title: Gefitinib-related interstitial lung disease in Taiwanese patients with non-small-cell lung cancer.
abstract: BACKGROUND
  Gefitinib (Iressa; AstreZeneca, Wilmington, DE) is effective in the treatment of NSCLC, especially in the Asian population. However, ILD is usually a serious pulmonary adverse effect and almost leads to cessation of gefitinib treatment. In this study, we investigated the incidence, clinical features, and prognosis of gefitinib-related ILD in Taiwanese patients with NSCLC.
  
  
  METHODS
  This was a retrospective observational study conducted in 2 medical centers and a local teaching hospital.
  
  
  RESULTS
  A total of 1080 patients with NSCLC, who received at least 1 dose (250 mg per day) of gefitinib treatment, were enrolled. Of these, 42 patients were diagnosed with ILD. Twenty-five of the 42 patients were diagnosed with gefitinib-related ILD (incidence, 2.3%). The main manifestations of ILD included dyspnea, cough, and hypoxemia. Six of the 25 patients (24%) with gefitinib-related ILD required invasive mechanical ventilation and all patients were treated with steroids. Twenty-two patients (88%) discontinued gefitinib treatment without further rechallenge. Ten (40%) patients died directly from ILD and in-hospital mortality was 52%. Eleven patients received subsequent cytotoxic chemotherapy with a mean of 33.5 days after ILD events. Kaplan-Meier analysis demonstrated that gefitinib nonresponder and gefitinib use rather than first-line treatment were associated with poor prognosis when ILD developed during gefitinib treatment.
  
  
  CONCLUSIONS
  Taiwanese patients with NSCLC had a relatively high incidence of ILD during gefitinib treatment. Gefitinib-related ILD is usually life-threatening, especially in gefitinib nonresponders and gefitinib use rather than first-line treatment.
authors.affiliation: Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan. 11319@ymuh.ym.edu.tw
authors.forename: Shih-Chieh
authors.initials: SC
authors.lastname: Chang
authors.forename: Cheng-Yu
authors.initials: CY
authors.lastname: Chang
authors.forename: Shu-Ju
authors.initials: SJ
authors.lastname: Chang
authors.forename: Mei-Kang
authors.initials: MK
authors.lastname: Yuan
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Lai
authors.forename: Yu-Chang
authors.initials: YC
authors.lastname: Liu
authors.forename: Cheng-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Li-Chiao
authors.initials: LC
authors.lastname: Kuo
authors.forename: Chong-Jen
authors.initials: CJ
authors.lastname: Yu
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003371:Cough / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D005260:Female; D000077156:Gefitinib; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000150:complications / Q000453:epidemiology*; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011799:Quinazolines / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D000077156:Gefitinib