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Amrubicin/everolimus Stomatitis and febrile neutropenia: case report

A man in late 70s’ developed stomatitis during treatment with everolimus and febrile neutropenia during treatment with amrubicin for carcinoma . The man presented (at the age of 74 years) for treatment of small cell carcinoma of the bladder. His medical history was significant for thyroid cancer, left adrenal pheochromocytoma, cigarette smoking, occasion intake of alcohol, had undergone transurethral resection of the bladder tumour in December 2015. In August 2017, he also underwent total bladder extirpation and illeal conduit construction. At the current presentation, he was diagnosed with small cell neuroendocrine carcinoma of the bladder and received 3 cycles of neoadjuvant chemotherapy with cisplatin and etoposide (EP regimen). Following initial improvement (in July 2018), the small cell carcinoma recurred with metastases to lymph node. Therefore, he again received EP regimen comprising cisplatin and etoposide that resulted in shrinkage of the metastatic lesion. However, in March 2019 (following 9th cycle of EP regimen), a CT scan showed regrowth in the pelvic metastatic lesion. Considering the disease progression, further treatment was started with everolimus 5mg two tablets daily [route not stated] from May 2019. Subsequently, he developed grade 2 stomatitis, which was considered as a sideeffect of everolimus [time to reaction onset not stated]. The man’s therapy with everolimus was therefore stopped temporarily [outcome of the reaction not stated]. Thereafter, the man restarted everolimus at the same dose, however, no further adverse reaction was noted. In September 2019, a CT scan showed a regrowth of the tumour and hydro-nephrosis. Therefore, amrubicin 40 mg/m2 was initiated. However, after the first course of amrubicin, he developed febrile neutropenia, which was considered to be a side-effect of amrubicin. Thus, the dose of amrubicin was reduced to 32 mg/m2 and at this dose, no further adverse event was noted. Ota H, et al. A Case of Small Cell Carcinoma of the Bladder Hinyokika Kiyo 66: 313-317, No. 9, Sep 2020. Available from: URL: http://doi.org/10.14989/ ActaUrolJap_66_9_313 [Japanese; summarised from a translation]

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Reactions 14 Nov 2020 No. 1830