The addition of the programmed death-ligand 1 inhibitor atezolizumab to the carboplatin and etoposide combination is the standard first-line treatment for patients with previously untreated extensive-stage small cell lung cancer (ES-SCLC). However, there is little information about its safety in an increasing number of cancer patients undergoing hemodialysis (HD).
An 80-year-old male received carboplatin (AUC = 5 125 mg/body on day 1), etoposide (40 mg/m2 on days 1, 2, and 3), and atezolizumab (1200 mg/body on day 1) as the first-line therapy for ES-SCLC. He was undergoing HD thrice a week for 7 years owing to chronic renal failure. HD was provided 16 hours after carboplatin administration. During the first cycle, grade 4 neutropenia (neutrophil count: 74 /μL) and leukopenia (white blood cell count: 680 /μL) occurred. Therefore, the chemotherapy was performed with a reduced dose of carboplatin (AUC = 4 100 mg/body) and etoposide (30 mg/m2) from the second to fourth cycles. After 4 cycles, the patient did not develop any severe non-hematologic adverse events, showing a remarkable response.
We conclude that the carboplatin, etoposide, and atezolizumab combination can be safely administered to cancer patients undergoing HD.