Successful treatment of gefitinib-induced acute interstitial pneumonitis with high-dose corticosteroid: a case report and literature review.
Cytotoxic chemotherapy offers a modest benefit for patients with advanced non-small cell lung cancer (NSCLC), with response rates of 20-35% and median survival of 10-12 months. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), gefitinib and erlotinib are active against lung cancer. In retrospective studies, EGFR-TKI therapy among patients harboring EGFR mutations showed response rates higher than 65% and a median survival of 20-30 months. Gefitinib is well tolerated and less toxic compared to conventional cytotoxic drugs, but gefitinib-related interstitial lung disease (ILD) has been reported as a serious adverse effect. Although the mechanism remains unknown, multivariate analysis revealed male sex, history of smoking, and the coexistence of interstitial pneumonia or pre-existence of pulmonary fibrosis and poor performance status were all significant risk factors. Here, we reported a case of gefitinib pneumonitis with severe hypoxemia and impending respiratory failure who showed poor response to intermediate dose of systemic steroids but good recovery with high-dose pulse therapy.
Kuo
Li-Chiao
LC
Department of Internal Medicine, National Yang-Ming University Hospital, No 152, Xin-Min Road, Yilan City 260, Taiwan.
Lin
Po-Chou
PC
Wang
Ko-Fan
KF
Yuan
Mei-Kang
MK
Chang
Shih-Chieh
SC
D000208:Acute Disease; D000230:Adenocarcinoma / Q000188:drug therapy* / Q000556:secondary; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D000077156:Gefitinib; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000188:drug therapy*; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011799:Quinazolines / Q000009:adverse effects*; D012196:Review Literature as Topic; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000970:Antineoplastic Agents; D011799:Quinazolines; D000077156:Gefitinib