P1.07-011 Extensive-Stage Small Cell Lung Cancer in a 13-Year-Old Male Patient Treated with Bevacizumab Followed by High-Dose Chemotherapy

Abstract

Small cell lung cancer (SCLC) is exceedingly rare in children. We herein report a pediatric case of extensive-stage SCLC in a patient who was treated with intensive chemotherapy and high-dose chemotherapy (HDC). A 13-year-old male patient was admitted to our department with a three-month history of cough. Thoracic CT and MRI showed two large masses, one was a 5.8 × 4.3 × 3.9 cm primary tumor that was located close to the right middle lobe bronchus; the other was a subcarinal lymph node. Systemic PET-CT revealed multiple bone metastases. A serological analysis revealed high levels of pro-GRP (4,075 pg/mL [normal, ≤ 81 pg/mL]) and NSE (52.3 ng/mL [normal, ≤ 16.3 ng/mL]). The patient’s plasma level of VEGF was 259 pg/mL (normal, ≤ 115 pg/mL). We diagnosed the patient with SCLC based on the results of the histopathological examination of endoscopically-obtained biopsy specimens that were obtained from part of the tumor that was partially exposed on the bronchial wall. Treatment was initiated with cisplatin and irinotecan (PI). After four courses of PI therapy followed by two courses of PI plus etoposide (PIE) therapy, there was a reduction in the tumor volume and a remarkable decrease in the patient’s biomarker levels. Thereafter, we administered three courses of chemotherapy consisting of bevacizumab, cisplatin and etoposide. Furthermore, HDC with autologous peripheral blood stem cell rescue and prophylactic cranial irradiation were performed. Early recurrence appeared one month after the completion of the series of initial treatments. He died ten months after the relapse. The long-term prognosis of adult SCLC patients is generally poor, even if desirable initial treatment responses are obtained. In order to improve their prognosis, new trials with other anti-cancer agents should be performed. Bevacizumab, an anti-VEGF monoclonal antibody that is effective against non-SCLC, is an intriguing candidate molecular target drug that should be evaluated for SCLC. Because the value of VEGF in the present patient’s plasma was high, we were of the opinion that the administration of bevacizumab after effective chemotherapy with PI and PIE might have represented an intensive treatment that had the potential to improve his prognosis. Because intensive chemotherapy has been observed to be highly tolerable in adolescence and young adults, we expected HDC to have a greater effect on the patient’s disease. However, the intensified therapy strategy had no impact on the patient’s disease and the results were similar to those observed in elderly patients with extensive-stage SCLC.