title: Interstitial pneumonitis after treatment with pemetrexed: a rare event?
abstract: BACKGROUND
  Pneumonitis after pemetrexed has been rarely reported in conjunction with radiation therapy.
  
  
  METHODS
  Two cases of pemetrexed-induced pneumonitis in different clinical settings and with unequal outcomes are discussed with a review of the literature.
  
  
  RESULTS
  Two patients with stage IIIB non-small cell lung cancer developed interstitial lung disease after chemotherapy with pemetrexed. The first patient was previously treated with thoracic radiotherapy, and radiation pneumonitis was initially suspected. He died shortly after pemetrexed reexposition. The second patient developed pemetrexed-induced interstitial lung disease despite no prior radiotherapy. After discontinuation of pemetrexed and administration of steroids, pneumonitis resolved completely.
  
  
  CONCLUSIONS
  Interstitial lung disease is a rare but potentially fatal side effect of pemetrexed. It occurs more often after radiotherapy but can also be encountered in the absence of radiotherapy. Reexposition to pemetrexed may lead to severe interstitial lung disease and even death and should be strictly avoided.
authors.affiliation: Cantonal Hospital St. Gallen, St. Gallen, Switzerland. andreas.hochstrasser@kssg.ch
authors.forename: Andreas
authors.initials: A
authors.lastname: Hochstrasser
authors.forename: Gabriel
authors.initials: G
authors.lastname: Benz
authors.forename: Markus
authors.initials: M
authors.lastname: Joerger
authors.forename: Arnoud
authors.initials: A
authors.lastname: Templeton
authors.forename: Martin
authors.initials: M
authors.lastname: Brutsche
authors.forename: Martin
authors.initials: M
authors.lastname: Früh
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000532:radiotherapy; D003131:Combined Modality Therapy; D005971:Glutamates / Q000009:adverse effects* / Q000627:therapeutic use; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000188:drug therapy / Q000209:etiology*; D008175:Lung Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000068437:Pemetrexed; D013256:Steroids / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D005971:Glutamates; D013256:Steroids; D000068437:Pemetrexed; D006147:Guanine