Thymic carcinoma with autoimmune syndrome: Successful treatment with weekly infusional high-dose 5-fluorouracil and leucovorin

Thymic carcinoma is known for its poor clinical outcome and unsatisfactory response to conventional chemotherapy. A 53-year-old woman was diagnosed as having metastatic thymic carcinoma in 1989. She received systemic chemotherapy containing cisplatin, doxorubicin, and cyclophosphamide, and involved-field radiotherapy. A durable complete remission was achieved and lasted for 4 years. When the disease recurred in 1995, she was found to have an autoimmune syndrome in addition to pleural effusion, a posterior mediastinal mass and a left adrenal mass. The autoimmune manifestations were seen as sclerodenna, high titers of rheumatoid factor and anti-nuclear antibody. We adopted a novel HDFL regimen, which is composed of weekly 24-hour infusion of high-dose 5-fluorouracil and leucovorin, for this patient. Complete remission was achieved again, and autoimmune syndrome was well controlled.