title: A commentary on interstitial pneumonitis induced by docetaxel: clinical cases and systematic review of the literature.
abstract: BACKGROUND
  Pulmonary toxicity is a well-known complication observed with several anticancer drugs. Docetaxel, a taxane chemotherapy drug widely used in the treatment of many types of solid tumors including non-small cell lung cancer (NSCLC), rarely causes infiltrative pneumonitis. The exact mechanism by which docetaxel develops this side effect is not well understood; probably it is produced by type I and IV hypersensitivity responses. Here we describe 2 cases of infiltrative pneumonitis induced by docetaxel as second-line chemotherapy in advanced NSCLC.
  
  
  METHODS
  Two patients with advanced NSCLC were treated with weekly docetaxel as second-line chemotherapy. After 3 courses of chemotherapy, restaging computed tomography (CT) of the chest revealed bilateral diffuse ground-glass opacities with a peribronchial distribution possibly indicative of hypersensitivity pneumonitis. No evidence of pulmonary embolus or pleural effusion was found. Fiberoptic bronchoscopy showed normal bronchi without lymphangitis; biopsies showed interstitial fibrosis without tumor cells. Bronchial tissue laboratory tests for fungi or bacilli were negative. No malignant cells were found at bronchoalveolar lavage. The patients were given high-dose corticosteroid therapy with prednisone 0.7 mg per kilogram per day.
  
  
  RESULTS
  After 1 month of therapy, contrast-enhanced chest CT showed complete disappearance of the pulmonary changes in both patients. Spirometry and blood gas analysis revealed complete recovery of pulmonary function. The patients continued their oncological follow-up program.
  
  
  CONCLUSIONS
  Pulmonary injury is a rare adverse event during docetaxel chemotherapy. Prompt treatment with high-dose corticosteroids is needed to avoid worsening of respiratory performance.
authors.affiliation: 1 Department of Clinical Oncology, AUSL Bologna, Bologna - Italy.
authors.forename: Giovenzio
authors.initials: G
authors.lastname: Genestreti
authors.forename: Monica
authors.initials: M
authors.lastname: Di Battista
authors.forename: Rocco
authors.initials: R
authors.lastname: Trisolini
authors.forename: Fabio
authors.initials: F
authors.lastname: Denicolò
authors.forename: Mirca
authors.initials: M
authors.lastname: Valli
authors.forename: Luigi Arcangelo
authors.initials: LA
authors.lastname: Lazzari-Agli
authors.forename: Giorgia
authors.initials: G
authors.lastname: Dalpiaz
authors.forename: Dario
authors.initials: D
authors.lastname: De Biase
authors.forename: Marco
authors.initials: M
authors.lastname: Bartolotti
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cavallo
authors.forename: Alba A
authors.initials: AA
authors.lastname: Brandes
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy; D000077192:Adenocarcinoma of Lung; D000368:Aged; D000542:Alveolitis, Extrinsic Allergic / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001784:Blood Gas Analysis; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000503:physiopathology; D000077143:Docetaxel; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D011241:Prednisone / Q000008:administration & dosage; D020127:Recovery of Function; D013147:Spirometry; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel; D011241:Prednisone