Paclitaxel-induced acute bilateral pneumonitis.
OBJECTIVE
To report three cases of paclitaxel-induced acute bilateral pneumonitis, as well as to ascertain its incidence and outcome.


METHODS
A total of 239 patients with a variety of underlying malignancies received 528 courses of paclitaxel-containing chemotherapy. Paclitaxel 200 mg/m2 was infused over 3 hours with standard premedication. Three patients developed bilateral interstitial infiltrates either during or within 6 hours of the administration of paclitaxel. Symptoms included a nonproductive cough, dyspnea, and sudden arterial oxygen desaturation. Response to parenteral corticosteroids was dramatic and reversed the process in all 3 patients.


CONCLUSIONS
Paclitaxel-induced acute bilateral pneumonitis appears to be a rare adverse reaction. It may either be a direct toxic effect of the chemotherapeutic agent or an adverse effect of its Cremophor EL diluent. Although the exact pathophysiology is unclear, a variety of immune and nonimmune mechanisms have been postulated, including hypersensitivity reactions, release of cytokines from macrophages, and the possible role of prior thoracic irradiation.


CONCLUSIONS
Acute bilateral pneumonitis occurs in less than 1% of individuals receiving 3-hour infusions of paclitaxel, and responds dramatically to parenteral corticosteroid therapy.
Khan
A
A
Department of Medicine, University of Connecticut Health Center, Farmington 06030, USA.
McNally
D
D
Tutschka
P J
PJ
Bilgrami
S
S
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000009:adverse effects*; D011014:Pneumonia / Q000139:chemically induced* / Q000188:drug therapy
D000305:Adrenal Cortex Hormones; D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel