[Acute pulmonary toxicity due to gemcitabine: a role for asbestos exposure?].
BACKGROUND
Gemcitabine is an important drug in the treatment of non-small cell lung cancer. Myelosuppression is the most common toxic effect but its use sometimes leads to severe pulmonary toxicity by means of diffuse alveolar damage or sub-acute interstitial pneumonitis.


METHODS
A retrospective study was made of all the patients treated in our department with this drug, alone or in combination. Episodes of acute dyspnoea during the course of chemotherapy were identified, and data were collected concerning the past history, the illness and the treatment in patients who had developed a respiratory failure attributable to gemcitabine.


RESULTS
312 patients had been treated with gemcitabine over a 5 year period and 18 had developed episodes of acute dyspnoea, of which 6 (1.9%) were attributed to the drug itself. Of these patients 4 had notifiable industrial disease (no. 30bis) secondary to asbestos exposure (odds ratio=85, 95% confidence interval 13-546) and 5 were active smokers. The possible role of intracellular ATP pool depletion secondary to asbestos exposure or smoking as a predisposing factor in the development of gemcitabine pulmonary toxicity is discussed.


CONCLUSIONS
Smoking and asbestos exposure should be taken into account in future studies of gemcitabine pulmonary toxicity.
Barlési
F
F
Service d'Oncologie Thoracique, Département des Maladies Respiratoires, Hôpital Sainte-Marguerite, Marseille, France. Fabrice.Barlesi@ap-hm.fr
Doddoli
C
C
Gimenez
C
C
Greillier
L
L
Lima
G
G
Kleisbauer
J-P
JP
D000208:Acute Disease; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D001194:Asbestos / Q000009:adverse effects*; D001195:Asbestosis / Q000150:complications*; D015984:Causality; D003841:Deoxycytidine / Q000009:adverse effects* / Q000031:analogs & derivatives*; D003937:Diagnosis, Differential; D004232:Diuretics / Q000627:therapeutic use; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016273:Occupational Exposure / Q000009:adverse effects*; D010102:Oxygen Inhalation Therapy; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D013256:Steroids; D000093542:Gemcitabine
D000893:Anti-Inflammatory Agents; D000964:Antimetabolites, Antineoplastic; D004232:Diuretics; D013256:Steroids; D003841:Deoxycytidine; D001194:Asbestos; D000093542:Gemcitabine