A Case of High-Grade Neuroendocrine Carcinoma That Improved with Bevacizumab plus Modified FOLFOX6 as the Fourth-Line Chemotherapy

Abstract

High-grade neuroendocrine carcinoma differs from usual neuroendocrine carcinoma, and its prognosis is dismal. In this case report, a case of high-grade neuroendocrine carcinoma that improved with bevacizumab plus modified FOLFOX6 as the fourth-line chemotherapy is presented. A 29-year-old male with a huge liver tumor was diagnosed with high-grade neuroendocrine carcinoma originating from the liver. Multiple liver and bone metastases were found one month after surgery. He was treated with three chemotherapy regimens used for the management of small-cell lung cancer with extensive disease. However, none of them could be maintained because of tumor progression. He was then treated with bevacizumab plus modified FOLFOX6 as the fourth-line regimen. Dramatic tumor shrinkage was obtained, and a partial response was achieved. This case suggests that high-grade neuroendocrine carcinoma can be treated with bevacizumab in combination with cytotoxic chemotherapy.

Keywords: Bevacizumab; High-grade neuroendocrine carcinoma; Liver origin; Small-cell lung cancer.

Fig. 1

CT scan at the first visit. A huge tumor (over 10 cm) is seen in the right liver lobe, along with liver metastasis and lymph node swelling. b ¹⁸F-FDG-PET scan at the first visit. No distant metastases were detected. The primary lesion was thought to be in the liver.

Fig. 2

Histopathological examination reveals high-grade neuroendocrine carcinoma. a Hematoxylin and eosin staining shows tumor cells are characterized by a solid and trabecular architecture. The forming of rosettes are seen (arrowheads). Tumor cells have nuclear pleomorphism and granular cytoplasm. b Chromogranin A immunostaining is seen in almost all carcinoma cells. c The MIB-1 index is about 70% in the lesion with the highest value. d TTF-1 immunostaining is negative.

Fig. 3

a, b CT scan prior to chemotherapy with bevacizumab plus mFOLFOX6. Three cytotoxic regimens for small-cell lung cancer with extensive-stage disease have been given by this point. c, d CT scan after four cycles of bevacizumab plus mFOLFOX6. Liver metastases are markedly smaller compared with those before the treatment with this regimen.