nab-Paclitaxel in Combination with Carboplatin for a Previously Treated Thymic Carcinoma
A 40-year-old man was admitted to our hospital in May 2013 because of progressive right-sided back pain. The patient had been surgically diagnosed with squamous cell carcinoma of the thymus in July 2009 (designated as stage II according to the Masaoka classification []) and had received postoperative thoracic irradiation. However, computed tomography (CT) scans of the chest in May 2010 showed pleural dissemination in the right thorax. The patient worked as an engineer and requested to avoid paclitaxel-induced neuropathy at that time. Therefore, he received combined chemotherapy consisting of cisplatin and docetaxel, and achieved a minor response. After the patient became refractory to this regimen, various antitumor agents, including gemcitabine, S-1, and amrubicin, were administered. However, pleural dissemination recurred and the patient's back pain gradually worsened, even while using opioids.\nUpon admission to our hospital, CT scans of the chest showed multiple pleural disseminated nodules with a pleural effusion in the right thorax (fig. ). The serum cytokeratin 19 fragment (CYFRA) level was increased (13.9 ng/ml; normal level <3.5 ng/ml). The patient received nab-paclitaxel in combination with carboplatin as described in a previous phase III trial []. He experienced grade 4 neutropenia, according to the NCI-CTCAE (National Cancer Institute – Common Terminology Criteria for Adverse Events) version 4.0, 2 weeks after beginning chemotherapy. Therefore, the nab-paclitaxel administration was omitted on day 15, and the patient received granulocyte colony-stimulating factor (G-CSF) for several days. The severity of thrombocytopenia and nonhematological toxicities such as reversible neuropathy did not exceed grade 1 during the treatment. Objective tumor shrinkage was obtained after 4 cycles of chemotherapy, and the pleural effusion disappeared (fig. ). The serum CYFRA level decreased to 1.7 ng/ml, and the patient's back pain was relieved without any opioids.