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The patient received carboplatin dose based on renal function utilizing measured creatinine clearance, pemetrexed based on body surface area and pembrolizumab at a fixed dose of 100mg for body weight &lt;65 kg. The doses of carboplatin and pemetrexed were adjusted after the first cycle based on therapeutic drug monitoring (TDM). The treatment was generally well tolerated, with the exception of grade 2 neutropenia, which resolved after a one-week delay of the third treatment cycle. A favorable clinical response was achieved after four treatment cycles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Given the uncertainty regarding the accuracy of dosing algorithms in patients with congenital achondroplasia, TDM may support dose optimization and attainment of adequate drug exposure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00280-026-04932-7","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:26:43Z","timestamp":1785767203000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dosing challenges for chemotherapy and immunotherapy in congenital achondroplasia: a case report and literature review"],"prefix":"10.1007","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0160-7601","authenticated-orcid":false,"given":"Karolijn W. 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