A case of fatal interstitial pneumonia during treatment of radiotherapy plus cetuximab for patient with head and neck carcinoma

Cetuximab-associated pulmonary toxicity in concurrent chemoradiation for the treatment of a squamous cell carcinoma of the head and neck

BACKGROUND

Cetuximab is a common EGFR monoclonal antibody used with radiotherapy to treat head-and-neck cancer. Severe pulmonary toxicity, including interstitial lung disease (ILD), caused by cetuximab is rare.

METHODS

We describe a patient who developed ILD and acute respiratory failure after concurrent chemoradiation with cetuximab for oropharyngeal squamous cell carcinoma, and review the literature.

RESULTS

A patient developed acute respiratory failure 2 months after starting concurrent chemoradiation with cetuximab and was hospitalized in intensive care after a procedure for progressive respiratory distress. Cultures and serology were negative for infection and radiologic findings were consistent with drug associated pneumonitits. Steroids were administered until the patient was stabilized. The patient fully recovered 1 month after the onset of respiratory distress, although he died of recurrent disease 10 months after completing treatment.

CONCLUSION

Although severe pulmonary toxicity caused by EGFR inhibitors has been well described in the literature, ILD caused by cetuximab, an EGFR monoclonal antibody, is rare and not well-documented. Given its life-threatening effects, awareness of this potential side effect and early diagnosis is critical.

Interstitial Lung Disease Associated With Cetuximab in Patients With Head and Neck Carcinoma: A Single-Institution Experience in Japan

Objective:

This study retrospectively analyzed the risk of interstitial lung disease with cetuximab using risk factors known to be associated with interstitial lung disease during administration of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI).

Summary of background data:

Cetuximab is an inhibitor of EGFR commonly used for advanced squamous cell carcinoma of the head and neck. Interstitial lung disease is a rare but serious adverse event of cetuximab. EGFR-TKIs are molecularly targeted drugs resembling cetuximab and show increased risk of interstitial lung disease associated with positive smoking history, age >55 years, preexisting lung disorder, and poor performance status.

Methods:

Among 44 patients treated with cetuximab for advanced squamous cell carcinoma of the head and neck between March 2013 and April 2015 at Tokyo Medical University, 6 patients developed interstitial lung disease. Smoking history, age, preexisting lung disorder, and performance status were examined for these 6 patients.

Results:

Two of these 6 patients died due to interstitial lung disease. All patients with interstitial lung disease were >55 years old and had a history of smoking. Three patients with interstitial lung disease had a preexisting lung disorder. Performance status was 0 in 4 patients and 1 in 2 patients.

Conclusions:

Age >55 years, smoking history, and preexisting lung disease may represent risk factors for interstitial lung disease during cetuximab treatment for head and neck carcinoma, whereas performance status may not.