title: Diffuse alveolar damage after a single dose of topotecan in a patient with pulmonary fibrosis and small cell lung cancer.
abstract: Drug-induced pulmonary toxicities of anticancer agents have been well described, but the pathophysiology of agents typically used in advanced disease has not been well studied. Symptoms of pulmonary drug toxicity in advanced lung cancer patients may frequently be attributed to disease progression, pulmonary embolism, or infection. In patients with pre-existing interstitial pulmonary fibrosis even less is known. This report describes an unfortunate patient with pre-existing pulmonary fibrosis and progressive extensive stage small cell lung cancer. After receiving a single intravenous dose of topotecan, the patient developed sub-acute respiratory failure, and died 15 days later with pathology findings of organizing, reparative phase, diffuse alveolar damage. To our knowledge this is the first pathology confirmation of diffuse alveolar damage in a patient developing dyspnea following topotecan therapy. The frequency with which camptothecin-related dyspnea is associated with diffuse alveolar damage might be underestimated and is of special concern in patients with limited pulmonary reserve.
authors.affiliation: Section of Hematology/Oncology, The Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA. mmaitlan@medicine.bsd.uchicago.edu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Maitland
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wilcox
authors.forename: D Kyle
authors.initials: DK
authors.lastname: Hogarth
authors.forename: Apurva A
authors.initials: AA
authors.lastname: Desai
authors.forename: Phil
authors.initials: P
authors.lastname: Caligiuri
authors.forename: Cyril
authors.initials: C
authors.lastname: Abrahams
authors.forename: Ravi
authors.initials: R
authors.lastname: Salgia
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D018288:Carcinoma, Small Cell / Q000150:complications / Q000188:drug therapy*; D004417:Dyspnea / Q000139:chemically induced; D017809:Fatal Outcome; D006801:Humans; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000473:pathology*; D011658:Pulmonary Fibrosis / Q000150:complications*; D012131:Respiratory Insufficiency / Q000139:chemically induced*; D019772:Topotecan / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D019772:Topotecan