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Mouillot P, Favrolt N, Khouri C, Grandvuillemin A, Chaumais MC, Schenesse D, Seferian A, Jais X, Savale L, Beltramo G, Sitbon O, Cracowski JL, Humbert M, Georges M, Bonniaud P, Montani D. Characteristics and outcomes of gemcitabine-associated pulmonary hypertension. ERJ Open Res 2024; 10:00654-2023. [PMID: 38770007 PMCID: PMC11103709 DOI: 10.1183/23120541.00654-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/18/2023] [Indexed: 05/22/2024] Open
Abstract
Background Despite its known cardiac and lung toxicities, the chemotherapy drug gemcitabine has only rarely been associated with pulmonary hypertension (PH), and the underlying mechanism remains unclear. The objective of the present study was to assess the association between gemcitabine and PH. Methods We identified incident cases of precapillary PH confirmed by right heart catheterisation in patients treated with gemcitabine from the French PH Registry between January 2007 and December 2022. The aetiology, clinical, functional, radiological and haemodynamic characteristics of PH were reviewed at baseline and during follow-up. A pharmacovigilance disproportionality analysis was conducted using the World Health Organization (WHO) pharmacovigilance database. Results We identified nine cases of pulmonary arterial hypertension, either induced (in eight patients) or exacerbated (in one patient) by gemcitabine. Patients exhibited severe precapillary PH, with a median mean pulmonary arterial pressure of 40 (range 26-47) mmHg, a cardiac index of 2.4 (1.6-3.9) L·min-1·m-2 and a pulmonary vascular resistance of 6.3 (3.1-12.6) Wood units. The median time from the initiation of gemcitabine to the onset of PH was 7 (4-50) months, with patients receiving a median of 16 (6-24) gemcitabine injections. Six patients showed clinical improvement upon discontinuation of gemcitabine. In the WHO pharmacovigilance database, we identified a significant signal with 109 cases reporting at least one adverse event related to PH with gemcitabine. Conclusion Both clinical cases and pharmacovigilance data substantiate a significant association between gemcitabine use and the onset or worsening of precapillary PH. The observed improvement following the discontinuation of treatment underscores the importance of PH screening in gemcitabine-exposed patients experiencing unexplained dyspnoea.
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Affiliation(s)
- Pierre Mouillot
- Department of Pneumology and Intensive Care, Reference Center for Rare Lung Diseases, François Mitterrand Hospital, Dijon, France
- Faculty of Medicine, INSERM 1231, University of Burgundy, Dijon, France
| | - Nicolas Favrolt
- Department of Pneumology and Intensive Care, Reference Center for Rare Lung Diseases, François Mitterrand Hospital, Dijon, France
- Faculty of Medicine, INSERM 1231, University of Burgundy, Dijon, France
| | - Charles Khouri
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
- Clinical Pharmacology Department INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France
| | | | - Marie-Camille Chaumais
- Faculty of Pharmacy, Université Paris-Saclay, Orsay, France
- Assistance Publique – Hôpitaux de Paris (AP-HP), Pharmacy Department, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
| | - Déborah Schenesse
- Department of Pneumology and Intensive Care, Reference Center for Rare Lung Diseases, François Mitterrand Hospital, Dijon, France
- Faculty of Medicine, INSERM 1231, University of Burgundy, Dijon, France
| | - Andrei Seferian
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- AP-HP, Department of Pneumology and Intensive Care, Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Xavier Jais
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- AP-HP, Department of Pneumology and Intensive Care, Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Laurent Savale
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- AP-HP, Department of Pneumology and Intensive Care, Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Guillaume Beltramo
- Department of Pneumology and Intensive Care, Reference Center for Rare Lung Diseases, François Mitterrand Hospital, Dijon, France
- Faculty of Medicine, INSERM 1231, University of Burgundy, Dijon, France
| | - Olivier Sitbon
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- AP-HP, Department of Pneumology and Intensive Care, Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean-Luc Cracowski
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France
| | - Marc Humbert
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- AP-HP, Department of Pneumology and Intensive Care, Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marjolaine Georges
- Department of Pneumology and Intensive Care, Reference Center for Rare Lung Diseases, François Mitterrand Hospital, Dijon, France
- Faculty of Medicine, INSERM 1231, University of Burgundy, Dijon, France
| | - Philippe Bonniaud
- Department of Pneumology and Intensive Care, Reference Center for Rare Lung Diseases, François Mitterrand Hospital, Dijon, France
- Faculty of Medicine, INSERM 1231, University of Burgundy, Dijon, France
- P. Bonniaud and D. Montani contributed equally
| | - David Montani
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- AP-HP, Department of Pneumology and Intensive Care, Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- P. Bonniaud and D. Montani contributed equally
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Alyamany R, Alnughmush A, Almutlaq M, Alyamany M, Alfayez M. Azacitidine induced lung injury: report and contemporary discussion on diagnosis and management. Front Oncol 2024; 14:1345492. [PMID: 38406809 PMCID: PMC10884222 DOI: 10.3389/fonc.2024.1345492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Azacitidine, a hypomethylating agent, has caused a paradigm shift in the outcomes of patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) who are not eligible for stem cell transplantation, particularly in combination with BCL2 and IDH inhibitors. Azacitidine and Azacitidine-based combinations have been widely considered a safe low-intensity therapy when compared to traditional conventional treatments. The development of lung toxicity from azacitidine is not a well-characterized adverse event. However, if it happens, it can be fatal, especially if not recognized and treated promptly. In this review, we aim to familiarize the reader with the presentation of azacitidine-induced lung injury, provide our suggested approach to management based on our experience and the current understanding of its mechanism, and review the literature of 20 case reports available on this topic.
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Affiliation(s)
- Ruah Alyamany
- Department of Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmed Alnughmush
- Department of Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Malak Almutlaq
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Alyamany
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Mansour Alfayez
- Department of Hematology, Stem Cell Transplant and Cellular Therapy, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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3
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Bayram E, Toyran T, Paydas S. Gemcitabine-associated DRESS syndrome: A case report. J Oncol Pharm Pract 2023; 29:1480-1483. [PMID: 37006201 DOI: 10.1177/10781552231167531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Gemcitabine is a well-tolerated pyrimidine antimetabolite chemotherapeutic that is increasingly utilized to treat non-small cell lung carcinoma, breast, pancreatic, and urogenital cancers. Myelosuppression is a common side effect and skin rashes can be observed. We discuss a case of the exceedingly rare DRESS syndrome, which appeared following Gemcitabine treatment. CASE REPORT A 60-year-old patient with pancreatic cancer and liver metastases received therapy with Gemcitabine as a single agent. Fever, itching, and redness started to be reported on the third day of receiving Gemcitabine treatment. The patient's diffuse maculopapular rash steadily got worse, leading to hospitalization. MANAGEMENT AND OUTCOME In the patient's physical examination, a high fever, hepatomegaly, and a diffuse macular papular rash were detected, an increase in eosinophils in the complete blood count and peripheral blood. A skin biopsy was performed. It was determined that the patient had Gemcitabine-associated DRESS syndrome. Antihistamines and local steroids were administered. On the fifth day following treatment, skin lesions and eosinophilia decreased. DISCUSSION The most common cause of DRESS syndrome, a disorder marked by extensive skin eruption, fever, eosinophilia, and systemic symptoms, is medication use. Infections including HHV-6, EBV, and CMV can occasionally be the reason. Gemcitabine is one of the medications that is frequently used in cancer, and a case was provided because the literature review did not mention Gemcitabine-related DRESS syndrome.
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Affiliation(s)
- Ertugrul Bayram
- Department of Medical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Tugba Toyran
- Department of Pathology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Semra Paydas
- Department of Medical Oncology, Çukurova University Faculty of Medicine, Adana, Turkey
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4
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Friend C, Parajuli P, Razzaque MS, Atfi A. Deciphering epithelial-to-mesenchymal transition in pancreatic cancer. Adv Cancer Res 2023; 159:37-73. [PMID: 37268401 DOI: 10.1016/bs.acr.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Epithelial to mesenchymal transition (EMT) is a complex cellular program that alters epithelial cells and induces their transformation into mesenchymal cells. While essential to normal developmental processes such as embryogenesis and wound healing, EMT has also been linked to the development and progression of various diseases, including fibrogenesis and tumorigenesis. Under homeostatic conditions, initiation of EMT is mediated by key signaling pathways and pro-EMT-transcription factors (EMT-TFs); however, in certain contexts, these pro-EMT regulators and programs also drive cell plasticity and cell stemness to promote oncogenesis as well as metastasis. In this review, we will explain how EMT and EMT-TFs mediate the initiation of pro-cancer states and how they influence late-stage progression and metastasis in pancreatic ductal adenocarcinoma (PDAC), the most severe form of pancreatic cancer.
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Affiliation(s)
- Creighton Friend
- Department of Biochemistry and Molecular Biology and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Parash Parajuli
- Department of Biochemistry and Molecular Biology and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States
| | - Mohammed S Razzaque
- Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, United States
| | - Azeddine Atfi
- Department of Biochemistry and Molecular Biology and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States; VCU Institute of Molecular Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States.
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5
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Yoshioka K, Abe M, Shiko Y, Koshikawa K, Kawasaki Y, Iwasawa S, Terada J, Tsushima K, Tatsumi K, Suzuki T. Clinical Characteristics and Risk Factors of Lung Injury Induced by Nab-Paclitaxel. Drug Des Devel Ther 2022; 16:759-767. [PMID: 35345618 PMCID: PMC8957296 DOI: 10.2147/dddt.s342283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/14/2022] [Indexed: 01/03/2023] Open
Affiliation(s)
- Keiichiro Yoshioka
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mitsuhiro Abe
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Correspondence: Mitsuhiro Abe, Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba, 260-8670, Japan, Tel +81 43 222 2576, Fax +81 43 226 2176, Email
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Ken Koshikawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Shunichiro Iwasawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jiro Terada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Pulmonary Medicine, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Kenji Tsushima
- Department of Pulmonary Medicine, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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6
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Anticancer Drugs-induced Capillary Leak Syndrome. Kidney Int Rep 2022; 7:945-953. [PMID: 35570987 PMCID: PMC9091576 DOI: 10.1016/j.ekir.2022.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 01/02/2023] Open
Abstract
The term capillary leak syndrome (CLS) describes the manifestations associated with an increased capillary permeability to proteins leading to an escape of plasma from the blood circulatory system to surrounding tissues, muscle, organs, or body cavities. This results clinically in the typical triad of hypotension, edema, and elevated hematocrit. The more severe cases of CLS may present with cardiovascular collapse, shock, and death. The most classic form of this pathology is represented by the idiopathic systemic CLS (SCLS) also called Clarkson’s disease, but capillary leaks are also described as adverse drug reactions foremost among which are anticancer drugs. This review will focus on oncologic drugs such as gemcitabine, therapeutic growth factors or cytokines, and monoclonal antibodies (mAbs) that appear now as the strongest candidates for anticancer drug-induced CLS.
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7
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ÇELİK P, HAVLUCU Y, KURHAN F, MUEZZİNOGLU T, GÖKTALAY T, ŞAKAR COŞKUN A, YORGANCIOĞLU A. RARE PULMONARY TOXICITY DUE TO GEMCITABINE: BOOP. CELAL BAYAR ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2021; 8:721-725. [DOI: 10.34087/cbusbed.877034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Gemsitabin bir primidin antimetabolitidir, küçük hücreli dışı akciğer karsinomu, pankreas, meme, ürogenital malignitelerde artan sıklıkta kullanılan, iyi tolere edilen bir kemoteropatiktir. En önemli doz kısıtlayıcı toksisitesi myelosupresyondur. Gemsitabin kullanımına bağlı gelişen pulmoner toksisiteler bronkospazm, Acute Respiratory Distress Syndrome (ARDS), plevral effüzyon ve interstisyel pnömonidir. Mesane karsinomu nedeniyle 5 kür sisplatin-gemsitabin kemoterapisi alan erkek hastada nefes darlığı, ateş ve öksürük yakınmaları ortaya çıkması, toraks bilgisayarlı tomografisinde (BT) periferik ağırlıklı, yamalı tarzda konsolidasyon alanları görülmesi, antibiyotik tedavisiyle yanıt alınamaması, olası dispne nedenleri dışlanması sonucunda klinik ve radyolojik olarak bronşiolitis obliterans organize pnömonisi (BOOP) düşünülmüş ve kortikosteroid tedavisi ile belirgin düzelme sağlanmıştır. Tanı ve tedavide gecikme fatal sonuçlara yol açabileceği için gemsitabin kullanımına bağlı pulmoner toksisite olarak BOOP gelişebileceği de akılda tutulmalıdır
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Affiliation(s)
| | | | - Fikret KURHAN
- Sağlık Bakanlığı Üniversitesi Van Eğitim ve Araştırma Hastanesi
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Rahman H, Hossain MR, Ferdous T. The recent advancement of low-dimensional nanostructured materials for drug delivery and drug sensing application: A brief review. J Mol Liq 2020; 320:114427. [PMID: 33012931 PMCID: PMC7525470 DOI: 10.1016/j.molliq.2020.114427] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 01/07/2023]
Abstract
In this review article, we have presented a detailed analysis of the recent advancement of quantum mechanical calculations in the applications of the low-dimensional nanomaterials (LDNs) into biomedical fields like biosensors and drug delivery systems development. Biosensors play an essential role for many communities, e.g. law enforcing agencies to sense illicit drugs, medical communities to remove overdosed medications from the human and animal body etc. Besides, drug delivery systems are theoretically being proposed for many years and experimentally found to deliver the drug to the targeted sites by reducing the harmful side effects significantly. In current COVID-19 pandemic, biosensors can play significant roles, e.g. to remove experimental drugs during the human trials if they show any unwanted adverse effect etc. where the drug delivery systems can be potentially applied to reduce the side effects. But before proceeding to these noble and expensive translational research works, advanced theoretical calculations can provide the possible outcomes with considerable accuracy. Hence in this review article, we have analyzed how theoretical calculations can be used to investigate LDNs as potential biosensor devices or drug delivery systems. We have also made a very brief discussion on the properties of biosensors or drug delivery systems which should be investigated for the biomedical applications and how to calculate them theoretically. Finally, we have made a detailed analysis of a large number of recently published research works where theoretical calculations were used to propose different LDNs for bio-sensing and drug delivery applications.
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Affiliation(s)
- Hamidur Rahman
- Department of Physics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Md Rakib Hossain
- Department of Physics, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj 8100, Bangladesh
| | - Tahmina Ferdous
- Department of Physics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
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9
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Nasser NJ, Gorenberg M, Agbarya A. First line Immunotherapy for Non-Small Cell Lung Cancer. Pharmaceuticals (Basel) 2020; 13:ph13110373. [PMID: 33171686 PMCID: PMC7695295 DOI: 10.3390/ph13110373] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/19/2022] Open
Abstract
Immunotherapy for non-small cell lung cancer (NSCLC) is incorporated increasingly in first line treatments protocols. Multiple phase 3 studies have tested different medications targeting programmed death receptor 1 (PD-1), programmed death-ligand 1 (PD-L1), cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), with or without chemotherapy. The inclusion criteria differ between the various clinical trials, including the cut-off levels of PD-L1 expression on tumor cells, and the tumor histology (squamous or non-squamous). Patients with tumor expression levels of PD-L1 ≥ 50% are candidates for treatment with single agent Pembrolizumab or Atezolizumab. Patients with PD-L1 < 50% are candidates for immunotherapy with pembrolizumab as a single agent if PL-1 > 1%; immunotherapy doublet, Nivolumab and Ipilimumab, or single agent immunotherapy combined with chemotherapy. Here we review phase 3 clinical trials utilizing immunotherapy in the first line for treatment of NSCLC, including Pembrolizumab in KEYNOTE-024, KEYNOTE-042, KEYNOTE-189 and KEYNOTE-407; Nivolumab and Ipilimumab in CHECKMATE-227 and CHECKMATE 9LA; and Atezolizumab in IMpower110, IMpower130 and IMpower150.
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Affiliation(s)
- Nicola J. Nasser
- Department of Radiation Oncology, University of Maryland School of Medicine, Maryland Proton Treatment Center, Baltimore, MD 21201, USA
- Correspondence: or
| | - Miguel Gorenberg
- Department of Nuclear Medicine, Bnai Zion Medical Center; the Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 31048, Israel;
| | - Abed Agbarya
- Institute of Oncology, Bnai Zion Medical Center, Haifa 31048, Israel;
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10
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Dores GM, Curtis RE, Dalal NH, Linet MS, Morton LM. Cause-Specific Mortality Following Initial Chemotherapy in a Population-Based Cohort of Patients With Classical Hodgkin Lymphoma, 2000-2016. J Clin Oncol 2020; 38:4149-4162. [PMID: 32946352 DOI: 10.1200/jco.20.00264] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Mortality for patients with classical Hodgkin lymphoma (cHL) treated during an era characterized in the United States by widespread use of doxorubicin, bleomycin, vinblastine, and dacarbazine and diminishing use of radiotherapy is not well understood. PATIENTS AND METHODS We identified 20,007 individuals diagnosed with stage I/II (early) or III/IV (advanced) cHL between age 20 and 74 years treated with initial chemotherapy in US population-based cancer registries during 2000-2015 (follow-up through 2016). We used standardized mortality ratios (SMRs) to compare cause-specific relative mortality risk following cHL to that expected in the general population and estimated excess absolute risks (EARs; per 10,000 patient-years) to quantify disease-specific death burden. RESULTS We identified 3,380 deaths in the cHL cohort, including 1,321 (39%) not attributed to lymphoma. Overall, noncancer SMRs were increased 2.4-fold (95% CI, 2.2 to 2.6; observed, 559; EAR, 61.6) and 1.6-fold (95% CI, 1.4 to 1.7; observed, 473; EAR, 18.2) for advanced- and early-stage cHL, respectively, compared with the general US population. SMRs and EARs differed substantially by cause of death and cHL stage. Among the highest EARs for noncancer causes of death were those for heart disease (EAR, 15.1; SMR, 2.1), infections (EAR, 10.6; SMR, 3.9), interstitial lung disease (ILD; EAR, 9.7; SMR, 22.1), and adverse events (AEs) related to medications/drugs (EAR, 7.4; SMR, 5.0) after advanced-stage cHL and heart disease (EAR, 6.6; SMR, 1.7), ILD (EAR, 3.7; SMR, 13.1), and infections (EAR, 3.1; SMR, 2.2) after early-stage cHL. Strikingly elevated SMRs for ILD, infections, and AEs were observed < 1 year after cHL. Individuals age 60-74 years with advanced-stage cHL experienced a disproportionate excess of deaths as a result of heart disease, ILD, infections, AEs, and solid tumors. CONCLUSION Despite evolving cHL treatment approaches, patients continue to face increased nonlymphoma mortality risks from multiple, potentially preventable causes. Surveillance, early interventions, and cHL treatment refinements may favorably affect patient longevity, particularly among high-risk subgroups.
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Affiliation(s)
- Graça M Dores
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD.,US Food and Drug Administration, Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Silver Spring, MD
| | - Rochelle E Curtis
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Nicole H Dalal
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD.,Duke University School of Medicine, Durham, NC
| | - Martha S Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Lindsay M Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
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11
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Shen J, Chung SY, Azimi-Nekoo E, Jose J, Saif MW. A Rare Case of Gemcitabine-Induced Pulmonary Hypertension. ACTA ACUST UNITED AC 2020; 5:1-3. [PMID: 32104721 PMCID: PMC7043207 DOI: 10.17140/prrmoj-5-139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Context Gemcitabine is the backbone of systemic treatment of locally advanced and metastatic intrahepatic cholangiocarcinoma. In recent literature, gemcitabine has been linked to various pulmonary side effects. Case Report We report a case of an 82-year-old male who developed acute pulmonary hypertension after receiving one cycle of gemcitabine for metastatic cholangiocarcinoma. His symptoms began with fatigue associated with shortness of breath and cough that worsened despite dose reduction. He developed new onset bilateral pulmonary effusions and an echocardiogram revealed findings consistent with pulmonary hypertension. A computed tomography (CT) angiogram was negative for pulmonary thromboembolism. Although he was promptly treated with diuretics and steroids, the patient could not tolerate any further therapy. Conclusion Gemcitabine-induced pulmonary hypertension is rare and can be challenging to diagnose, as it remains a diagnosis of exclusion. However, physicians should be vigilant of new pulmonary symptoms, as delayed treatment can cause significant patient morbidity and mortality.
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Affiliation(s)
- Janice Shen
- Division of Hematology-Oncology, Department of Medicine, Northwell Health, Manhasset, NY, USA.,Northwell Health Cancer Institute, Monter Cancer Center, Lake Success, NY, USA
| | - Su Yun Chung
- Division of Hematology-Oncology, Department of Medicine, Northwell Health, Manhasset, NY, USA.,Northwell Health Cancer Institute, Monter Cancer Center, Lake Success, NY, USA
| | - Elham Azimi-Nekoo
- Division of Hematology-Oncology, Department of Medicine, Northwell Health, Manhasset, NY, USA.,Northwell Health Cancer Institute, Monter Cancer Center, Lake Success, NY, USA
| | - Jyothi Jose
- Northwell Health Cancer Institute, Monter Cancer Center, Lake Success, NY, USA
| | - Muhammad W Saif
- Division of Hematology-Oncology, Department of Medicine, Northwell Health, Manhasset, NY, USA.,Northwell Health Cancer Institute, Monter Cancer Center, Lake Success, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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12
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Matsushita K, Okuda T, Mori S, Konno M, Eguchi H, Asai A, Koseki J, Iwagami Y, Yamada D, Akita H, Asaoka T, Noda T, Kawamoto K, Gotoh K, Kobayashi S, Kasahara Y, Morihiro K, Satoh T, Doki Y, Mori M, Ishii H, Obika S. A Hydrogen Peroxide Activatable Gemcitabine Prodrug for the Selective Treatment of Pancreatic Ductal Adenocarcinoma. ChemMedChem 2019; 14:1384-1391. [DOI: 10.1002/cmdc.201900324] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Katsunori Matsushita
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan)
- Department of Frontier Science for Cancer and ChemotherapyGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan
| | - Takumi Okuda
- Graduate School of Pharmaceutical SciencesOsaka University 1-6 Yamadaoka Suita Osaka 565-0871 Japan
| | - Shohei Mori
- Graduate School of Pharmaceutical SciencesOsaka University 1-6 Yamadaoka Suita Osaka 565-0871 Japan
| | - Masamitsu Konno
- Department of Frontier Science for Cancer and ChemotherapyGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan
- Department of Medical Data ScienceGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan)
| | - Ayumu Asai
- Department of Frontier Science for Cancer and ChemotherapyGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan
- Department of Medical Data ScienceGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan
| | - Jun Koseki
- Department of Frontier Science for Cancer and ChemotherapyGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan
- Department of Medical Data ScienceGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan
| | - Yoshifumi Iwagami
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan)
| | - Daisaku Yamada
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan)
- Present address: Department of Digestive SurgeryOsaka International Cancer Institute 3-1-69 Otemae, Chuo-ku Osaka Osaka 541-8567 Japan
| | - Hirofumi Akita
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan)
| | - Tadafumi Asaoka
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan)
| | - Takehiro Noda
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan)
| | - Koichi Kawamoto
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan)
- Present address: Kinki Regional Bureau of Health and WelfareMinistry of Health, Labour and Welfare 4-1-76 Nonin Bashi, Chuo-ku Osaka Osaka 540-0008 Japan
| | - Kunihito Gotoh
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan)
| | - Shogo Kobayashi
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan)
| | - Yuuya Kasahara
- Graduate School of Pharmaceutical SciencesOsaka University 1-6 Yamadaoka Suita Osaka 565-0871 Japan
- National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN) 7-6-8 Saito-Asagi Ibaraki Osaka 567-0085 Japan
| | - Kunihiko Morihiro
- Graduate School of Pharmaceutical SciencesOsaka University 1-6 Yamadaoka Suita Osaka 565-0871 Japan
- National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN) 7-6-8 Saito-Asagi Ibaraki Osaka 567-0085 Japan
- Present address: Department of Chemistry and BiotechnologyGraduate School of EngineeringThe University of Tokyo 7-3-1 Hongo Bunkyo-ku Tokyo 113-8656 Japan
| | - Taroh Satoh
- Department of Frontier Science for Cancer and ChemotherapyGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan)
| | - Masaki Mori
- Department of Gastroenterological SurgeryGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan)
- Present address: Department of Surgery and ScienceGraduate School of Medical SciencesKyushu University 3-1-1 Maidashi, Higashi-ku Fukuoka 812-8582 Japan
| | - Hideshi Ishii
- Department of Medical Data ScienceGraduate School of MedicineOsaka University 2-2 Yamadaoka Suita Osaka 565-0871 Japan
| | - Satoshi Obika
- Graduate School of Pharmaceutical SciencesOsaka University 1-6 Yamadaoka Suita Osaka 565-0871 Japan
- National Institutes of Biomedical Innovation, Health and Nutrition (NIBIOHN) 7-6-8 Saito-Asagi Ibaraki Osaka 567-0085 Japan
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13
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Pneumonitis in Patients with Lung Cancer Following Treatment: the Effects of Chemotherapy, Immunotherapy, and Tyrosine Kinase Inhibitors. CURRENT PULMONOLOGY REPORTS 2018. [DOI: 10.1007/s13665-018-0219-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Li L, Mok H, Jhaveri P, Bonnen MD, Sikora AG, Eissa NT, Komaki RU, Ghebre YT. Anticancer therapy and lung injury: molecular mechanisms. Expert Rev Anticancer Ther 2018; 18:1041-1057. [PMID: 29996062 PMCID: PMC6290681 DOI: 10.1080/14737140.2018.1500180] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chemotherapy and radiation therapy are two mainstream strategies applied in the treatment of cancer that is not operable. Patients with hematological or solid tumor malignancies substantially benefit from chemotherapeutic drugs and/or ionizing radiation delivered to the site of malignancy. However, considerable adverse effects, including lung inflammation and fibrosis, are associated with the use of these treatment modalities. Areas covered: As we move toward the era of precision health, we are compelled to understand the molecular basis of chemoradiation-induced pathological lung remodeling and to develop effective treatment strategies that mitigate the development of chronic lung disease (i.e. fibrosis) in cancer patients. The review discusses chemotherapeutic agents that are reported to induce or associate with acute and/or chronic lung injury. Expert commentary: There is a need to molecularly understand how chemotherapeutic drugs induce or associate with respiratory toxicities and whether such characteristics are inherently related to their antitumor effect or are collateral. Once such mechanisms have been identified and/or fully characterized, they may be able to guide disease-management decisions including effective intervention strategies for the adverse effects. In the meantime, radiation oncologists should be judicious on the dose of radiation delivered to the lungs, the volume of lung irradiated, and concurrent use of chemotherapeutic drugs.
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Affiliation(s)
- Li Li
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
- Departmet of Endocrinology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Henry Mok
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Pavan Jhaveri
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Mark D Bonnen
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew G Sikora
- Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - N. Tony Eissa
- Department of Medicine, Section on Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ritsuko U Komaki
- University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yohannes T Ghebre
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Section on Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
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15
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Bajwa R, Starr J, Daily K. Gemcitabine-induced chronic systemic capillary leak syndrome. BMJ Case Rep 2017; 2017:bcr-2017-221068. [PMID: 28855215 PMCID: PMC5589048 DOI: 10.1136/bcr-2017-221068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 56-year-old woman presented with anasarca, hypoalbuminaemia and hypotension following cycle 3 day 1 of adjuvant gemcitabine for stage II pancreatic cancer. Due to the temporal nature of presentation, suspicion for gemcitabine-induced capillary leak syndrome was included in the differential diagnosis. Vascular endothelial growth factor levels were elevated at 707 pg/mL (reference range: 9-86 pg/mL). Corticosteroids were initiated, resulting in complete resolution of symptoms and hypotension. The patient suffered relapse of symptoms on discontinuation of steroids, further supporting chronic capillary leak syndrome.
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Affiliation(s)
- Ravneet Bajwa
- Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jason Starr
- Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Karen Daily
- Division of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA
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16
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Leduc C, Antoni D, Charloux A, Falcoz PE, Quoix E. Comorbidities in the management of patients with lung cancer. Eur Respir J 2017; 49:49/3/1601721. [PMID: 28356370 DOI: 10.1183/13993003.01721-2016] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/25/2016] [Indexed: 12/13/2022]
Abstract
Lung cancer represents a major public health issue worldwide. Unfortunately, more than half of them are diagnosed at an advanced stage. Moreover, even if diagnosed early, diagnosis procedures and treatment can be difficult due to the frequent comorbidities observed in these patients. Some of these comorbidities have a common major risk factor, i.e. smoking, whereas others are unrelated to smoking but frequently observed in the general population. These comorbidities must be carefully assessed before any diagnostic and/or therapeutic decisions are made regarding the lung cancer. For example, in a patient with severe emphysema or with diffuse lung fibrosis, transthoracic needle biopsy can be contraindicated, meaning that in some instances a precise diagnosis cannot be obtained; in a patient with chronic obstructive pulmonary disease, surgery may be impossible or should be preceded by intensive rehabilitation; patients with interstitial lung disease are at risk of radiation pneumonitis and should not receive drugs which can worsen the respiratory insufficiency. Patients who belong to what are called "special populations", e.g. elderly or HIV infected, should be treated specifically, especially regarding systemic treatment. Last but not least, psychosocial factors are of great importance and can vary from one country to another according to health insurance coverage.
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Affiliation(s)
- Charlotte Leduc
- Pneumology Dept, Nouvel Hôpital Civil, Strasbourg Cedex, France
| | - Delphine Antoni
- Radiotherapy Dept, Centre Paul Strauss, Strasbourg Cedex, France
| | - Anne Charloux
- Physiology and Functional Explorations Dept, Strasbourg Cedex, France
| | | | - Elisabeth Quoix
- Pneumology Dept, Nouvel Hôpital Civil, Strasbourg Cedex, France
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17
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Abstract
Despite significant recent progress in precision medicine and immunotherapy, conventional chemotherapy remains the cornerstone of the treatment of most cancers. Chemotherapy-induced lung toxicity represents a serious diagnostic challenge for health care providers and requires careful consideration because it is a diagnosis of exclusion with significant impact on therapeutic decisions. This review aims to provide clinicians with a valuable guide in assessing their patients with possible chemotherapy-induced lung toxicity.
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Affiliation(s)
- Paul Leger
- Division of Internal Medicine, Vanderbilt University Medical Center, T1218 Medical Center North, Nashville, TN 37232-2650, USA
| | - Andrew H Limper
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, T1218 Medical Center North, Nashville, TN 37232-2650, USA.
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18
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The ATS/ERS/JRS/ALAT statement "IPF by HRCT" could predict acute exacerbation of interstitial lung disease in non-small cell lung cancer. TUMORI JOURNAL 2016; 103:60-65. [PMID: 27791236 DOI: 10.5301/tj.5000574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patients with non-small cell lung cancer (NSCLC) and interstitial lung disease (ILD) are at high risk of acute exacerbation of ILD (AE-ILD) when treated with systemic chemotherapy. Standard treatment for NSCLC complicated by ILD has not been established. PURPOSE AND METHODS To examine whether the type of ILD categorized by the official ATS/ERS/JRS/ALAT statement as "idiopathic pulmonary fibrosis (IPF) by high-resolution computed tomography (HRCT)" could predict chemotherapy-induced AE-ILD in NSCLC patients with ILD, we retrospectively reviewed all patients with NSCLC complicated by ILD who had received chemotherapy at our institute from January 2007 until December 2013. Patients' characteristics, pathology and clinical staging of lung cancer, chemotherapy, type of ILD and AE-ILD during chemotherapy were evaluated. ILD was classified according to the statement as follows: usual interstitial pneumonia (UIP), possible UIP, and inconsistent with a UIP pattern. RESULTS A total of 46 patients had pre-existing ILD and received chemotherapy. The mean age was 73 years (range 46-83 years). Fifteen (32.6%) of 46 patients with ILD developed chemotherapy-induced AE-ILD, which was seen more frequently in patients with ILD with a UIP pattern or possible UIP pattern than in patients with a pattern inconsistent with UIP (80% versus 9.7%, p<0.001). Multivariate analyses including age, sex, performance status and radiographic patterns of ILD showed that the presence of a UIP or possible UIP pattern was an independent risk factor for chemotherapy-induced AE-ILD. CONCLUSIONS ILD with a UIP pattern or possible UIP pattern by the classification could be a risk factor for AE-ILD in NSCLC patients with ILD.
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Hamada T, Yasunaga H, Nakai Y, Isayama H, Matsui H, Fushimi K, Koike K. Interstitial lung disease associated with gemcitabine: A Japanese retrospective cohort study. Respirology 2015; 21:338-43. [PMID: 26775618 DOI: 10.1111/resp.12665] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/29/2015] [Accepted: 07/31/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Interstitial lung disease (ILD) is a widely recognized adverse consequence of gemcitabine administration, but data on gemcitabine-associated ILD are limited. This study aimed to elucidate the incidence and risk factors for this adverse event. METHODS Patients who underwent gemcitabine-based chemotherapy between July 2010 and March 2013 were retrospectively identified using a Japanese nationwide administrative database. ILD was defined according to the International Classification of Diseases and Related Health Problems 10th Revision, codes: J70.2-70.4, J84.1 and J84.9. The cumulative incidence and risk factors for ILD were evaluated using a competing risk analysis. RESULTS In total, 25 924 patients who underwent gemcitabine-based chemotherapy were identified from 331 hospitals (primary cancer; pancreatic, urothelial, biliary tract, lung, ovarian and breast, in 9070, 5578, 4803, 4388, 1339 and746 patients, respectively). ILD was observed in 428 patients (1.7%), and the cumulative incidence was estimated at 1.1% (95% CI: 1.0-1.2%), 1.5% (95% CI: 1.4-1.7%) and 1.9% (95% CI: 1.7-2.1%) at 3, 6 and 12 months, respectively. In the multivariable regression model, age >80 years and lung cancer were the strongest predictors for ILD (subdistribution hazard ratio (SHR), 2.61; 95% CI: 1.69-4.02 and SHR, 2.81; 95% CI: 2.16-3.65, respectively). Other significant risk factors included heavy smoking, prior chemotherapy and advanced cancer stage. CONCLUSION This study successfully demonstrated the clinical course of gemcitabine-associated ILD. Clinical oncologists should stratify individual patients for risk of ILD based on identified risk factors and fully consider the indication for gemcitabine-based chemotherapy.
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Affiliation(s)
- Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Care Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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20
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Turco C, Jary M, Kim S, Moltenis M, Degano B, Manzoni P, Nguyen T, Genet B, Rabier MBV, Heyd B, Borg C. Gemcitabine-Induced Pulmonary Toxicity: A Case Report of Pulmonary Veno-Occlusive Disease. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2015; 9:75-9. [PMID: 26380562 PMCID: PMC4559186 DOI: 10.4137/cmo.s26537] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Gemcitabine is a chemotherapeutic agent frequently used by for the treatment of several malignancies both in the adjuvant and metastatic setting. Although myelosuppression is the most adverse event of this therapy, gemcitabine might induce severe pulmonary toxicities. We describe a case of pulmonary veno-occlusive disease (PVOD) related to gemcitabine. CASE PRESENTATION The patient was an 83-year-old man with a metastatic pancreatic cancer who was treated by gemcitabine as first-line therapy. He was in good health and received no other chemotherapy. A dose of 1000 mg/m(2) of gemcitabine was administered over a 30-minute intravenous infusion on days 1, 8, and 15 of a 28-day cycle. After a period of 6 months, a complete response was observed. Nevertheless, the patient developed a severe dyspnea, with arterial hypoxemia and very low lung diffusion for carbon monoxide. A CT scan showed diffuse ground glass opacities with septal lines, bilateral pleural effusion, and lymph node enlargement. On echocardiography, there was a suspicion of pulmonary hypertension with elevated systolic pulmonary artery pressure and normal left ventricular pressures. Right heart catheterization confirmed pulmonary hypertension and normal pulmonary artery occlusion pressure. Diagnosis of PVOD was made, and a gemcitabine-induced toxicity was suspected. A symptomatic treatment was started. At last follow-up, patient was in functional class I with near-normal of CT scan, arterial blood gases, and echocardiography. A gemcitabine-induced PVOD is the more likely diagnosis.
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Affiliation(s)
- Célia Turco
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France. ; Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France. ; INSERM, Unit 1098, University of Franche-Comté, Besançon, France
| | - Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France. ; INSERM, Unit 1098, University of Franche-Comté, Besançon, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Mélanie Moltenis
- Regional center of Pharmacovigilance, University Hospital of Besançon, Besançon, France
| | - Bruno Degano
- Functional Explorations, University Hospital of Besançon, Besançon, France
| | - Philippe Manzoni
- Radiology and Interventional Pain Management Unit, University Hospital of Besançon, Besançon, France
| | - Thierry Nguyen
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Bruno Genet
- Department of Cardiology, University Hospital of Besançon, Besançon, France
| | | | - Bruno Heyd
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France. ; INSERM, Unit 1098, University of Franche-Comté, Besançon, France
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21
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Effect of platinum-based chemotherapy for non-small cell lung cancer patients with interstitial lung disease. Cancer Chemother Pharmacol 2015; 75:521-6. [DOI: 10.1007/s00280-014-2670-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 12/30/2014] [Indexed: 02/02/2023]
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22
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Kurimoto R, Sekine I, Iwasawa S, Sakaida E, Tada Y, Tatsumi K, Takahashi Y, Nakatani Y, Imai C, Takiguchi Y. Alveolar hemorrhage associated with pemetrexed administration. Intern Med 2015; 54:833-6. [PMID: 25832952 DOI: 10.2169/internalmedicine.54.3414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein describe a 67-year-old man with advanced adenocarcinoma of the lung who developed an alveolar hemorrhage (AH) associated with pemetrexed. He received four courses of pemetrexed therapy with carboplatin and seven courses of pemetrexed maintenance therapy. One week after the last pemetrexed administration, the patient developed hemoptysis with deteriorating dyspnea and anemia. Chest images showed diffuse ground-glass attenuation. The diagnosis of AH was based on findings of bloody bronchoalveolar lavage (BAL) fluid, hemosiderin-laden macrophages in the BAL fluid, and a transbronchial lung biopsy sample. This report is the first to describe AH associated with pemetrexed.
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Affiliation(s)
- Ryota Kurimoto
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Japan
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23
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The safety and efficacy of paclitaxel and carboplatin with or without bevacizumab for treating patients with advanced nonsquamous non-small cell lung cancer with interstitial lung disease. Cancer Chemother Pharmacol 2014; 74:1159-66. [DOI: 10.1007/s00280-014-2590-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/10/2014] [Indexed: 12/24/2022]
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24
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Lingaratnam SM, Slavin MA, Thursky KA, Teh BW, Haeusler GM, Seymour JF, Rischin D, Worth LJ. Pneumocystis jiroveciipneumonia associated with gemcitabine chemotherapy: experience at an Australian center and recommendations for targeted prophylaxis. Leuk Lymphoma 2014; 56:157-62. [DOI: 10.3109/10428194.2014.911861] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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25
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Belknap SM, Kuzel TM, Yarnold PR, Slimack N, Lyons EA, Raisch DW, Bennett CL. Cisplatin: process and future. Cancer 2014; 106:2051-7. [PMID: 16568459 DOI: 10.1002/cncr.21808] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
One of the most important anticancer agents is cisplatin (CDDP). Numerous studies with a CDDP-based combination have been reported over the last 30 years. The use of CDDP in the 1980s and 1990s showed responses in advanced stage non-small-cell lung cancer (NSCLC). Over the years it was found that the side effects of this agent (particularly nephrotoxicity) were a common problem. Agents such as carboplatin, taxanes, gemcitabine, irinotecan and pemetrexed proved to be effective in NSCLC with reduced or no nephrotoxicity. The administration of these newer agents improved several side effects, but without improving efficacy. When prophylactic (adjuvant) treatment for NSCLC was introduced, CDDP was the agent selected, which indicated the value of the drug. Recently, a novel formulation of CDDP, liposomal cisplatin, which has shown very low toxicity, no nephrotoxicity and equal effectiveness was produced; its importance is its higher effectiveness than standard CDDP in lung adenocarcinoma.
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Affiliation(s)
- Steven M Belknap
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Kelsey CR, Vujaskovic Z, Jackson IL, Riedel RF, Marks LB. Lung. ALERT • ADVERSE LATE EFFECTS OF CANCER TREATMENT 2014. [PMCID: PMC7121399 DOI: 10.1007/978-3-540-75863-1_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The lungs are particularly sensitive to RT, and are often the primary dose-limiting structure during thoracic therapy. The alveolar/capillary units and pneumocytes within the alveoli appear to be particularly sensitive to RT. Hypoxia may be important in the underlying physiology of RT-associated lung injury. The cytokine transforming growth factor-beta (TGF-β), plays an important role in the development of RT-induced fibrosis. The histopathological changes observed in the lung after RT are broadly characterized as diffuse alveolar damage. The interaction between pre-treatment PFTs and the risk of symptomatic lung injury is complex. Similarly, the link between changes in PFTs and the development of symptoms is uncertain. The incidence of symptomatic lung injury increases with increase in most dosimetric parameters. The mean lung dose (MLD) and V20 have been the most-often considered parameters. MLD might be a preferable metric since it considers the entire 3D dose distribution. Radiation to the lower lobes appears to be more often associated with clinical symptoms than is radiation to the upper lobes. This might be related to incidental cardiac irradiation. In pre-clinical models, there appears to be a complex interaction between lung and heart irradiation. TGF-β has been suggested in several studies to predict for RT-induced lung injury, but the data are still somewhat inconsistent. Oral prednisone (Salinas and Winterbauer 1995), typically 40–60 mg daily for 1–2 weeks with a slow taper, is usually effective in treating pneumonitis. There are no widely accepted treatments for fibrosis. A number of chemotherapeutic agents have been suggested to be associated with a range of pulmonary toxicities.
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Casadei Gardini A, Aquilina M, Oboldi D, Lucchesi A, Carloni S, Tenti E, Burgio MA, Amadori D, Frassineti GL. Separate episodes of capillary leak syndrome and pulmonary hypertension after adjuvant gemcitabine and three years later after nab-paclitaxel for metastatic disease. BMC Cancer 2013; 13:542. [PMID: 24215543 PMCID: PMC3840643 DOI: 10.1186/1471-2407-13-542] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systemic capillary leak syndrome is a rare disease with a high mortality rate. This syndrome is characterised by generalised edema, hypotension, hemoconcentration, and hypoproteinemia. The cause is the sudden onset of capillary hyperpermeability with extravasations of plasma from the intravascular to the extravascular compartment. We present the case of a patient who experienced two episodes of systemic capillary leak syndrome and pulmonary hypertension; the first after gemcitabine in an adjuvant setting and the second three years later after treatment with nab-paclitaxel for metastatic disease. CASE PRESENTATION A 65-year-old patient underwent a pancreatectomy in January 2010 for ductal carcinoma (pT3 N0 M0, stage IIa), followed by adjuvant chemotherapy. Seven days after the last cycle, she developed dyspnea associated with orthopnea and cough. A transthoracic cardiac ecocolordoppler was performed, with evidence of pulmonary hypertension (58 mmHg). Blood tests showed an increase in creatinine, pro-BNP and D-Dimer. She began high-dose diuretic therapy combined with cortisone. After a month, the patient was eupneic and the anasarca had resolved. We decided gradually to reduce the steroid and diuretic therapy. After ten days of the reduction, the patient began to re-present the same symptoms after treatment with gemcitabine. Corticosteroid therapy was restored with rapid clinical benefit and decreased pro-BNP after a week of treatment. After two years, the disease returned. As a first line treatment, it was decided to use nab-paclitaxel 100 mg/m2 weekly. After two doses, followed by approximately 14 days of treatment, the patient developed acute respiratory distress syndrome. The clinical suspicion was a relapse of capillary leak syndrome and treatment with a high-dose diuretic (furosemide 250 mg daily) was started combined with cortisone (40 mg methylprednisolone). The patient showed a progressive clinical benefit. CONCLUSIONS In patients treated with gemcitabine and nab-paclitaxel who experience a sudden onset of diffuse edema with respiratory distress, capillary leak syndrome should be suspected. Immediate treatment with corticosteroids may be life-saving.
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Affiliation(s)
- Andrea Casadei Gardini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via Piero Maroncelli 40, 47014 Meldola, FC, Italy.
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Ullah K, O'Reilly A, Power DG, O'Connor TM. A case series of patients on chemotherapy with dyspnoea and pulmonary infiltrates. BMJ Case Rep 2013; 2013:bcr-2013-009105. [PMID: 23744855 DOI: 10.1136/bcr-2013-009105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clinicians often assume that patients who develop pulmonary symptoms and radiographic infiltrates while receiving cytotoxic chemotherapy have opportunistic pulmonary infection or chemotherapy-related interstitial lung disease. We describe two cases of rare complications of commonly used chemotherapeutic agents (gemcitabine-induced eosinophilic pneumonia and rituximab-induced hypersensitivity pneumonitis) that vindicate this assumption but a third case of scleroderma-associated interstitial lung disease that became clinically manifest in a patient who was receiving chemotherapy. The latter case highlights the need for vigilance for other causes of interstitial lung disease in patients receiving chemotherapy.
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Affiliation(s)
- Khalil Ullah
- Department of Respiratory Medicine, Mercy University Hospital, Cork, Ireland
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Gemcitabine-induced extensive skin necrosis. Case Rep Med 2012; 2012:831616. [PMID: 23304162 PMCID: PMC3523642 DOI: 10.1155/2012/831616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/29/2012] [Indexed: 11/17/2022] Open
Abstract
An 82-year-old woman presented with oedema and extensive necrotic ulcerative lesions on the back side of her lower limbs, emerging after the second cycle of chemotherapy consisting of Gemcitabine for metastatic pancreatic cancer. The absence of any convincing argument in favor of cardiovascular or autoimmune disease led us to attribute the onset of skin necrosis to chemotherapy administration. Although skin ischemia has also been described as a paraneoplastic syndrome, in this case we could observe a temporal and causal relationship to Gemcitabine infusion. Recently, this drug has been associated with important vascular side effects; its vascular toxicity is in fact higher than previously estimated. To our knowledge, careful attention should be reserved to neoplastic patients candidated to Gemcitabine administration, especially if previously affected by arterial vascular disease, venous thromboembolism, or collagenoses.
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New-onset acute interstitial lung disease after treatment with erlotinib in a patient with metastatic squamous cell carcinoma of the lung. Am J Ther 2012; 18:e19-21. [PMID: 20019587 DOI: 10.1097/mjt.0b013e3181c2df83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Erlotinib is a Human Epidermal Growth Factor Receptor Type 1/tyrosine kinase (EGFR) inhibitor, which is used for non-small-cell lung cancer treatment. Erlotinib usually has a favorable safety profile however; adverse events such as interstitial lung disease (ILD) have been reported in pivotal studies. ILD usually occurs weeks to months after initiating therapy with Erlotinib. We report a case of Erlotinib induced ILD presenting within 5 days of initiating treatment with Erlotinib.
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Forero-Torres A, Bartlett N, Beaven A, Myint H, Nasta S, Northfelt DW, Whiting NC, Drachman JG, Lobuglio AF, Moskowitz CH. Pilot study of dacetuzumab in combination with rituximab and gemcitabine for relapsed or refractory diffuse large B-cell lymphoma. Leuk Lymphoma 2012; 54:277-83. [PMID: 22775314 DOI: 10.3109/10428194.2012.710328] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Dacetuzumab, a CD40-targeted, humanized antibody, mediates antitumor activity through effector cell functions and direct apoptotic signal transduction. Preclinical studies demonstrated synergistic activity between dacetuzumab, gemcitabine and rituximab against non-Hodgkin lymphoma in vivo. A phase 1b safety/efficacy study of dacetuzumab in combination with rituximab and gemcitabine was conducted in relapsed/refractory diffuse large B-cell lymphoma (DLBCL). Patients received dacetuzumab at doses of 8 or 12 mg/kg IV weekly with rituximab (375 mg/m(2) IV weekly in cycle 1, then every 28 days) and gemcitabine (1000 mg/m(2) IV, days 1, 8 and 15, or days 1 and 15). Thirty-three patients with a median age of 67 years were enrolled. Common adverse events (≥ 15%) were grade 1/2 cytokine release syndrome, nausea, fatigue, thrombocytopenia, headache, decreased appetite, dyspnea, neutropenia, pyrexia, anemia, diarrhea, edema, constipation and cough. Dacetuzumab-related grade 3/4 adverse events occurred infrequently. Six of 30 evaluable patients achieved a complete response (CR) and eight a partial response (PR) per investigator assessment for an overall response rate (ORR) of 47%.
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Buyukoglan H, Tutar N, Gülmez İ, Oymak FS, Demir R. Gemcitabine Induced Pulmonary Toxicity with Late Onset. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2012. [DOI: 10.29333/ejgm/82465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Azacitidine is a pyrimidine nucleoside analog licensed for treatment of adult patients with myelodysplastic syndrome. Azacitidine acts as an inducer of cell differentiation by causing demethylation and re-expression of genes silenced by hypermethylation. We report a 56-year-old man with myelodysplastic syndrome who developed interstitial lung disease after azacitidine therapy. Open lung biopsy revealed a nonresolving organizing pneumonia pattern and bronchocentric granulomatous pattern suggestive of drug-induced lung injury. Treatment with steroids and discontinuation of azacitidine led to resolution of interstitial lung disease. The Naranjo adverse drug reaction probability scale score indicated that the association between azacitidine and interstitial lung disease was probable. Interstitial lung disease is a serious but uncommon side effect of this relatively safe drug. The mechanism underlying this is still unclear. The patient was subsequently treated with decitabine with no recurrence of interstitial lung disease.
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Li L, Yue GGL, Lau CBS, Sun H, Fung KP, Leung PC, Han Q, Leung PS. Eriocalyxin B induces apoptosis and cell cycle arrest in pancreatic adenocarcinoma cells through caspase- and p53-dependent pathways. Toxicol Appl Pharmacol 2012; 262:80-90. [PMID: 22561874 DOI: 10.1016/j.taap.2012.04.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/11/2012] [Accepted: 04/17/2012] [Indexed: 01/06/2023]
Abstract
Pancreatic cancer is difficult to detect early and responds poorly to chemotherapy. A breakthrough in the development of new therapeutic agents is urgently needed. Eriocalyxin B (EriB), isolated from the Isodon eriocalyx plant, is an ent-kaurane diterpenoid with promise as a broad-spectrum anti-cancer agent. The anti-leukemic activity of EriB, including the underlying mechanisms involved, has been particularly well documented. In this study, we demonstrated for the first time EriB's potent cytotoxicity against four pancreatic adenocarcinoma cell lines, namely PANC-1, SW1990, CAPAN-1, and CAPAN-2. The effects were comparable to that of the chemotherapeutic camptothecin (CAM), but with much lower toxicity against normal human liver WRL68 cells. EriB's cytoxicity against CAPAN-2 cells was found to involve caspase-dependent apoptosis and cell cycle arrest at the G2/M phase. Moreover, the p53 pathway was found to be activated by EriB in these cells. Furthermore, in vivo studies showed that EriB inhibited the growth of human pancreatic tumor xenografts in BALB/c nude mice without significant secondary adverse effects. These results suggest that EriB should be considered a candidate for pancreatic cancer treatment.
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Affiliation(s)
- Lin Li
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Zarogoulidis P, Chatzaki E, Porpodis K, Domvri K, Hohenforst-Schmidt W, Goldberg EP, Karamanos N, Zarogoulidis K. Inhaled chemotherapy in lung cancer: future concept of nanomedicine. Int J Nanomedicine 2012; 7:1551-72. [PMID: 22619512 PMCID: PMC3356182 DOI: 10.2147/ijn.s29997] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Regional chemotherapy was first used for lung cancer 30 years ago. Since then, new methods of drug delivery and pharmaceuticals have been investigated in vitro, and in animals and humans. An extensive review of drug delivery systems, pharmaceuticals, patient monitoring, methods of enhancing inhaled drug deposition, safety and efficacy, and also additional applications of inhaled chemotherapy and its advantages and disadvantages are presented. Regional chemotherapy to the lung parenchyma for lung cancer is feasible and efficient. Safety depends on the chemotherapy agent delivered to the lungs and is dose-dependent and time-dependent. Further evaluation is needed to provide data regarding early lung cancer stages, and whether regional chemotherapy can be used as neoadjuvant or adjuvant treatment. Finally, inhaled chemotherapy could one day be administered at home with fewer systemic adverse effects.
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Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Greece.
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Kim S, Tannock I, Sridhar S, Seki J, Bordeleau L. Chemotherapy-induced infiltrative pneumonitis cases in breast cancer patients. J Oncol Pharm Pract 2012; 18:311-5. [DOI: 10.1177/1078155211429384] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
A number of chemotherapy drugs are well known to cause various histopathologic patterns of lung injury. The incidence of chemotherapy-induced infiltrative pneumonitis is rare and the diagnosis is difficult due to the nonspecific clinical and radiological presentations. However, it can cause significant morbidity and mortality in cancer patients. There is no consensus on the treatment of this adverse event, but prompt diagnosis and intervention is important as fatal outcomes have been reported. We present five cases of chemotherapy-induced infiltrative pneumonitis in breast cancer patients involving docetaxel, paclitaxel, gemcitabine and cyclophosphamide.
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Affiliation(s)
- Sophie Kim
- Department of Pharmacy, Princess Margaret Hospital, Toronto, Canada
| | - Ian Tannock
- Department of Medical Oncology, Princess Margaret Hospital, Toronto, Canada
| | - Srikala Sridhar
- Department of Medical Oncology, Princess Margaret Hospital, Toronto, Canada
| | - Jack Seki
- Department of Pharmacy, Princess Margaret Hospital, Toronto, Canada
| | - Louise Bordeleau
- Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, Canada
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Hayashi M, Takayasu H, Tada M, Yamazaki Y, Tateno H, Tazawa S, Wakabayashi A, Iwasaki T, Tsuchiya Y, Yamashita J, Takeda N, Tomita S, Mori H, Kokubu F. Azacitidine-induced pneumonitis in a patient with myelodysplastic syndrome: first case report in Japan. Intern Med 2012; 51:2411-5. [PMID: 22975559 DOI: 10.2169/internalmedicine.51.8167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 74-year-old Japanese man with myelodysplastic syndrome (MDS) received chemotherapy with azacitidine. From the second day after starting the administration, he complained of fever, cough and shortness of breath. Chest roentgenography and computed tomography showed consolidations and ground-glass opacities. His symptoms grew from worse to life-threatening. We diagnosed him with azacitidine-induced pneumonitis and began administering corticosteroids. Thereafter, his symptoms and radiographic abnormalities improved. Azacitidine is a hypomethylating agent that improves the survival of MDS patients. Although this drug is commonly well tolerated and rarely causes severe lung injury, it is important to consider the potentially serious adverse effects of azacitidine-induced pneumonitis.
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Affiliation(s)
- Makoto Hayashi
- Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Japan
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The risk of cytotoxic chemotherapy-related exacerbation of interstitial lung disease with lung cancer. J Thorac Oncol 2011; 6:1242-6. [PMID: 21623239 DOI: 10.1097/jto.0b013e318216ee6b] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION It is unknown what type of interstitial lung disease (ILD) has high risk for chemotherapy-related exacerbation of ILD. We investigated the risk of exacerbation of ILD for patients with lung cancer with ILD. METHODS One hundred nine patients with lung cancer with ILD treated with cytotoxic chemotherapy at Shizuoka Cancer Center between August 2002 and April 2010 were retrospectively reviewed. RESULTS On pretreatment computed tomography (CT) of the chest, 69 patients (63%) were identified with usual interstitial pneumonia (UIP) pattern, and 40 patients (37%) had non-UIP pattern. Patients with UIP pattern developed cytotoxic chemotherapy-related exacerbation of ILD more frequently than those with non-UIP pattern (30 versus 8%, p = 0.005). The incidence of grade 5 pulmonary toxicities was 9% in patients with UIP pattern, compared with 3% in those with non-UIP pattern. Multivariate analyses demonstrated that age (<70 years) and CT pattern (UIP) were significant independent risk factors for cytotoxic chemotherapy-related exacerbation of ILD. In small cell lung cancer, overall survival (OS) from the start of first-line chemotherapy was significantly shorter in UIP pattern than non-UIP pattern (median OS: 9 versus 16 months, p = 0.0475), whereas there was no significant difference in patients with non-small cell lung cancer (median OS: 12 versus 9 months, p = 0.2529). CONCLUSIONS Our results indicated that the incidence of exacerbation of ILD was significantly higher in patients with lung cancer with UIP pattern on CT findings than in those with non-UIP pattern. Therefore, great care is required when administering cytotoxic chemotherapy agents for patients with lung cancer with UIP pattern.
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Interstitial lung disease associated with gemcitabine treatment in patients with non-small-cell lung cancer and pancreatic cancer. J Cancer Res Clin Oncol 2011; 137:1469-75. [PMID: 21818557 DOI: 10.1007/s00432-011-1013-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 07/18/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Although there are several reports concerning gemcitabine-induced interstitial lung disease (ILD), the risk factors for ILD are not well known. In addition, data comparing the incidence and pattern of ILD associated with gemcitabine treatment in patients with non-small-cell lung cancer (NSCLC) versus those with pancreatic cancer are scarce. METHODS We reviewed clinical records of 118 patients treated with gemcitabine between November 2004 and November 2010. The radiographic findings and other relevant clinical data were reviewed to identify patients who had developed ILD associated with gemcitabine treatment. RESULTS Out of these 118 patients, we identified 62 patients with NSCLC (group A) and 56 patients with pancreatic cancer (group B), which were then analysed. After gemcitabine administration, ILD was detected in 9 out of the total 118 patients (7.6%). Three patients had grade 2 ILD and 6 patients had grade 3 ILD. Multivariate analysis revealed that prior thoracic radiotherapy (odds ratio: 26.3) and pre-existing pulmonary fibrosis (PF) (odds ratio: 6.5) were correlated with ILD occurrence, but the incidence of ILD was not different between groups A and B. The median dose of gemcitabine administered till the manifestation of ILD tended to be lower in group A than in group B. CONCLUSIONS Prior thoracic radiotherapy and pre-existing PF were correlated with higher ILD rate in gemcitabine-treated patients. ILD incidence did not differ between NSCLC and pancreatic cancer patients, which may be due to the differences in treatment strategy and tumour properties.
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Lemarie E, Vecellio L, Hureaux J, Prunier C, Valat C, Grimbert D, Boidron-Celle M, Giraudeau B, le Pape A, Pichon E, Diot P, el Houfia A, Gagnadoux F. Aerosolized gemcitabine in patients with carcinoma of the lung: feasibility and safety study. J Aerosol Med Pulm Drug Deliv 2011; 24:261-70. [PMID: 21793717 DOI: 10.1089/jamp.2010.0872] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND We investigated the biodistribution, pharmacokinetics, safety profile, and feasibility of aerosolized gemcitabine (GCB) in patients with lung carcinoma. METHOD Eleven patients with carcinoma localized in the lungs were studied in a dose escalation study of aerosolized GCB administered 1 day/week for 9 consecutive weeks. Safety data, scintigraphic assessment of the delivered dose and pharmacokinetic monitoring were analyzed. Patients were treated with doses of between 1 mg/kg and 4 mg/kg (dose in the nebulizer), using a new inhaler device (Aeroneb Pro with an Idehaler Chamber). RESULTS AND CONCLUSIONS The total dose of GCB delivered to the patient's lung was 42±16% of the initial amount of dose in the nebulizer. Safety data showed no hematologic toxicity, nephrotoxicity or neurotoxicity. At 4 mg/kg, one patient experienced grade 4 pulmonary toxicity (bronchospasm), which was the dose-limiting toxicity. Grade 2 and 3 toxic effects included fatigue, vomiting, dyspnea, and cough. Overall response: minor response in one patient, stable disease in four patients, progressive disease in four patients. Pharmacokinetic data showed very low plasma GCB levels. Maximal plasma concentration was observed at the end of nebulization. Aerosolized gemcitabin was safe, with minimal toxicity, for patients with lung carcinoma.
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Affiliation(s)
- Etienne Lemarie
- INSERM U 618, IFR135, Bretonneau University Hospital, François Rabelais University, Tours, France.
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Sherrod AM, Brufsky A, Puhalla S. A case of late-onset gemcitabine lung toxicity. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2011; 5:171-6. [PMID: 21695101 PMCID: PMC3117630 DOI: 10.4137/cmo.s6643] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Gemcitabine is a chemotherapeutic agent used for the treatment of a number of malignancies. Although its major dose-limiting side effect is myelosuppression, many pulmonary toxicities have been described with its use. Severe pulmonary toxicity is rare, but symptoms tend to be rapid in onset and potentially deadly. The average time from initiation of chemotherapy to onset of symptoms is less than two months. The most effective therapy is steroid administration, the efficacy of which has been variable. In this report, we describe a unique case of gemcitabine pulmonary toxicity in a patient who did not experience symptoms of pulmonary dysfunction until after 1 year of treatment. Her symptoms did not improve rapidly with steroids, nor did she rapidly decompensate as has been frequently described. To our knowledge, this is one of the first reported descriptions of late-onset gemcitabine lung toxicity.
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Affiliation(s)
- Amanda M Sherrod
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Binder D, Hübner RH, Temmesfeld-Wollbrück B, Schlattmann P. Pulmonary toxicity among cancer patients treated with a combination of docetaxel and gemcitabine: a meta-analysis of clinical trials. Cancer Chemother Pharmacol 2011; 68:1575-83. [PMID: 21547571 DOI: 10.1007/s00280-011-1648-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 04/03/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE The combination of docetaxel and gemcitabine was tested in several studies in patients with lung, breast, and pancreatic cancers and other tumor entities. Some studies reported cases of severe or even fatal pulmonary toxicity that led to early termination of some trials. We created a meta-analysis model of published studies to identify explanatory factors for docetaxel-gemcitabine-dependent pulmonary toxicity. METHODS We searched MEDLINE/Pubmed, EMBASE, and Cochrane Clinical Trials database for prospective full-text studies that used a schedule of docetaxel and gemcitabine to treat a malignant disease. We performed a meta-analysis for proportions using the arcsine transformation and a meta-regression using a generalized linear mixed model based on a binomial distribution and a logit link. RESULTS We included 103 trials with 113 treatment arms comprising 5,065 patients (major entities included non-small cell lung cancer (n = 2,550), breast cancer (n = 1,119), pancreatic cancer (n = 466), and urothelial cancer (n = 161)). For the incidence of severe lung toxicity (common toxicity criteria [CTC] grades 3-5), we found a combined estimate of 2.70% (95% CI 2.26, 3.14). The estimate for the proportion of fatal cases was 0.35% (95% CI 0.21, 0.58). We found that the sequence of the chemotherapy schedule had no influence on the incidence of severe pulmonary adverse events (F-test F = 0.65, df = 3,113, P = 0.58) nor did the study phase, treatment line or ethnicity of the participants. We found that patients with breast cancer, compared to lung cancer patients, developed severe lung toxicity less frequently (OR = 0.18, 95% CI (0.09, 0.36)). CONCLUSION We could not demonstrate that a particular chemotherapy sequence of docetaxel-gemcitabine is associated with excess pulmonary toxicity. Patients with lung cancer are at a higher risk for severe pulmonary side effects with docetaxel-gemcitabine than are patients with breast cancer.
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Affiliation(s)
- Daniel Binder
- Department of Internal Medicine/Infectious and Respiratory Diseases, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Thomas JG, Sethi S, Norby SM. Chronic Thrombotic Microangiopathy Secondary to Chemotherapy for Urothelial Carcinoma in a Patient With a History of Wegener Granulomatosis. Am J Kidney Dis 2011; 57:799-802. [DOI: 10.1053/j.ajkd.2011.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 01/02/2011] [Indexed: 12/21/2022]
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Nojiri S, Gemba K, Aoe K, Kato K, Yamaguchi T, Sato T, Kubota K, Kishimoto T. Incidence of interstitial lung disease in patients with mesothelioma in the west part of Japan. Pharmacoepidemiol Drug Saf 2011; 20:643-52. [DOI: 10.1002/pds.2123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Shuko Nojiri
- Department of Pharmacoepidemiology; Faculty of Medicine; University of Tokyo; Tokyo; Japan
| | - Kenichi Gemba
- Department of Respiratory Medicine; Japan Labor Health and Welfare Organization; Okayama Rosai Hospital; Okayama; Japan
| | - Keisuke Aoe
- Department of Respiratory Medicine; National Hospital Organization Yamaguchi - Ube Medical Center; Yamaguchi; Japan
| | - Katsuya Kato
- Department of Radiology; Okayama University Hospital; Okayama; Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics; Graduate School of Medicine; Tohoku University; Miyagi; Japan
| | - Tsugumichi Sato
- NPO (Nonprofit Organization) Drug Safety Research Unit Japan; Tokyo; Japan
| | - Kiyoshi Kubota
- Department of Pharmacoepidemiology; Faculty of Medicine; University of Tokyo; Tokyo; Japan
| | - Takumi Kishimoto
- Department of Respiratory Medicine; Japan Labor Health and Welfare Organization; Okayama Rosai Hospital; Okayama; Japan
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De Sanctis A, Taillade L, Vignot S, Novello S, Conforti R, Spano JP, Scagliotti GV, Khayat D. Pulmonary toxicity related to systemic treatment of nonsmall cell lung cancer. Cancer 2011; 117:3069-80. [PMID: 21283982 DOI: 10.1002/cncr.25894] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 12/01/2010] [Accepted: 12/12/2010] [Indexed: 11/09/2022]
Abstract
Physicians who are responsible for the delivery of systemic treatment in lung cancer should be aware of the potential risk of drug-induced pulmonary toxicity (DIPT), because such toxicity may develop in the context of a multifactorial clinical condition. First, most patients with lung cancer may suffer from other non-neoplastic, smoking-related lung diseases, such as emphysema and chronic obstructive lung disease, which may generate pathologic changes in lung parenchyma. In addition, lung cancer itself may worsen the respiratory function, inducing atelectasis and lymphangitic carcinomatosis. The superimposed iatrogenic damage may lead to respiratory failure and, sometimes, death. The risk of DIPT from chemotherapeutic agents has been widely examined in the past; and, currently, the potential for lung toxicity has been extended by the introduction of molecular targeted therapies. Because there are no univocal criteria with which to recognize DIPT, the diagnosis often is made by exclusion; consequently, it is hard to establish an early diagnosis. The objective of this review was to describe the major DIPTs associated with antineoplastic agents against nonsmall cell lung cancer to help physicians with this difficult diagnostic challenge.
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Affiliation(s)
- Alice De Sanctis
- Department of Clinical and Biological Sciences, University of Torino, San Luigi Hospital, Orbassano, Torino, Italy.
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Abstract
Chemotherapy can induce various clinical emergencies. Prompt recognition and management of these adverse events are important for avoiding further morbidity and mortality. Some events such as hypersensitivity and extravasation are quite common, whereas emergencies such as neutropenic typhlitis, pancreatitis, and acute haemolysis are very rare. Little information exists on the management of rare chemotherapy-induced emergencies that affect fewer than 1% of patients. We review these uncommon chemotherapy-induced life-threatening emergencies, their pathogenesis and management, and recommendations for rechallenge with the offending chemotherapy.
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Azoulay E. Pleuropulmonary Changes Induced by Drugs in Patients with Hematologic Diseases. PULMONARY INVOLVEMENT IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES 2011. [PMCID: PMC7123804 DOI: 10.1007/978-3-642-15742-4_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patients with hematologic diseases who are being treated with therapy drugs, or receive radiation therapy or blood transfusions may develop a host of potentially fatal infectious and noninfectious pulmonary complications [1]. The increased complexity of multimodality and high-dose treatment regimens with the intended benefit of augmented antineoplastic efficacy and prolonged disease-free survival, the use of a panel of novel drugs to treat malignant and nonmalignant hematologic conditions (e.g., azacytidine, bortezomib, cladribine, dasatinib, fludarabine, imatinib, lenalidomide, rituximab, and thalidomide), total body irradiation (TBI) and hematopietic stem cell transplantation (HSCT) have increased the incidence of severe sometimes life-threatening pulmonary complications.
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Affiliation(s)
- Elie Azoulay
- Service de Réanimation Médicale, Hôpital Saint Louis, Avenue Claude Vellefaux 1, Paris, 75010 France
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Gemcitabine as first-line chemotherapy in elderly patients with unresectable pancreatic carcinoma. J Gastroenterol 2010; 45:1146-54. [PMID: 20549255 DOI: 10.1007/s00535-010-0258-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 05/04/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gemcitabine (GEM) is the key drug for the chemotherapy of unresectable pancreatic cancer. However, the efficacy and safety of GEM has not been established in elderly patients. We retrospectively examined the prognosis of elderly pancreatic cancer patients treated with GEM. METHODS Sixty-six patients with unresectable pancreatic cancer (pathologically identified) and no prior chemotherapy were divided into three groups. Group A: patients aged 70 years or more who received standard GEM (1000 mg/m(2)) on days 1, 8, and 15 and rest on day 21; Group B: patients less than 70 years old who received standard GEM therapy; and Group C: patients under best supportive care. RESULTS Median survival times (MSTs) (days) were 311 in group A (p < 0.05 vs. group C), 292 in group B (p < 0.05 vs. group C), and 127 in group C. Among the patients who received GEM, 23% patients in group A and 16% patients in group B obtained partial responses. The response rates and MSTs were similar in groups A and B, as well as in more aged (≥75 years) patients. Bone marrow suppression was more frequently seen in elderly patients. Cox's hazard model in patients aged 70 years or more revealed that GEM therapy reduced the hazard ratio for death (hazard ratio: 0.683, p = 0.041). CONCLUSIONS Chemotherapy with GEM appears to be effective and safe in elderly patients as well as in younger patients. Patients with unresectable pancreatic carcinoma should receive GEM therapy even if they are aged 70 or more, even if they are aged 75 or more.
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Antolín S, Calvo L, Dopico D, Quindós M, Reboredo M, Carral A. Locally advanced breast cancer: pulmonary toxicity secondary to gemcitabine. Clin Transl Oncol 2010; 12:450-2. [PMID: 20534401 DOI: 10.1007/s12094-010-0533-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Gemcitabine is indicated for the treatment of nonmicrocytic lung, breast, pancreatic, bladder and ovarian cancer. Mild dyspnea has been reported but the incidence of severe lung damage is low. We report the case of a 58-year-old woman diagnosed with locally advanced infiltrating ductal carcinoma of the breast who received gemcitabine as part of neoadjuvant chemotherapy and suffered from severe pulmonary toxicity. We reviewed the cases published in the literature and conclude that although Gemcitabine is generally well tolerated, pulmonary toxicity requires high level of suspicion and prompt treatment to prevent an unfavourable outcome.
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Affiliation(s)
- Silvia Antolín
- Oncology Service, A Coruña University Hospital, A Coruña, Spain.
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