title: Adverse pulmonary reactions associated with the use of monoclonal antibodies in cancer patients.
abstract: BACKGROUND
  The incidence and clinical characteristics of adverse pulmonary reactions resulting from anticancer monoclonal antibody (mAbs) therapy have not been well described. We determined the incidence and clinical characteristics of adverse pulmonary reactions in patients treated with anticancer chemotherapy including mAbs.
  
  
  METHODS
  A retrospective cohort study was performed including patients who were treated with a chemotherapeutic regimen that included rituximab, trastuzumab, cetuximab, or bevacizumab at Seoul National University Hospital between January 1, 2004 and December 31, 2008. Rates of adverse pulmonary reactions classified as non-infectious and infectious complications were compared with those among patients treated with comparable regimens without mAbs.
  
  
  RESULTS
  In total, 1078 patients were included (418 for rituximab, 329 for trastuzumab, 122 for cetuximab, 209 for bevacizumab). Adverse pulmonary reactions were identified in 36 patients (3.5%) and the incidence differed among agents: cetuximab (9%), rituximab (5.3%), trastuzumab (0.6%), bevacizumab (0.5%). Infectious pulmonary complications occurred in 28 patients, and eight patients experienced non-infectious pulmonary complications, most commonly interstitial lung disease (6 patients). In a multivariate analysis, low serum albumin level was associated with the development of pulmonary complications. The incidence of overall adverse pulmonary reactions did not differ between the mAbs users and the 1012 patients treated with comparable regimens other than mAbs (3.5% vs. 2.8%, P=0.53).
  
  
  CONCLUSIONS
  Infectious and non-infectious adverse pulmonary reactions occur in patients with cancer who are administered a regimen including mAbs. Clinicians should be alert for the possibility of pulmonary adverse reactions, particularly among patients with low serum albumin levels.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul 110-744, Republic of Korea.
authors.forename: Hyo Jae
authors.initials: HJ
authors.lastname: Kang
authors.forename: Jong Sun
authors.initials: JS
authors.lastname: Park
authors.forename: Dong-Wan
authors.initials: DW
authors.lastname: Kim
authors.forename: Jinwoo
authors.initials: J
authors.lastname: Lee
authors.forename: Yun Jeong
authors.initials: YJ
authors.lastname: Jeong
authors.forename: Sun Mi
authors.initials: SM
authors.lastname: Choi
authors.forename: Sang-Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Seok-Chul
authors.initials: SC
authors.lastname: Yang
authors.forename: Chul-Gyu
authors.initials: CG
authors.lastname: Yoo
authors.forename: Young Whan
authors.initials: YW
authors.lastname: Kim
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Han
authors.forename: Jae-Joon
authors.initials: JJ
authors.lastname: Yim
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D000068258:Bevacizumab; D000068818:Cetuximab; D015897:Comorbidity; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D009894:Opportunistic Infections / Q000139:chemically induced; D012141:Respiratory Tract Infections / Q000139:chemically induced; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D012709:Serum Albumin / Q000032:analysis; D000068878:Trastuzumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D012709:Serum Albumin; D000068258:Bevacizumab; D000069283:Rituximab; D000068878:Trastuzumab; D000068818:Cetuximab