Fatal interstitial lung disease associated with gemcitabine and erlotinib therapy for lung cancer.
Gemcitabine in combination with the oral epidermal growth factor receptor tyrosine kinase inhibitor, erlotinib, is a treatment option for patients with advanced pancreatic cancer. Lung toxicity has been described for each of these drugs. A 59-year-old man with advanced non-small-cell lung cancer developed acute respiratory failure with bilateral interstitial lung disease 4 weeks after the onset of second-line combination therapy that included gemcitabine and erlotinib. Despite discontinuation of gemcitabine and erlotinib, treatment with corticosteroids was ineffective and the patient gradually deteriorated and died with progressive respiratory failure 2 months after the start of the gemcitabine/erlotinib combination. It was concluded that a synergistic effect between gemcitabine and erlotinib could have been responsible for this fatal pulmonary toxicity. Physicians should be aware of the potential severe lung toxicity of this combination. The potential role of corticosteroids in the management of this toxicity is unknown.
Division of Oncology, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, POB 9602, Haifa 31096, Israel.
Haitam
H
Nasrallah
Gil
G
Bar-Sela
Nissim
N
Haim
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D000069347:Erlotinib Hydrochloride; D017809:Fatal Outcome; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000503:physiopathology; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011799:Quinazolines / Q000008:administration & dosage / Q000009:adverse effects; D000093542:Gemcitabine
D011799:Quinazolines; D003841:Deoxycytidine; D000069347:Erlotinib Hydrochloride; D000093542:Gemcitabine
Med Oncol. 2006;23(2):161-70
16720916
Cancer. 2006 May 1;106(9):2051-7
16568459
J Clin Oncol. 2007 Apr 20;25(12):1545-52
17442998
J Oncol Pharm Pract. 2005 Sep;11(3):127-30
16390601
BMC Cancer. 2007 Aug 05;7:150
17683587
Rev Pneumol Clin. 2007 Dec;63(6):379-83
18166944
Oncologist. 2010;15(11):1227-37
21045191
J Clin Oncol. 2006 Jun 1;24(16):2549-56
16735708
J Thorac Oncol. 2010 Jun;5(6):924-5
20502274
J Clin Oncol. 2009 Oct 20;27(30):5080-7
19738125
Oncology (Williston Park). 2006 Apr;20(5 Suppl 2):35-40
16736981
J Clin Oncol. 2007 May 20;25(15):1960-6
17452677
Anticancer Drugs. 2007 Oct;18(9):1109-11
17704662