1
|
Limpawittayakul P, Petchjorm S, Chueansuwan W, Boonfueang W. Paclitaxel-induced acute fibrinous and organizing pneumonitis in early breast cancer: A case report. Respir Med Case Rep 2024; 48:102004. [PMID: 38500560 PMCID: PMC10945270 DOI: 10.1016/j.rmcr.2024.102004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
Background Paclitaxel is a chemotherapeutic drug widely used in breast cancer treatment. While common side effects are possible, paclitaxel-induced pneumonitis is rare, with an estimated incidence of 1%-5% and a high mortality rate. Case presentation A 57-year-old Thai woman diagnosed with stage II right breast cancer. She received adjuvant chemotherapy comprising doxorubicin and cyclophosphamide, followed by weekly paclitaxel. After the ninth paclitaxel cycle, she developed acute respiratory failure. Transbronchial biopsies revealed acute fibrinous and organizing pneumonitis. The patient was placed in prone position. Following the administration of dexamethasone, her symptoms improved. However, while reducing the dexamethasone dosage, she developed new-onset dyspnea as well as Takotsubo cardiomyopathy. Intravenous methylprednisolone 500 mg/day was administered for 3 days followed by transition to intravenous dexamethasone and slow tapering to prednisolone. Prednisolone was gradually tapered and eventually discontinued after 3 months. Conclusions Paclitaxel-induced pneumonitis is a rare complication. The diagnosis should be considered in any patient who develops respiratory symptoms while receiving paclitaxel. Acute fibrinous and organizing pneumonitis is a rare type of interstitial pneumonitis with high recurrence and mortality rates. High-dose steroids are needed to treat this type of pneumonitis.
Collapse
Affiliation(s)
- Piyarat Limpawittayakul
- Division of Medical Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Supinda Petchjorm
- Division of Pathology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | - Wanvisa Boonfueang
- Division of Pulmonary Medicine, Ramkhamhaeng Hospital, Bangkok, Thailand
| |
Collapse
|
2
|
Tuğral A, Arıbaş Z, Akyol M, Bakar Y. Understanding changes in pulmonary function and functional status in breast cancer patients after systemic chemotherapy and radiotherapy: a prospective study. BMC Pulm Med 2024; 24:83. [PMID: 38355489 PMCID: PMC10865615 DOI: 10.1186/s12890-024-02890-5] [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] [Received: 10/30/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Respiratory complications in breast cancer (BC) patients after chemotherapy (CT) and radiotherapy (RT) have been well acquainted and these complications should be investigated to prevent secondary problems and/or improve BC patients' clinical outcomes. Therefore, this study aimed to assess the potential acute effect of systemic chemotherapy and radiotherapy on respiratory function and functional status of patients with breast cancer. METHODS A total of 25 BC patients who were candidates for systemic chemotherapy and radiotherapy were recruited after oncological examination and included in this study. Respiratory function and functional status were assessed with the Pulmonary Function Test (PFT) and the Six-Minute Walk Test (6MWT), respectively. Patients were assessed before CT (c0), after CT (c1), and after RT (r1). RESULTS 25 BC patients were assessed in c0 and c1 while only 15 out of 25 patients (60%) were assessed in r1. The actual values of Forced vital capacity (FVC) (t = 2.338, p =.028), Forced expiratory volume in 1s (FEV1 (t = 2.708, p =.012), and the forced expiratory flow of between 25% and 75% of vital capacity (FEF25-75%) (t = 2.200, p =.038) were found significantly different after systemic CT. Inspiratory (MIP) and expiratory (MEP) muscle strength also did not show a significant change from c0 to c1. A significant effect of the type of surgery was found (Wilks' lambda, F [1, 19] = 6.561, p =.019, ηp2 = 0.25) between c0 and c1 in actual FVC value. The main effect of time was found significant in FVC (F [2, 28] = 4.840, p =.016, ηp2 = 0.25) from c0 to r1. Pairwise comparisons with Bonferroni correction showed that there was a significant difference between c0 and r1 (p =.037). DISCUSSION The present study showed decreased FVC and FEV1 actual values and percent predicted rates from baseline to the completion of treatment. Since the interactional effect of the type of surgery was significant, we suggest that clinical and demographic factors such as age should be considered when interpreting the early changes in PFT. In addition, the significant linear trend of decreasing in some specific outcomes in respiratory function also highlighted the need for continuous monitoring of potential respiratory problems in patients with BC from baseline to the completion of chemotherapy and radiotherapy.
Collapse
Affiliation(s)
- Alper Tuğral
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir Bakırçay University, Izmir, Turkey.
| | - Zeynep Arıbaş
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Trakya University, Edirne, Turkey
| | - Murat Akyol
- Faculty of Medicine, Department of Medical Oncology, Izmir Bakırçay University, Izmir, Turkey
| | - Yeşim Bakar
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir Bakırçay University, Izmir, Turkey
| |
Collapse
|
3
|
Natural Taxanes: From Plant Composition to Human Pharmacology and Toxicity. Int J Mol Sci 2022; 23:ijms232415619. [PMID: 36555256 PMCID: PMC9779243 DOI: 10.3390/ijms232415619] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Biologically active taxanes, present in small- to medium-sized evergreen conifers of various Taxus species, are widely used for their antioxidant, antimicrobial and anti-inflammatory effects, but mostly for their antitumour effects used in the treatment of solid tumours of the breast, ovary, lung, bladder, prostate, oesophagus and melanoma. More of the substances found in Taxus plant extracts have medical potential. Therefore, at the beginning of this review, we describe the methods of isolation, identification and determination of taxanes in different plant parts. One of the most important taxanes is paclitaxel, for which we summarize the pharmacokinetic parameters of its different formulations. We also describe toxicological risks during clinical therapy such as hypersensitivity, neurotoxicity, gastrointestinal, cardiovascular, haematological, skin and renal toxicity and toxicity to the respiratory system. Since the effect of the drug-form PTX is enhanced by various Taxus spp. extracts, we summarize published clinical intoxications and all fatal poisonings for the Taxus baccata plant. This showed that, despite their significant use in anticancer treatment, attention should also be focused on the risk of fatal intoxication due to ingestion of extracts from these plants, which are commonly found in our surroundings.
Collapse
|
4
|
Tvsvgk T, Handa A, Kumar K, Mutreja D, Subramanian S. Chemotherapy-Associated Pulmonary Toxicity-Case Series from a Single Center. South Asian J Cancer 2022; 10:255-260. [PMID: 34984206 PMCID: PMC8719973 DOI: 10.1055/s-0041-1731581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background Pulmonary toxicity due to chemotherapeutic agents can occur with many established and new drugs. Strong clinical suspicion is important as the clinical presentation is usually with nonspecific symptoms like cough, dyspnea, fever, and pulmonary infiltrates. Timely discontinuation of the offending agent alone can improve the condition. Methods A prospective observational study on patients receiving chemotherapy at an 800-bedded tertiary care hospital was performed from 2014 to 2016. Consecutive patients on chemotherapy, presenting with nonresolving respiratory symptoms were evaluated with contrast-enhanced computerized tomography of chest, diffusion lung capacity for carbon monoxide (DLCO), fiberoptic bronchoscopy with lavage, and biopsy, after excluding all causes for pulmonary infections. Descriptive data has been depicted. Results A total of 18 patients were evaluated for persistent symptoms of dry cough, dyspnea, and fever among 624 who received chemotherapy during the study period. Ground-glass opacities on high-resolution CT was the most common imaging finding, others being patchy subpleural consolidation and pleural effusion. Lymphocyte-predominant bronchoalveolar lavage was detected in nine. Eight of the 15 patients who underwent DLCO, had abnormal results. Seven had significant histopathological findings on bronchoscopic lung biopsy, which revealed organizing pneumonia as the most common pattern. Paclitaxel, fluorouracil, gemcitabine, and tyrosine kinase inhibitors were the common culprit drugs. Discontinuation alone of the culprit drug was effective in 15 and 3 needed oral corticosteroids for relief of symptoms. None of the patients died due to the toxicity. Conclusion An incidence of 2.8% for chemotherapy-induced lung injury was seen in our observational study of 3 years, with parenchymal, interstitial, and pleural involvement due to various chemotherapeutic agents. Oral steroids maybe required in a subset of patients not responding to discontinuation of the culprit agent.
Collapse
Affiliation(s)
- Tilak Tvsvgk
- Department of Internal Medicine, Armed Forces Medical College (AFMC), Pune, Maharashtra, India
| | - Ajay Handa
- Department of Medicine, INHS Asvini, Mumbai, Maharashtra, India
| | - Kishore Kumar
- Department Medicine, Command Hospital Air Force (CHAF), Bangalore, Karnataka, India
| | - Deepti Mutreja
- Department of Pathology, Armed Forces Medical College (AFMC), Pune, Maharashtra, India
| | - Shankar Subramanian
- Department of Internal Medicine, Armed Forces Medical College (AFMC), Pune, Maharashtra, India
| |
Collapse
|
5
|
Chintamani, Tandon M, Ghosh J. Breast Cancer with Associated Problems. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
6
|
Tezuka K, Miura K, Nakano Y, Ueda T, Yagyu K, Matsuyama S, Shirai M, Okuda H, Ujikawa M, Ota T. Interstitial lung disease associated with adjuvant and neoadjuvant chemotherapy in early breast cancer. World J Surg Oncol 2021; 19:169. [PMID: 34116698 PMCID: PMC8196499 DOI: 10.1186/s12957-021-02289-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/04/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) is a rare adverse event in patients receiving adjuvant or neoadjuvant chemotherapy (NAC) for breast cancer. Few studies have reported the frequency of ILD in detail, and only small numbers of cases have been described in the literature. Given these previous findings concerning ILD, we retrospectively examined the clinicopathological characteristics of five cases of ILD who had received epirubicin and cyclophosphamide (EC) and compared their findings with non-ILD cases. METHODS The present single-center retrospective study included breast cancer patients who underwent adjuvant chemotherapy or NAC at our hospital between January 2014 and January 2021. RESULTS Thirty-nine patients who had received EC for operable breast cancer were enrolled in this study. ILD developed 5 out of 39 patients (12.8%). The incidence of ILD in patients with non-dose-dense (dd) or dd chemotherapy was statistically significantly different (p = 0.0149). ILD occurred in three patients during dd EC treatment and two during weekly paclitaxel (wPTX) after dd EC. ILD was detected in one patient with high Krebs von den Lungen-6 (KL-6) levels, in two patients with continuous pyrexia, and in two patients from computed tomography imaging, which was taken to estimate the efficacy of chemotherapy, in two patients. Three of the 5 ILD patients underwent bronchoalveolar lavage, and 2 of these patients were diagnosed with Pneumocystis jirovecii pneumonia (PCP). There were no cases of serious ILD that required steroid pulse therapy. CONCLUSIONS Dd chemotherapy may be associated with an increased ILD frequency, which may reflect developing PCP. Careful monitoring and a timely diagnosis are useful for detecting early-stage ILD.
Collapse
Affiliation(s)
- Kenji Tezuka
- Department of Breast Surgery, Izumi City General Hospital, 4-5-1 Wake, Izumi, Osaka, 594-0073, Japan.
| | - Kotaro Miura
- Department of Surgery, Izumi City General Hospital, 4-5-1 Wake, Izumi, Osaka, 594-0073, Japan
| | - Yusuke Nakano
- Department of Medical Oncology, Izumi City General Hospital, 4-5-1 Wake, Izumi, Osaka, 594-0073, Japan
| | - Takahiro Ueda
- Department of Respiratory Medicine, Izumi City General Hospital, 4-5-1 Wake, Izumi, Osaka, 594-0073, Japan
| | - Kyoko Yagyu
- Department of Respiratory Medicine, Izumi City General Hospital, 4-5-1 Wake, Izumi, Osaka, 594-0073, Japan
| | - Shimako Matsuyama
- Nursing Department, Izumi City General Hospital Izumi, 4-5-1 Wake, Izumi, Osaka, 594-0073, Japan
| | - Masami Shirai
- Nursing Department, Izumi City General Hospital Izumi, 4-5-1 Wake, Izumi, Osaka, 594-0073, Japan
| | - Hiroshi Okuda
- Department of Pharmacy, Izumi City General Hospital, 4-5-1 Wake, Izumi, Osaka, 594-0073, Japan
| | - Miho Ujikawa
- Department of Pharmacy, Izumi City General Hospital, 4-5-1 Wake, Izumi, Osaka, 594-0073, Japan
| | - Takayo Ota
- Department of Medical Oncology, Izumi City General Hospital, 4-5-1 Wake, Izumi, Osaka, 594-0073, Japan.
| |
Collapse
|
7
|
Falchook G, Infante J, Arkenau HT, Patel MR, Dean E, Borazanci E, Brenner A, Cook N, Lopez J, Pant S, Frankel A, Schmid P, Moore K, McCulloch W, Grimmer K, O'Farrell M, Kemble G, Burris H. First-in-human study of the safety, pharmacokinetics, and pharmacodynamics of first-in-class fatty acid synthase inhibitor TVB-2640 alone and with a taxane in advanced tumors. EClinicalMedicine 2021; 34:100797. [PMID: 33870151 PMCID: PMC8040281 DOI: 10.1016/j.eclinm.2021.100797] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We conducted a first-in-human dose-escalation study with the oral FASN inhibitor TVB-2640 to determine the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D), as monotherapy and with a taxane. METHODS This completed open-label outpatient study was conducted at 11 sites in the United States and United Kingdom. Patients with previously-treated advanced metastatic solid tumors and adequate performance status and organ function were eligible. TVB-2640 was administered orally daily until PD. Dose escalation initially followed an accelerated titration design that switched to a standard 3 + 3 design after Grade 2 toxicity occurred. Disease-specific cohorts were enrolled at the MTD. Statistical analyses were primarily descriptive. Safety analyses were performed on patients who received at least 1 dose of study drug. (Clinicaltrials.gov identifier NCT02223247). FINDINGS The study was conducted from 21 November 2013 to 07 February 2017. Overall, 136 patients received TVB-2640, 76 as monotherapy (weight-based doses of 60 mg/m2 to 240 mg/m2 and flat doses of 200 and 250 mg) and 60 in combination, (weight-based doses of 60 mg/m2 to 100 mg/m2 and flat dose of 200 mg) (55 paclitaxel, 5 docetaxel). DLTs with TVB-2640 were reversible skin and ocular effects. The MTD/RP2D was 100 mg/m2. The most common TEAEs (n,%) with TVB-2640 monotherapy were alopecia (46; 61%), PPE syndrome (35; 46%), fatigue (28; 37%), decreased appetite (20; 26%), and dry skin (17; 22%), and with TVB-2640+paclitaxel were fatigue (29 ; 53%), alopecia (25; 46%), PPE syndrome (25; 46%), nausea (22; 40%), and peripheral neuropathy (20; 36%). One fatal case of drug-related pneumonitis occurred with TVB-2640+paclitaxel; no other treatment-related deaths occurred. Target engagement (FASN inhibition) and inhibition of lipogenesis were demonstrated with TVB-2640. The disease control rate (DCR) with TVB-2640 monotherapy was 42%; no patient treated with monotherapy had a complete or partial response (CR or PR). In combination with paclitaxel, the PR rate was 11% and the DCR was 70%. Responses were seen across multiple tumor types, including in patients with KRASMUT NSCLC, ovarian, and breast cancer. INTERPRETATION TVB-2640 demonstrated potent FASN inhibition and a predictable and manageable safety profile, primarily characterized by non-serious, reversible adverse events affecting skin and eyes. Further investigation of TVB-2640 in patients with solid tumors, particularly in KRASMUT lung, ovarian, and breast cancer, is warranted. FUNDING This trial was funded by 3-V Biosciences, Inc. (now known as Sagimet Biosciences Inc.).
Collapse
Affiliation(s)
- Gerald Falchook
- Sarah Cannon Research Institute at HealthONE, 1800 Williams St Ste 300, Denver, CO, 80218, United States
| | - Jeffrey Infante
- Tennessee Oncology, 250 25th Ave N #100, Nashville, TN 37203, United States
| | - Hendrik-Tobias Arkenau
- Sarah Cannon Research Institute UK, 93 Harley St., Marylebone, London W1G 6AD, United Kingdom
| | - Manish R. Patel
- Florida Cancer Specialists and Research Institute, 600 N Cattleman Rd, Ste 200, Sarasota, FL 34232, United States
- Sarah Cannon Research Institute, 1100 Martin L. King Jr. Boulevard, Nashville, TN 37203 United States
| | - Emma Dean
- Christie Hospital – Clinical Oncology, The Christie NHS Foundation Trust, Clinical Oncology Department, Wilmslow Road, Manchester, M20 4BX, United Kingdom
| | - Erkut Borazanci
- Scottsdale Healthcare Research Institute, 10510 North 92nd Street, Suite 200, Scottsdale, AZ 85258, United States
| | - Andrew Brenner
- CTRC at The University of Texas Health Center, 7979 Wurzbach Rd., San Antonio, TX 78229, United States
| | - Natalie Cook
- Christie Hospital – Clinical Oncology, The Christie NHS Foundation Trust, Clinical, Oncology Department, Wilmslow Road, Manchester, M20 4BX, United Kingdom
- Division of Cancer Sciences, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom
| | - Juanita Lopez
- Royal Marsden Hospital, Downs Road, Sutton, SM25PT, United Kingdom
| | - Shubham Pant
- University of Oklahoma Health Sciences, 800 NE 10 Street, 5th Floor, Oklahoma City, OK 73104, United States
| | - Arthur Frankel
- UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States
| | - Peter Schmid
- St Bartholomew's Hospital, West Smithfield, London, EC1A7BE, United Kingdom
| | - Kathleen Moore
- University of Oklahoma Health Sciences, 800 NE 10 Street, 5th Floor, Oklahoma City, OK 73104, United States
| | - William McCulloch
- Sagimet Biosciences Inc., 155 Bovet Rd., San Mateo, CA 94402, United States
- Corresponding author at: Sagimet Biosciences Inc., 155 Bovet Rd., San Mateo, CA 94402, USA.
| | - Katharine Grimmer
- Sagimet Biosciences Inc., 155 Bovet Rd., San Mateo, CA 94402, United States
| | - Marie O'Farrell
- Sagimet Biosciences Inc., 155 Bovet Rd., San Mateo, CA 94402, United States
| | - George Kemble
- Sagimet Biosciences Inc., 155 Bovet Rd., San Mateo, CA 94402, United States
| | - Howard Burris
- Sarah Cannon Research Institute, 1100 Martin L. King Jr. Boulevard, Nashville, TN 37203 United States
- Tennessee Oncology, 250 25th Ave N #100, Nashville, TN 37203, United States
| |
Collapse
|
8
|
Risk Analysis of Pneumonitis in Taxane Therapy After Chemoradiotherapy for Patients With Metastatic or Recurrent Esophageal Cancer. Am J Clin Oncol 2018; 41:41-45. [DOI: 10.1097/coc.0000000000000232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Nakaya A, Kurata T, Yokoi T, Takeyasu Y, Niki M, Kibata K, Satsutani N, Torii Y, Katashiba Y, Ogata M, Miyara T, Nomura S. Retrospective analysis of single-agent nab-paclitaxel in patients with platinum-resistant non-small cell lung cancer. Mol Clin Oncol 2017; 7:803-807. [PMID: 29181169 PMCID: PMC5700274 DOI: 10.3892/mco.2017.1392] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/02/2017] [Indexed: 02/06/2023] Open
Abstract
A retrospective study was conducted to investigate the efficacy and toxicity of single-agent nab-paclitaxel in 67 patients with platinum-resistant non-small cell lung cancer in Kansai Medical University Hospital from August 2013 to December 2015. Overall, 25% of patients experienced disease progression, 48% exhibited a partial response, 27% had stable disease and 0% had a complete response. The median progression-free survival (PFS) time was 4.8 months and the median overall survival time was 18.2 months. There was no statistically significant difference in PFS between patients with non-squamous carcinoma and squamous carcinoma, or between second-line use and post-second-line use. The most common severe adverse event was neutropenia, followed by interstitial lung disease, infection and fatigue. The results revealed that single agent nab-paclitaxel was associated with an acceptable level of toxicity and a favorable response. This regimen has been developed recently, thus it has not been sufficiently evaluated its toxicity and efficacy. Additional studies to evaluate these parameters in non-small cell lung cancer are warranted.
Collapse
Affiliation(s)
- Aya Nakaya
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Takayasu Kurata
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Takashi Yokoi
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Yuki Takeyasu
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Maiko Niki
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Kayoko Kibata
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Naoko Satsutani
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Yoshitaro Torii
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Yuichi Katashiba
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Makoto Ogata
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Takayuki Miyara
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka 573-1010, Japan
| |
Collapse
|
10
|
Nakatani Y, Nakaya A, Kurata T, Yokoi T, Takeyasu Y, Niki M, Kibata K, Satsutani N, Ogata M, Miyara T, Nomura S. Interstitial Lung Disease Following Single-Agent Nanoparticle Albumin-Bound Paclitaxel Treatment in Patients with Advanced Non-Small Cell Lung Cancer. Case Rep Oncol 2017; 10:683-688. [PMID: 28878650 PMCID: PMC5582424 DOI: 10.1159/000479148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 12/16/2022] Open
Abstract
Interstitial lung disease (ILD) is a serious and potentially fatal adverse event in lung cancer therapy. Nanoparticle albumin-bound paclitaxel (nab-PTX) is a novel, solvent-free formulation of paclitaxel (PTX). Although the incidence of nab-PTX-induced ILD is not clear, it is generally considered that this formulation presents a similar risk of developing ILD as PTX. Here, we report 3 patients who developed severe ILD following treatment with nab-PTX. We draw attention to the risk of developing drug-induced ILD following nab-PTX treatment, and highlight that this novel formulation might therefore not be as safe as PTX with respect to the development of ILD.
Collapse
Affiliation(s)
| | - Aya Nakaya
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Gupta A, Teo L, Masel P, Godbolt D, Beadle G. Transtuzumab induced organizing pneumonia: a case report. SPRINGERPLUS 2016; 5:1964. [PMID: 27933242 PMCID: PMC5108743 DOI: 10.1186/s40064-016-3647-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/03/2016] [Indexed: 01/05/2023]
Abstract
Background Patients with metastatic breast cancer often have pulmonary symptoms with varying aetiologies. Transtuzumab is an extremely important drug used in the treatment of Her 2 neu over-expressing breast cancers. In this report we describe a case of organizing pneumonia associated with use of transtuzumab in metastatic breast cancer. Only three such cases have previously been reported. Case description A 43 year old lady with Her 2 neu 3+, estrogen and progesterone receptor positive, metastatic breast cancer was started on weekly transtuzumab and albumen bound paclitaxel. She was admitted with an episode of bilateral pneumonitis after her fourth dose of therapy. It was managed conservatively with antibiotics. Subsequently, single agent transtuzumab was administered resulting in an anaphylactoid reaction followed by worsening dyspnoea requiring hospitalization and oxygen support for 3 days. Discussion and evaluation The pneumonitis warranted further investigations including bronchoscopy which were performed. Bronchoscopic biopsy was consistent with a diagnosis of organizing pneumonia. Transtuzumab was stopped and she was started on steroids (dexamethasone). She improved remarkably and was discharged home on hormonal therapy, lapatinib and tapering doses of steroids. Conclusion Organizing pneumonia closely mimics infection or progressive disease and can be difficult to diagnose in the setting of malignancy. Correct diagnosis is of paramount importance since delay in treatment can result in significantly adverse patient outcomes.
Collapse
Affiliation(s)
- Ajay Gupta
- Asian Cancer Center, Faridabad, India ; Medical Oncology, Hervey Bay Hospital, Hervey Bay, QLD Australia
| | - Louise Teo
- Medical Oncology, Hervey Bay Hospital, Hervey Bay, QLD Australia
| | - Philip Masel
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD Australia
| | - David Godbolt
- Department of Pathology, The Prince Charles Hospital, Chermside, QLD Australia
| | - Geoffrey Beadle
- Department of Medical Oncology, Wesley Hospital, Auchenflower, QLD Australia
| |
Collapse
|
12
|
Abstract
Docetaxel (Taxotere®) is an agent that is indicated for the treatment of patients with locally advanced or metastatic non-small-cell lung cancer. In recent years, docetaxel-related interstitial lung disease (ILD) has been reported in several case series studies. The onset of ILD occurred ~10–20 days (median time: 18 days) after docetaxel administration. Here, we reported the case of a patient who had pulmonary toxicity of ILD within 3 days after using a relatively low-dose docetaxel administration. Although some articles have described patients who progressed to respiratory failure and needed intubation, this patient responded well to steroid treatment and discontinued docetaxel administration.
Collapse
Affiliation(s)
- Chung-Jen Wang
- Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hou-Tai Chang
- Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-Yu Chang
- Division of Chest Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| |
Collapse
|
13
|
Mas C, Boda B, CaulFuty M, Huang S, Wiszniewski L, Constant S. Antitumour efficacy of the selumetinib and trametinib MEK inhibitors in a combined human airway-tumour-stroma lung cancer model. J Biotechnol 2015; 205:111-9. [PMID: 25615947 DOI: 10.1016/j.jbiotec.2015.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/25/2014] [Accepted: 01/12/2015] [Indexed: 01/29/2023]
Abstract
With more than 1 million deaths worldwide every year, lung cancer remains an area of unmet need. Accessible human in vitro 3D tissue models are required to improve preclinical predictivity. OncoCilAir™ is a new in vitro model of Non Small Cell Lung Cancer which combines a reconstituted human airway epithelium, human lung fibroblasts and lung adenocarcinoma cell lines. Remarkably, we found that in this 3D microenvironment tumour cells expand by forming nodules, mimicking a human lung cancer feature. OncoCilAir™ mutated for KRAS and expressing the green fluorescent protein were used to test the antitumour potential of the investigational MEK inhibitors selumetinib and trametinib. As primary endpoint, changes in tumour size were assessed by fluorescence measurements. Tumours showed a reduced growth in response to the MEK inhibitors, but halting the selumetinib dosing resulted in tumour relapse. Importantly, toxicity study on the normal part of the cultures revealed that the airway epithelium integrity was also affected by anticancer drug treatments. These results highlight the possibility to assess simultaneously drug efficacy, drug side-effect and tumour recurrence within a single culture model. OncoCilAir™ heralds a new generation of integrated in vitro tumour models that should be valuable tools for drug development, while reducing animal testing.
Collapse
Affiliation(s)
- Christophe Mas
- OncoTheis Sàrl, 14 chemin des aulx, CH-1228 Plan-les-Ouates, Geneva, Switzerland.
| | - Bernadett Boda
- OncoTheis Sàrl, 14 chemin des aulx, CH-1228 Plan-les-Ouates, Geneva, Switzerland
| | | | - Song Huang
- Epithelix Sàrl, Plan-les-Ouates, Switzerland
| | | | - Samuel Constant
- OncoTheis Sàrl, 14 chemin des aulx, CH-1228 Plan-les-Ouates, Geneva, Switzerland; Epithelix Sàrl, Plan-les-Ouates, Switzerland
| |
Collapse
|
14
|
Castillo R, Pham N, Ansari S, Meshkov D, Castillo S, Li M, Olanrewaju A, Hobbs B, Castillo E, Guerrero T. Pre-radiotherapy FDG PET predicts radiation pneumonitis in lung cancer. Radiat Oncol 2014; 9:74. [PMID: 24625207 PMCID: PMC3995607 DOI: 10.1186/1748-717x-9-74] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 03/02/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND A retrospective analysis is performed to determine if pre-treatment [18 F]-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) image derived parameters can predict radiation pneumonitis (RP) clinical symptoms in lung cancer patients. METHODS AND MATERIALS We retrospectively studied 100 non-small cell lung cancer (NSCLC) patients who underwent FDG PET/CT imaging before initiation of radiotherapy (RT). Pneumonitis symptoms were evaluated using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4) from the consensus of 5 clinicians. Using the cumulative distribution of pre-treatment standard uptake values (SUV) within the lungs, the 80th to 95th percentile SUV values (SUV(80) to SUV(95) were determined. The effect of pre-RT FDG uptake, dose, patient and treatment characteristics on pulmonary toxicity was studied using multiple logistic regression. RESULTS The study subjects were treated with 3D conformal RT (n=23), intensity modulated RT (n=64), and proton therapy (n=13). Multiple logistic regression analysis demonstrated that elevated pre-RT lung FDG uptake on staging FDG PET was related to development of RP symptoms after RT. A patient of average age and V(30) with SUV(95)=1.5 was an estimated 6.9 times more likely to develop grade ≥ 2 radiation pneumonitis when compared to a patient with SUV(95)=0.5 of the same age and identical V(30). Receiver operating characteristic curve analysis showed the area under the curve was 0.78 (95% CI=0.69 - 0.87). The CT imaging and dosimetry parameters were found to be poor predictors of RP symptoms. CONCLUSIONS The pretreatment pulmonary FDG uptake, as quantified by the SUV(95), predicted symptoms of RP in this study. Elevation in this pre-treatment biomarker identifies a patient group at high risk for post-treatment symptomatic RP.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Thomas Guerrero
- The University of Texas Health Science Center, Houston, TX, USA.
| |
Collapse
|
15
|
Abstract
Carcinoma of the bladder is the second most prevalent genitourinary malignancy and the fifth most common solid malignancy in the USA. Combination chemotherapy is used in most patients with advanced disease. Traditionally, on the basis of favorable response rates and survival data, cisplatin-based regimens have been the preferred chemotherapy for patients with metastatic bladder cancer. However, the toxicity profile of cisplatin precludes its use in a significant subset of patients with advanced bladder cancer. Conversely, noncisplatin-containing regimens have been shown to have a more favorable toxicity profile and to have activity in advanced bladder cancer. Here, various nonplatinum chemotherapy regimens for advanced disease are reviewed.
Collapse
Affiliation(s)
- Sandy Srinivas
- Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305, USA.
| | | |
Collapse
|
16
|
Cruz P, Torres M, Higuera O, Espinosa E. Taxane-induced pneumonitis: our clinical experience. Arch Bronconeumol 2013; 50:45. [PMID: 24074747 DOI: 10.1016/j.arbres.2013.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 07/19/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Patricia Cruz
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid, España.
| | - Marisa Torres
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid, España
| | - Oliver Higuera
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid, España
| | - Enrique Espinosa
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid, España
| |
Collapse
|
17
|
Storaas E, Holmaas G, Gravdal K, Børretzen A, Eikesdal HP. Lethal pneumonitis after docetaxel chemotherapy: case report and review of the literature. Acta Oncol 2013; 52:1034-8. [PMID: 23244676 DOI: 10.3109/0284186x.2012.750734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
18
|
Kawajiri H, Takashima T, Onoda N, Kashiwagi S, Ishikawa T, Hirakawa K. Interstitial pneumonia associated with neoadjuvant chemotherapy in breast cancer. Mol Clin Oncol 2013; 1:433-436. [PMID: 24649188 DOI: 10.3892/mco.2013.87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 02/19/2013] [Indexed: 11/06/2022] Open
Abstract
Interstitial pneumonia (IP) is a critical adverse event that may occur during anticancer chemotherapy. Physicians should be aware of the possibility of IP, particularly when dealing with patients on neoadjuvant chemotherapy (NAC) since delays in diagnosis and treatment interfere with the scheduled operation. In our institution, fluorouracil, epirubicin and cyclophosphamide (FEC) followed by weekly paclitaxel is the standard NAC regimen for operable breast cancer cases. In the present study, 95 patients with breast cancer were treated with this regimen, 5 of whom (5.3%) developed IP during NAC. All 5 cases were diagnosed when anticancer therapy was withdrawn and steroid pulse therapy was initiated. Consequently, the standard operation was immediately performed. In conclusion, physicians should be aware that IP may occur at any point during NAC and that it should be immediately diagnosed and treated to avoid delay of the therapeutic plan.
Collapse
Affiliation(s)
- Hidemi Kawajiri
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Tsutomu Takashima
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Naoyoshi Onoda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Shinichiro Kashiwagi
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Tetsurou Ishikawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| |
Collapse
|
19
|
KAWAJIRI HIDEMI, TAKASHIMA TSUTOMU, ONODA NAOYOSHI, KASHIWAGI SHINICHIRO, NODA SATORU, ISHIKAWA TETSUROU, WAKASA KENICHI, HIRAKAWA KOSEI. Efficacy and feasibility of neoadjuvant chemotherapy with FEC 100 followed by weekly paclitaxel for operable breast cancer. Oncol Lett 2012; 4:612-616. [PMID: 23205071 PMCID: PMC3506652 DOI: 10.3892/ol.2012.801] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 07/04/2012] [Indexed: 11/06/2022] Open
Abstract
Sequential administration of anthracyclin and taxane for neoadjuvant chemotherapy (NAC) is the standard treatment for operable breast cancer. The pathological complete response (pCR) is a significant predictor of overall survival (OS), regardless of treatment. In this study, the pCR rate was retrospectively examined and compared with the treatment efficacy and the characteristics of pCR patients were analyzed. A total of 54 female patients with operable breast cancer, treated with FEC 100 followed by weekly paclitaxel between December 2005 and May 2009 at the Osaka City University Hospital, Osaka, Japan, were retrospectively reviewed. A total of 21 patients (39%) achieved pCR. The overall response rate was 91%. Only one patient had progressive disease. The pCR rate was significantly higher in those patients with estrogen receptor (ER)- and progesterone receptor (PR)-negative tumors and in those patients who completed the treatment course. An NAC regimen incorporating FEC 100 followed by weekly paclitaxel is effective for treating operable breast cancer.
Collapse
Affiliation(s)
| | | | | | | | | | | | - KENICHI WAKASA
- Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka 545-8585,
Japan
| | | |
Collapse
|
20
|
Fertility Preservation Options for Females. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 732:9-28. [DOI: 10.1007/978-94-007-2492-1_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
21
|
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.
Collapse
|
22
|
Rapid-Onset Acute Respiratory Distress Syndrome (ARDS) in a Patient Undergoing Metastatic Liver Resection: A Case Report and Review of the Literature. Anesthesiol Res Pract 2010; 2010. [PMID: 20814556 PMCID: PMC2931399 DOI: 10.1155/2010/586425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 05/10/2010] [Accepted: 07/03/2010] [Indexed: 01/11/2023] Open
Abstract
Metastatic liver resection following cytoreductive chemotherapy is an accepted treatment for oligometastatic tumor diseases. Although pulmonary complications are frequently reported in patients undergoing liver surgery including liver transplantation, life-threatening acute respiratory failures in the absence of aspiration, embolism, transfusion-related acute lung injury (TRALI), pulmonary infection, or an obvious source of systemic sepsis are rare. We performed an extensive clinical review of a patient undergoing metastatic liver resection who had a clinical course compatible to an acute respiratory distress syndrome (ARDS) without an obvious cause except for the surgical procedure and multiple preoperative chemotherapies. We hypothesize that either the surgical procedure mediated by cytokines and tumor necrosis factor or possible toxic effects of oxygen applied during general anesthesia were associated with life-threatening respiratory failure in the patient. Discrete and subclinical inflammated alveoli (probably due to multiple preoperative chemotherapies with substances at potential risk for interstitial pneumonitis as well as chest radiation) might therefore be considered as risk factors.
Collapse
|
23
|
Ferrarotto R, Schetino G, Freitas D, Capelozzi V, Hoff PM. Paclitaxel induced chronic fibrosing interstitial pneumonitis: a case report and review of the literature. Oncol Rev 2010. [DOI: 10.1007/s12156-010-0043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
24
|
Severe interstitial pneumonitis associated with the administration of taxanes. J Infect Chemother 2010; 16:340-4. [PMID: 20354889 DOI: 10.1007/s10156-010-0058-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
Abstract
Interstitial pneumonitis has sporadically been reported as a toxic effect of taxanes such as docetaxel and paclitaxel. This report describes 2 patients who developed interstitial pneumonitis after receiving chemotherapy including taxanes, and both cases grew serious enough to require respiratory support. The first case was a 57-year-old man with gastric cancer treated with docetaxel biweekly and S-1 for 2 weeks as adjuvant chemotherapy. After 4 courses of docetaxel, he presented acute dyspnea. The second case was a 66-year-old woman with breast cancer and postoperative pleural recurrence treated with weekly paclitaxel as fourth-line chemotherapy. She developed a dry cough, high fever, and dyspnea after 1 course of paclitaxel. In both cases, computed tomography (CT) showed extensive bilateral areas of ground-glass attenuation. They developed progressive interstitial infiltrates and respiratory failure that required mechanical ventilation. Taxane-induced interstitial pneumonitis was diagnosed to exclude other causes. From previous reports, intubation is associated with the survival of patients with taxane-induced interstitial pneumonitis. However, corticosteroid therapy was dramatically effective and resolved the interstitial pneumonitis in both our patients. Clinicians should be aware of this occasional complication during the course of chemotherapy with taxanes and initiate treatment, including respiratory support, as soon as possible.
Collapse
|
25
|
Lim W, Tan E, Toh C, Hee S, Leong S, Ang P, Wong N, Chowbay B. Phase I pharmacokinetic study of a weekly liposomal paclitaxel formulation (Genexol®-PM) in patients with solid tumors. Ann Oncol 2010; 21:382-388. [DOI: 10.1093/annonc/mdp315] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
26
|
Cerfolio RJ, Talati A, Bryant AS. Changes in Pulmonary Function Tests After Neoadjuvant Therapy Predict Postoperative Complications. Ann Thorac Surg 2009; 88:930-5; discussion 935-6. [DOI: 10.1016/j.athoracsur.2009.06.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 06/01/2009] [Accepted: 06/04/2009] [Indexed: 11/29/2022]
|
27
|
Fujimaki T, Kato K, Fukuda S, Watanabe K, Mori T, Hibino T. Acute interstitial pneumonitis after implantation of paclitaxel-eluting stents: a report of two fatal cases. Int J Cardiol 2009; 148:e21-4. [PMID: 19239975 DOI: 10.1016/j.ijcard.2009.01.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 01/30/2009] [Indexed: 11/29/2022]
Abstract
Paclitaxel is an anti-neoplastic agent widely used as a coating substance for coronary stents to reduce the rate of restenosis. Although the release rate of paclitaxel from stents is quite slow and the dose of paclitaxel is extremely small, long-term safety and avoidance of potentially lethal pulmonary damage is not well established. We report two cases of paclitaxel-eluting stent implantation in ischemic heart disease patients who developed acute interstitial pneumonitis a few days afterward, and who succumbed to fatal respiratory dysfunction despite corticosteroid therapy. Based upon the clinical course and autopsy findings in these two patients, paclitaxel eluted from the stent may have played a causal role in the development of acute interstitial pneumonitis. Physicians should bear in mind that paclitaxel has the potential of causing acute interstitial pneumonitis not only when used for anti-neoplastic therapy, but also following stent implantation, where the objective is to inhibit coronary neointimal proliferation.
Collapse
|
28
|
Kato K, Fukuda S, Fujimaki T, Takano Y, Kunii E, Kato K, Watanabe K, Suzuki S, Yamada K, Yokoi K, Mori T. Paclitaxel-induced interstitial pneumonia after drug-eluting stent implantation: report of a fatal case. Intern Med 2009; 48:911-3. [PMID: 19483360 DOI: 10.2169/internalmedicine.48.1901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of paclitaxel-eluting stent implantation in an angina patient who developed interstitial pneumonia a few days afterward, and succumbed to fatal respiratory dysfunction despite corticosteroid therapy. Paclitaxel is an anti-neoplastic agent currently used as a coating substance for coronary stents to reduce the rate of restenosis. Pulmonary toxicity related to paclitaxel is not very common; however, this adverse event may on occasion be lethal. Although the efficacy and safety of drug-eluting stents for the treatment of ischemic heart disease is well established, physicians should keep in mind that paclitaxel-eluting stents have the potential to cause interstitial pneumonia.
Collapse
Affiliation(s)
- Kimihiko Kato
- Department of Internal Medicine, Gifu Prefectural Tajimi Hospital, Tajimi
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Dimopoulou I, Bamias A, Lyberopoulos P, Dimopoulos MA. Pulmonary toxicity from novel antineoplastic agents. Ann Oncol 2005; 17:372-9. [PMID: 16291774 DOI: 10.1093/annonc/mdj057] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The pulmonary side-effects induced by novel antineoplastic agents have not been well characterized. METHODS To further investigate this topic, relevant English and non-English language studies were identified through Medline. For our search we used the generic names of novel cytotoxic or non-cytotoxic antineoplastic agents and the key phrases pulmonary/lung toxicity, dyspnea, pneumonitis, acute lung injury, acute respiratory distress syndrome and alveolar damage. The references from the articles identified were reviewed for additional sources. Abstracts from International Meetings were also included. Furthermore, information was obtained from the Pneumotox website, which provides updated knowledge on drug-induced respiratory disease as well as from pharmaceutical websites. RESULTS Most novel antineoplastic drugs may induce pulmonary toxicity, which involves mainly the parenchyma, and less frequently the airways, pleura or the pulmonary circulation. Furthermore, a subset of these agents impairs pulmonary function tests. The exact incidence of lung toxicity remains unclear. The most common patterns consist of dyspnea without further details and infiltrative lung disease (ILD), denoting changes in the interstitium or alveoli. The diagnosis is one of exclusion. ILD is usually benign and responds to appropriate treatment; however, fatalities have been reported. CONCLUSIONS Clinicians should be aware of the potential of most novel antineoplastic agents to cause lung toxicity. A high index of suspicion is required if these are combined with other cytotoxic drugs or radiation.
Collapse
Affiliation(s)
- I Dimopoulou
- Second Department of Critical Care Medicine, Attikon University Hospital, Athens, Greece.
| | | | | | | |
Collapse
|
30
|
McNeish IA, Kanfer EJ, Haynes R, Giles C, Harland SJ, Driver D, Rustin GJS, Newlands ES, Seckl MJ. Paclitaxel-containing high-dose chemotherapy for relapsed or refractory testicular germ cell tumours. Br J Cancer 2004; 90:1169-75. [PMID: 15026797 PMCID: PMC2410221 DOI: 10.1038/sj.bjc.6601664] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
High-dose regimes containing etoposide, carboplatin and an oxazaphospharine can salvage 30–40% of patients with relapsed or refractory male germ cell tumours (GCTs). The additional benefit of paclitaxel in such high-dose therapy has not been tested. Between March 1995 and November 2002, 36 male GCT patients were treated with Carbop-EC-T (paclitaxel 75 mg m−2, etoposide 450 mg m−2, carboplatin AUC 10 on days −7, −5 and −3 and cyclophosphamide 60 mg kg−1 on days −5 and −3) followed by peripheral blood stem cell infusion (day 0). The 1-year overall survival rate for all patients is 67% (median follow-up 29 months). For the 24 patients with cisplatin-sensitive disease, the 1-year overall and event-free survivals are 88 and 64%, respectively. For those with cisplatin refractory or absolutely refractory disease, the 1-year overall survival is 25%. In all, 12 patients relapsed at a median duration of 5 months, 11 of whom have died. There were also six treatment-related deaths, five associated with pneumonitis. Pulmonary toxicity has been reported with paclitaxel in other high-dose regimes. Since altering our protocol so that paclitaxel is infused over 24 h with steroid prophylaxis, only one of 18 patients (13 testicular GCTs and five other tumour types) has had a treatment-related death. Our results suggest that Carbop-EC-T may enable a greater proportion of patients with relapsed and refractory GCTs to enter long-term remission.
Collapse
Affiliation(s)
- I A McNeish
- Department of Medical Oncology, Imperial College School of Medicine, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - E J Kanfer
- Department of Haematology, Imperial College School of Medicine, Hammersmith Hospital, London, UK
| | - R Haynes
- Department of Medical Oncology, Imperial College School of Medicine, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - C Giles
- Department of Haematology, Imperial College School of Medicine, Hammersmith Hospital, London, UK
| | - S J Harland
- Department of Medical Oncology, Meyerstein Institute of Oncology, Middlesex Hospital, London, UK
| | - D Driver
- Department of Medical Oncology, Meyerstein Institute of Oncology, Middlesex Hospital, London, UK
| | - G J S Rustin
- Department of Medical Oncology, Mount Vernon Hospital, Harrow, Middlesex, England, UK
| | - E S Newlands
- Department of Medical Oncology, Imperial College School of Medicine, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - M J Seckl
- Department of Medical Oncology, Imperial College School of Medicine, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
- Department of Medical Oncology, Imperial College School of Medicine, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK. E-mail:
| |
Collapse
|
31
|
Kvolik S, Glavas-Obrovac L, Sakic K, Margaretic D, Karner I. Anaesthetic implications of anticancer chemotherapy. Eur J Anaesthesiol 2004; 20:859-71. [PMID: 14649337 DOI: 10.1017/s026502150300139x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In anaesthetic practice we deal with cancer patients who are scheduled for operations on tumours or other manifestations of malignant disease. Those patients are often debilitated and have significant weight loss accompanied with hypoproteinaemia, anaemia and coagulation disorders. Oncological patients usually present to the anaesthetist before tumour disease surgery, but they are also candidates for elective operations (e.g. hernia repair) and urgent/emergency surgery (e.g. trauma, fractures and ileus). Chemotherapeutic agents given to these patients are potentially noxious, can affect the conduct of anaesthesia and, furthermore, may aggravate the patient's condition. In this review the most commonly used cytostatic drug regimens and their common side-effects are listed. Some preclinical studies on anaesthetic and cytostatic drug metabolism and interactions are emphasized, as well as clinically relevant perioperative alterations that may affect anaesthetic management in cancer patients. An anaesthetist may have to modify a routine anaesthetic regimen in cancer patients especially if anticancer chemotherapeutics were given. Clinically silent toxic drug effects may become apparent during operation, trauma or in the early postoperative course in such patients. Altered reactions to commonly used anaesthetics in patients receiving chemotherapeutics and an impaired stress reaction may occur in such patients. Special attention must be drawn to protection against opportunistic infections.
Collapse
Affiliation(s)
- S Kvolik
- University Clinical Hospital Osijek, Department of Anaesthesiology and ICU, Osijek, Croatia.
| | | | | | | | | |
Collapse
|
32
|
Dinçbas FO, Atalar B, Koca S. Two-dimensional radiotherapy and docetaxel in treatment of stage III non-small cell lung carcinoma: no good survival due to radiation pneumonitis. Lung Cancer 2004; 43:241-2. [PMID: 14739045 DOI: 10.1016/j.lungcan.2003.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
33
|
|
34
|
Ash-Bernal R, Browner I, Erlich R. Early detection and successful treatment of drug-induced pneumonitis with corticosteroids. Cancer Invest 2002; 20:876-9. [PMID: 12449717 DOI: 10.1081/cnv-120005899] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A 69-year-old patient with non-small cell lung cancer developed pneumonitis with the use of the chemotherapeutic drugs gemcitabine, paclitaxel, and vinorelbine. He developed progressively worsening dyspnea, fevers, chills, and night sweats three weeks after initiation of chemotherapy treatment with no improvement with antibiotics. Bronchoscopic lung biopsy and endotracheal cultures were negative. Four weeks after the onset of symptoms, chest computed tomography scan showed a ground glass appearance of the lung parenchyma bilaterally consistent with pneumonitis. Gemcitabine is a nucleoside analog with activity against solid tumors, including breast and non-small cell lung cancers. Pneumonitis is a rare and potentially deadly complication of gemcitabine. Early treatment with corticosteroids leads to a complete resolution of this patients pneumonitis. Gemcitabine was discontinued and his chemotherapeutic regimen was changed to include paclitaxel, vinorelbine, and topotecan with no recurrence of pneumonitis. Pneumonitis should be included in the differential diagnosis of dyspnea in patients undergoing gemcitabine-based chemotherapy.
Collapse
Affiliation(s)
- Rachel Ash-Bernal
- Department of Internal Medicine, Division of Hematology and Oncology, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine, 4940 Eastern Ave., Baltimore, MD 21224-2780, USA
| | | | | |
Collapse
|
35
|
Kudrik FJ, Rivera MP, Molina PL, Maygarden S, Socinski MA. Hypersensitivity Pneumonitis in Advanced Non-Small-Cell Lung Cancer Patients Receiving Gemcitabine and Paclitaxel: Report of Two Cases and a Review of the Literature. Clin Lung Cancer 2002; 4:52-6. [PMID: 14653877 DOI: 10.3816/clc.2002.n.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Gemcitabine (2'-2'-difluorodeoxycytidine) is a recently developed pyrimidine antagonist that is structurally related to cytarabine (ara-C). When phosphorylated intracellularly, gemcitabine inhibits ribonucleotide reductase and arrests cell cycling in the S phase. Paclitaxel is a potent promoter and stabilizer of microtubule spindle formation and an inhibitor of cell cycling. In this report, we discuss 2 patients with advanced-stage non-small-cell lung cancer (NSCLC) treated with a combination of gemcitabine/paclitaxel who developed pulmonary symptoms of dyspnea and cough. Chest radiographs and computed tomography revealed diffuse pulmonary infiltrates. Bronchoscopic evaluation revealed diffuse alveolar damage with associated type II pneumocyte hyperplasia without evidence of infection or metastatic carcinoma, suggesting the development of a drug-induced pulmonary toxicity. Both cases improved with the discontinuation of gemcitabine/paclitaxel and with supportive care including steroids in one of the patients. We also review the published case reports of pneumonitis believed to be secondary to the taxanes or gemcitabine when used as single agents and a solitary case report describing pneumonitis in the setting of both a taxane and gemcitabine. Because the combination of gemcitabine/paclitaxel has demonstrated activity in NSCLC, the use of this combination is likely to increase. Clinicians caring for lung cancer patients receiving this combination should be aware of this potential pulmonary toxicity.
Collapse
Affiliation(s)
- Fred J Kudrik
- Multidisciplinary Thoracic Oncology Program, University of North Carolina at Chapel Hill, NC 27599, USA
| | | | | | | | | |
Collapse
|
36
|
Read WL, Mortimer JE, Picus J. Severe interstitial pneumonitis associated with docetaxel administration. Cancer 2002; 94:847-53. [PMID: 11857321 DOI: 10.1002/cncr.10263] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Interstitial pneumonitis has not been reported as a toxicity of docetaxel. The authors report the presentation and natural history of four patients who developed a severe interstitial pneumonitis after receiving docetaxel. METHODS The hospital and outpatient records of patients treated with docetaxel were reviewed to identify whether any of these patients required an evaluation for respiratory problems. RESULTS Four patients developed an interstitial pneumonitis that could be explained only as a toxicity of docetaxel. None had metastatic disease to the lung, and all had normal liver function before receiving chemotherapy. The patients presented with acute dyspnea and fever within 1-2 weeks of receiving docetaxel. All developed progressive interstitial infiltrates and respiratory failure that required mechanical ventilation. An exhaustive workup for other causes of pneumonitis was negative. Broad-spectrum antibiotics and corticosteroids were ineffective. Two patients died of complications related to the pulmonary process. The two survivors required ventilatory support for more than 21 days. The clinical and pathologic findings of these patients are presented. CONCLUSIONS Interstitial pneumonitis is a rare and potentially fatal complication of docetaxel treatment. Prolonged ventilatory support is appropriate in patients with a favorable prognosis.
Collapse
Affiliation(s)
- William L Read
- Department of Medicine, Division of Medical Oncology at Washington University, St. Louis, Missouri, USA.
| | | | | |
Collapse
|
37
|
Dimopoulou I, Galani H, Dafni U, Samakovii A, Roussos C, Dimopoulos MA. A prospective study of pulmonary function in patients treated with paclitaxel and carboplatin. Cancer 2002; 94:452-8. [PMID: 11900231 DOI: 10.1002/cncr.10182] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adverse effects of paclitaxel and carboplatin have been well described; however, pulmonary toxicity after patients receive this regimen has not been investigated extensively. METHODS To clarify this issue, 33 consecutive patients who were treated with paclitaxel and carboplatin underwent prospective evaluation of respiratory function, which included pulmonary symptoms, pulmonary function tests (PFTs), arterial blood gas levels, and radiographic studies. Assessment was performed before and after completion of chemotherapy in all patients. Patients with substantial declines in PFTs, defined as a decline > or = 20 percent in forced expiratory volume in 1 second (FEV1), total lung capacity (TLC), or diffusion capacity for carbon monoxide (DLCO), were reassessed 5 months later. RESULTS After chemotherapy, there were no significant changes in forced vital capacity (FVC; 111%+/-21% of the predicted value before chemotherapy vs. 111+/-20% of the predicted value after chemotherapy), FEV1 (108%+/-24% of the predicted value before chemotherapy vs. 107%+/-22% of the predicted value after chemotherapy), FEV1/FVC ratio (79%+/-8% before chemotherapy vs. 78%+/-6% after chemotherapy), alveolar volume (VA; 95%+/-14% of the predicted value before chemotherapy vs. 96%+/-14% of the predicted value after chemotherapy), or TLC (96%+/-14% of the predicted value before chemotherapy vs. 97%+/-13% of the predicted value after chemotherapy). In contrast, there was a significant decline in DLCO (101%+/-20% of the predicted value before chemotherapy vs. 96+/-21% of the predicted value after chemotherapy; P < 0.05). Arterial blood gas levels did not change after treatment. No patient had decreased FEV1 or TLC levels by > or = 20%, whereas 4 of 33 patients (12%) exhibited a substantial decline (> or = 20%) in DLCO that persisted 5 months after treatment (DLCO at baseline, immediately after chemotherapy, and 5 months after the completion of chemotherapy, respectively: 99%+/-36% of the predicted value vs. 75%+/-28% of the predicted value vs. 74%+/-31% of the predicted value; P < 0.05). None of the 33 patients developed respiratory symptoms or had radiologic signs suggestive of lung toxicity. Among the various risk factors examined, baseline DLCO and FEV1 levels were associated with changes in DLCO post-treatment. CONCLUSIONS This prospective analysis showed that the combination of paclitaxel with carboplatin induced an isolated decrease in DLCO level in the absence of clinical or radiologic evidence of toxicity. Further studies are needed to clarify whether this reduction in DLCO is predictive of subsequent pulmonary impairment.
Collapse
Affiliation(s)
- Ioanna Dimopoulou
- Department of Pulmonary and Critical Care, Evangelismos Hospital, Medical School, Athens, Greece.
| | | | | | | | | | | |
Collapse
|
38
|
Taghian AG, Assaad SI, Niemierko A, Kuter I, Younger J, Schoenthaler R, Roche M, Powell SN. Risk of pneumonitis in breast cancer patients treated with radiation therapy and combination chemotherapy with paclitaxel. J Natl Cancer Inst 2001; 93:1806-11. [PMID: 11734597 DOI: 10.1093/jnci/93.23.1806] [Citation(s) in RCA: 135] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Some chemotherapy (CT) drugs, including taxanes, may enhance the effectiveness of radiation therapy (RT). However, combining these therapies may increase the incidence of radiation pneumonitis, a lung inflammation. In a retrospective cohort study, we evaluated the incidence of radiation pneumonitis in breast cancer patients treated with RT and standard adjuvant CT by use of doxorubicin (Adriamycin) and cyclophosphamide, with and without paclitaxel. METHODS Forty-one patients with breast cancer were treated with RT and adjuvant CT, including paclitaxel. Paclitaxel and RT (to breast-chest wall in all and lymph nodes in some) were delivered sequentially in 20 patients and concurrently in 21 patients. Paclitaxel was given weekly in some patients and every 3 weeks in other patients. The incidence of radiation pneumonitis was compared with that among patients in our database whose treatments did not include paclitaxel (n = 1286). The percentage of the lung volume irradiated was estimated. The Cox proportional hazards model was used to find covariates that may be associated with the observed outcomes. All P values were two-sided. RESULTS Radiation pneumonitis developed in six of the 41 patients. Three patients received paclitaxel concurrently with RT, and three received it sequentially (P =.95). The mean percentage of lung volume irradiated was 20% in patients who developed radiation pneumonitis and 22% in those who did not (P =.6). For patients treated with CT including paclitaxel, the crude rate of developing radiation pneumonitis was 14.6% (95% confidence interval [CI] = 5.6% to 29.2%). For patients treated with CT without paclitaxel, the crude rate of pneumonitis was 1.1% (95% CI = 0.2% to 2.3%). The difference between the crude rates with or without paclitaxel is highly statistically significant (P<.0001). The mean time to develop radiation pneumonitis in patients treated concurrently with RT and paclitaxel was statistically significantly shorter in patients receiving paclitaxel weekly than in those receiving it every 3 weeks (P =.002). CONCLUSIONS The use of paclitaxel and RT in the primary treatment of breast cancer should be undertaken with caution. Clinical trials with the use of combination CT, including paclitaxel plus RT, whether concurrent or sequential, must evaluate carefully the incidence of radiation pneumonitis.
Collapse
Affiliation(s)
- A G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA 02114, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
4 patients with advanced non-small-cell lung cancer (NSCLC) treated with docetaxel developed life-threatening pneumonitis requiring mechanical ventilation. Docetaxel (30-60 mg x m(-2), according to a different protocol) was infused within one hour with standard premedications. One patient's pneumonitis occurred 5 days after the first dose of docetaxel, and that of the other 3 between the 2nd and 6th cycles. Based on the clinical course, radiological findings of an interstitial pneumonitis, and exclusion of other possible resultant causes, including metastatic cancer, radiation pulmonary injury, infection, or connective tissue disease, hypersensitivity pneumonitis was diagnosed. The patients were treated with hydrocortisone at 1200 mg per day or methylprednisolone at 240 mg per day. Although 3 of the 4 had a partial improvement in lung oxygenation, all patients' conditions of hypersensitivity pneumonitis persisted and were complicated by other events, such as hospital-acquired infection and tension pneumothorax. The presence of this unusual hypersensitivity pneumonitis, which was so severe as to be life-threatening and refractory to high-dose corticosteroid therapy, should be taken into account during docetaxel treatment.
Collapse
Affiliation(s)
- G S Wang
- Chest Department, Taipei Veterans General Hospital, Taiwan, ROC
| | | | | |
Collapse
|
40
|
Wong P, Leung AN, Berry GJ, Atkins KA, Montoya JG, Ruoss SJ, Stockdale FE. Paclitaxel-induced hypersensitivity pneumonitis: radiographic and CT findings. AJR Am J Roentgenol 2001; 176:718-20. [PMID: 11222212 DOI: 10.2214/ajr.176.3.1760718] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- P Wong
- Department of Radiology, S072A, Stanford University Medical Center, Stanford, CA 94305-5105, USA
| | | | | | | | | | | | | |
Collapse
|
41
|
Dunsford ML, Mead GM, Bateman AC, Cook T, Tung K. Severe pulmonary toxicity in patients treated with a combination of docetaxel and gemcitabine for metastatic transitional cell carcinoma. Ann Oncol 1999; 10:943-7. [PMID: 10509156 DOI: 10.1023/a:1008377819875] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Both gemcitabine and docetaxel have been associated with pulmonary toxicity when used as single agents. We report a study in which three of five cases developed pulmonary toxicity (which proved fatal in one case) when these drugs were used in combination to treat metastatic transitional cell cancer. PATIENTS AND METHODS Three patients developed dyspnoea, in two cases associated with pulmonary infiltrates, whilst receiving the combination of gemcitabine and docetaxel in a phase I trial. The case notes of all five patients entered into this trial were studied. A literature review was undertaken to gain information on reported pulmonary toxicity with the deoxy-cytidine analogues and taxanes given alone or in combination with or without radiotherapy. RESULTS Three patients developed delayed dyspnoea whilst receiving gemcitabine/docetaxel in combination. This settled with cessation of treatment in one patient, however in the remaining two cases significant hypoxia developed, associated radiologically with evidence of progressive pulmonary infiltrates. One of these patients developed respiratory failure after bronchoscopy and biopsy and died. His chest X-ray changes were consistent with adult respiratory distress syndrome. The transbronchial biopsy and post mortem lung histology in this patient showed diffuse alveolar damage. The remaining patient settled with high dose prednisolone but died subsequently of progressive metastatic disease. CONCLUSION The combination of gemcitabine and docetaxel showed promising activity in this small study. The development of pulmonary symptoms in three cases with radiological lung infiltrates in two other cases was cause for concern. Patients receiving this drug combination should be closely monitored for similar problems.
Collapse
Affiliation(s)
- M L Dunsford
- CRC Wessex Medical Oncology Unit, Department of Histopathology and Radiology, Southampton University Hospitals, UK
| | | | | | | | | |
Collapse
|