Antineoplastics
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Reactions 1352 - 21 May 2011 ★ S Antineoplastics Lung injury (first report with irinotecan) in an elderly patient: case report A woman in her late 60s developed lung injury following chemotherapy for colorectal cancer [dosage information incomplete; routes not stated]. The woman was hospitalised with a 3-day history of fever, anorexia, slight cough and reduced sputum volume. During the preceding 14 months, she had received 15 courses of FOLFOX6 chemotherapy (5–14 months before admission), six courses of additional bevacizumab (2–3 months before admission) and three cycles of FOLFIRI plus bevacizumab (11–40 days before admission). Total administered drug doses were: fluorouracil 53 510 mg/m 2 , oxaliplatin 1418 mg/m 2 , folinic acid [leucovorin] 4542 mg/m 2 , bevacizumab 45 mg/m 2 and irinotecan 454 mg/m 2 . On admission, she had a body temperature of 37.9°C, a RR of 24/min with type-1 respiratory failure, neutrophil left-shift, and elevated CRP, LDH and SP-D levels. Chest imaging identified ground glass opacities over both lungs and interlobular septal thickening. The following day, bronchoalveolar lavage (BAL) revealed an elevated CD4/8 count, and a lung biopsy showed alveolar septal fibrosis. Chemotherapy-related lung injury was diagnosed, and the woman started receiving methylprednisolone. Her respiratory failure and lung findings improved and her therapy was changed to a prednisolone taper. She was then discharged. Chest opacities, respiratory failure and fever subsequently resolved, and her laboratory findings normalised. Drug-lymphocyte stimulation tests (DLSTs) were negative for all five antineoplastics. Pulmonary lesions did not recur. She subsequently died of her underlying condition. Author comment: The lung injury had occurred 40 days after starting irinotecan while all of the other anti-cancer agents had been used for 3–14 months before onset; therefore, irinotecan was thought more likely to have been the causal drug. Komaki C, et al. [A case of drug-induced lung injury associated with chemotherapy (FOLFOX6, FOLFIRI, Bevacizumab) for an advanced colon cancer]. Gan to Kagaku Ryoho 38: 113-6, No. 1, Jan 2011 [Japanese; summarised from a translation.] - Japan 803054372 » Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of lung injury associated with irinotecan. The WHO ADR database contained 11 reports of lung disorder associated with irinotecan. 1 Reactions 21 May 2011 No. 1352 0114-9954/10/1352-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1352 - 21 May 2011
★ SAntineoplastics
Lung injury (first report with irinotecan) in anelderly patient: case report
A woman in her late 60s developed lung injury followingchemotherapy for colorectal cancer [dosage informationincomplete; routes not stated].
The woman was hospitalised with a 3-day history offever, anorexia, slight cough and reduced sputum volume.During the preceding 14 months, she had received15 courses of FOLFOX6 chemotherapy (5–14 monthsbefore admission), six courses of additional bevacizumab(2–3 months before admission) and three cycles of FOLFIRIplus bevacizumab (11–40 days before admission). Totaladministered drug doses were: fluorouracil 53 510 mg/m2,oxaliplatin 1418 mg/m2, folinic acid [leucovorin]4542 mg/m2, bevacizumab 45 mg/m2 and irinotecan454 mg/m2. On admission, she had a body temperature of37.9°C, a RR of 24/min with type-1 respiratory failure,neutrophil left-shift, and elevated CRP, LDH and SP-Dlevels. Chest imaging identified ground glass opacities overboth lungs and interlobular septal thickening. The followingday, bronchoalveolar lavage (BAL) revealed an elevatedCD4/8 count, and a lung biopsy showed alveolar septalfibrosis. Chemotherapy-related lung injury was diagnosed,and the woman started receiving methylprednisolone. Herrespiratory failure and lung findings improved and hertherapy was changed to a prednisolone taper. She was thendischarged. Chest opacities, respiratory failure and feversubsequently resolved, and her laboratory findingsnormalised. Drug-lymphocyte stimulation tests (DLSTs)were negative for all five antineoplastics. Pulmonary lesionsdid not recur. She subsequently died of her underlyingcondition.
Author comment: The lung injury had occurred 40 daysafter starting irinotecan while all of the other anti-canceragents had been used for 3–14 months before onset;therefore, irinotecan was thought more likely to have beenthe causal drug.Komaki C, et al. [A case of drug-induced lung injury associated withchemotherapy (FOLFOX6, FOLFIRI, Bevacizumab) for an advanced coloncancer]. Gan to Kagaku Ryoho 38: 113-6, No. 1, Jan 2011 [Japanese; summarisedfrom a translation.] - Japan 803054372
» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of lunginjury associated with irinotecan. The WHO ADR databasecontained 11 reports of lung disorder associated withirinotecan.
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Reactions 21 May 2011 No. 13520114-9954/10/1352-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
