Tolerability and efficacy of IMpower133 regimen modified for dialysis patients with extensive‐stage small cell lung cancer: Two case reports

The IMpower133 regimen, composed of atezolizumab/etoposide (VP‐16)/carboplatin (CBDCA), is the standard first‐line treatment for extensive‐stage small cell lung cancer (ES‐SCLC). However, the safety and efficacy of triplet therapy in patients receiving dialysis have not been sufficiently evaluated. Here, we report two cases of dialysis patients with ES‐SCLC who received the modified IMpower133 regimen. Patient 1 was a 69‐year‐old man, and patient 2 was a 73‐year‐old man who received dialysis because of end‐stage renal failure caused by diabetic nephropathy. Both patients received a modified IMpower133 regimen in the following order: atezolizumab (1200 mg/body) on day 1, VP‐16 (50 mg/m(2)) on days 1 and 3, and CBDCA (300 mg/m(2)) on day 1. Four hours of dialysis was performed 1 hour after completing the administration of CBDCA on Day 1 and 2 hours after completing the administration of VP‐16 on Day 3. Both patients achieved a partial response and received atezolizumab maintenance therapy after four cycles of triplet therapy without uncontrollable adverse events. By modifying the dosage, the order of drugs, and the timing of dialysis, the IMpower133 regimen may be tolerable and effective for patients receiving dialysis.