Refractory neuroendocrine tumor-response to liposomal doxorubicin and capecitabine.

BACKGROUND: A 61-year-old patient with no relevant medical or family history presented with a 2 month history of refractory dry cough that led to the diagnosis of typical carcinoid tumor of the lung metastatic to the mediastinal lymph nodes and liver. She initially received a long-acting somatostatin analog (octreotide) and chemotherapy with cisplatin and etoposide, which was ineffective. INVESTIGATIONS: Physical examination, laboratory test, chromogranin A test, CT scan, (111)In-diethylenetriaminepentaacetic acid (DTPA)-octreotide scan, (18)F-FDG-PET scan, fine-needle and tissue core liver biopsies. DIAGNOSIS: Pulmonary spindle-cell carcinoid tumor with metastases to mediastinal lymph nodes and liver. MANAGEMENT: Systemic treatment with oral capecitabine (1,500 mg/m(2) daily from day 1 to day 21) and intravenous liposomal doxorubicin (10 mg/m(2) on days 1, 8 and 15), both repeated every 4 weeks, administered concomitantly with long-acting octreotide 30 mg every 3 weeks. The patient achieved a significant and long-lasting response with the combination of capecitabine and liposomal doxorubicin. She reported no severe adverse effects.