title: Successful treatment of gemcitabine-induced acute interstitial pneumonia with imatinib mesylate: a case report.
abstract: Gemcitabine is currently the standard chemotherapy for the adjuvant treatment of pancreatic cancer. This chemotherapeutic agent is generally well-tolerated, myelosuppression and gastrointestinal toxicity being common side effects. Nevertheless, gemcitabine-induced pulmonary toxicity has been rarely reported. Despite its low incidence, the spectrum of pulmonary injury is wide, including potentially fatal conditions. We report a case of acute interstitial pneumonia related to gemcitabine, completely solved with Imatinib Mesylate (IM).
  
  
  
  The patient was a 69-year-old man, who developed a hypoxemic respiratory distress during adjuvant treatment with gemcitabine for stage IIA pancreatic cancer. The nonspecific diffuse alveolar involvement found on computed tomography (CT), together with the negative tests for infectious aetiology and the continuing severe respiratory failure despite a long course of broad-spectrum therapy, suggested gemcitabine-induced acute pneumonia as the most likely diagnosis. Thus, after the failure of steroids and all other conventional therapies, the patient was treated with imatinib mesylate on the basis of its activity in the management of graft-versus-host-induced lung fibrosis. A follow-up CT scan of chest one month later showed complete resolution of pneumonia.
  
  
  
  Despite the low frequency of serious pulmonary toxicity, gemcitabine widespread use warns clinicians to consider this life-threatening toxicity. The favourable clinical outcome with IM treatment was remarkable, warranting additional study of IM in the treatment of lung fibrosis.
authors.affiliation: Department of Medical Oncology, University of Turin Medical School, Candiolo Cancer Institute, FPO, IRCCS, Str. Prov.le 142 Km 3.95, 10060, Candiolo, Turin, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Fenocchio
authors.affiliation: Department of Medical Oncology, University of Turin Medical School, Candiolo Cancer Institute, FPO, IRCCS, Str. Prov.le 142 Km 3.95, 10060, Candiolo, Turin, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Depetris
authors.affiliation: Radiology Department, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy.
authors.forename: Delia
authors.initials: D
authors.lastname: Campanella
authors.affiliation: Department of Medical Oncology, University of Turin Medical School, Candiolo Cancer Institute, FPO, IRCCS, Str. Prov.le 142 Km 3.95, 10060, Candiolo, Turin, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Garetto
authors.affiliation: Department of Medical Oncology, University of Turin Medical School, Candiolo Cancer Institute, FPO, IRCCS, Str. Prov.le 142 Km 3.95, 10060, Candiolo, Turin, Italy.
authors.forename: Fabrizio Carnevale
authors.initials: FC
authors.lastname: Schianca
authors.affiliation: Department of Medical Oncology, University of Turin Medical School, Candiolo Cancer Institute, FPO, IRCCS, Str. Prov.le 142 Km 3.95, 10060, Candiolo, Turin, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Galizia
authors.affiliation: Department of Medical Oncology, University of Turin Medical School, Candiolo Cancer Institute, FPO, IRCCS, Str. Prov.le 142 Km 3.95, 10060, Candiolo, Turin, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Grignani
authors.affiliation: Department of Medical Oncology, University of Turin Medical School, Candiolo Cancer Institute, FPO, IRCCS, Str. Prov.le 142 Km 3.95, 10060, Candiolo, Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Aglietta
authors.affiliation: Department of Medical Oncology, University of Turin Medical School, Candiolo Cancer Institute, FPO, IRCCS, Str. Prov.le 142 Km 3.95, 10060, Candiolo, Turin, Italy. francesco.leone@ircc.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Leone
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use*; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D011014:Pneumonia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D047428:Protein Kinase Inhibitors; D003841:Deoxycytidine; D000068877:Imatinib Mesylate; D000093542:Gemcitabine
keywords: Gemcitabine; Imatinib mesylate; Pancreatic cancer; Pulmonary toxicity; Treatment outcome