir Crit Care Med. 2010; 182(3): 396–403.