Curative Resection of Double Primary Lung Cancer after 15-Month Bortezomib Administration

noma, mixed subtype, in the right S1, and brochioloalveolar carcinoma in the right S6 segment, respectively. Both tumors were completely resected with negative margins (pT2aN0M0 and pT1aN0M0). There was no apparent effect of bortezomib therapy on the tumor specimens. The patient remains in complete remission and good health, as noted on follow-up 15 months after the operation. For treatment of AL amyloidosis, he continues to receive bortezomib at 0.7 mg/m, reduced from twice per month to once monthly since 10 months after the operation. Neoadjuvant therapy such as preoperative chemotherapy has been reported to significantly improve the overall survival of patients with operable NSCLC, including patients with Early detection combined with surgical resection remains the gold standard of curative treatment for stage I non-small cell lung cancer (NSCLC) [1]. High-risk surgical candidates require effective alternatives to surgery to prevent tumor growth and lymph node metastasis. We present herein a case of successful operation after bortezomib administration in a patient with stage I NSCLC, in whom surgery had to be deferred for 15 months because of the treatment required for cardiac failure due to multiple myeloma-associated immunoglobulin light-chain (AL) amyloidosis. A 63-year-old Japanese man who had never smoked was diagnosed with stage I lung cancer, as confirmed from bronchial washing specimens positive for malignancy, only in the right upper lobe. Chest computed tomography (CT) scans showed a 40-mm ground-glass opacity in the right upper lobe and a 12-mm ground-glass opacity in the right lower lobe, suggestive of double primary lung cancer (fig. 1). However, the life expectancy of the patient was less than 6 months because of symptomatic cardiac AL amyloidosis, treatment for which was prioritized over tumor resection. After administration of bortezomib plus dexamethasone for 15 months, cardiac function markedly improved after achievement of a hematological response with regard to the AL amyloidosis, as previously reported [2]. The 2 ground-glass opacities on chest CT showed almost no change in size compared to their appearance before 15 months (fig. 1). Positron emission tomography/CT (PET/CT) showed no 18-fluorodeoxyglucose uptake in these lesions either before or after bortezomib treatment. A work-up with 18-fluorodeoxyglucose PET/CT revealed no metastasis. All other organ evaluations showed normal function. Therefore, we considered the patient a candidate for surgery, and could safely perform right upper lobectomy and right lower partial resection with mediastinal lymphadenectomy. Postoperative evaluation confirmed double primary well differentiated lung cancer with adenocarciFig. 1. Chest computed tomography images before and after 15 months of bortezomib therapy. Ground-glass opacities are seen in the right upper and lower lung in the upper and lower panels, respectively.