Gemcitabine-Induced Pulmonary Toxicity

Gupta, Niraj; Ahmed, Imran; Steinberg, Harry; Patel, Dilip; Nissel-Horowitz, S.; Mehrotra, Bhoomi

doi:10.1097/00000421-200202000-00021

Cited by 75 publications

(22 citation statements)

References 15 publications

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“…In contrast, other studies have shown that the rate of grades 3–4 pneumonitis is similar across tumor types, but with more treatment-related deaths due to pneumonitis in patients with NSCLC 10,11,30. It is unclear why NSCLC may be associated with more pneumonitis and/or treatment-related deaths, but a number of hypotheses (while not yet studied) seem plausible, including higher rates of pre-existing adverse pulmonary conditions (i.e., tobacco exposure, previous lung radiation) and previous exposure to drugs associated with interstitial lung disease, including taxanes,31 epidermal growth factor receptor tyrosine kinase inhibitors,32,33 and gemcitabine 34…”

Section: Epidemiologymentioning

confidence: 99%

Clinical features, diagnostic challenges, and management strategies in checkpoint inhibitor-related pneumonitis

Chuzi¹,

Távora²,

Cruz³

et al. 2017

CMAR

151

146

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Immune checkpoint inhibitors, including cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death-1 (PD-1) inhibitors, represent an effective treatment modality for multiple malignancies. Despite the exciting clinical benefits, checkpoint inhibition is associated with a series of immune-related adverse events (irAEs), many of which can be life-threatening and result in significant treatment delays. Pneumonitis is an adverse event of special interest as it led to treatment-related deaths in early clinical trials. This review summarizes the incidence of pneumonitis during treatment with the different checkpoint inhibitors and discusses the prognostic significance of tumor type. The wide range of clinical, radiographic, and histologic characteristics of checkpoint inhibitor-related pneumonitis is reviewed and followed by guidance on the different management strategies.

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Section: Epidemiologymentioning

confidence: 99%

Clinical features, diagnostic challenges, and management strategies in checkpoint inhibitor-related pneumonitis

Chuzi¹,

Távora²,

Cruz³

et al. 2017

CMAR

151

146

View full text Add to dashboard Cite

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“…The onset of drug-associated ILD during therapy for advanced NSCLC usually occurs within a few weeks of the start of treatment (Thomas et al , 2000; Gupta et al , 2002; Kudrik et al , 2002; Read et al , 2002). Indeed, retrospective analysis of the first 152 patients in Japan to experience gefitinib-associated ILD showed that >75% of cases occurred within 3 months, with the majority of these occurring within 4 weeks.…”

Section: Suspicion Of Drug-associated Ild In Patients With Nsclcmentioning

confidence: 99%

“…The symptoms of drug-associated ILD, as with all forms of the condition, include rapidly developing breathlessness and a dry and unproductive cough, together with fever (Thomas et al , 2000; Gupta et al , 2002; Kudrik et al , 2002; Read et al , 2002). Such symptoms are nonspecific and can occur with a large number of common illnesses often associated with NSCLC, or they may be due to cancer progression or lung cancer therapy.…”

Section: Suspicion Of Drug-associated Ild In Patients With Nsclcmentioning

confidence: 99%

Diagnosis and management of drug-associated interstitial lung disease

et al. 2004

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Symptoms of drug-associated interstitial lung disease (ILD) are nonspecific and can be difficult to distinguish from a number of illnesses that commonly occur in patients with non-small-cell lung cancer (NSCLC) on therapy. Identification of drug involvement and differentiation from other illnesses is problematic, although radiological manifestations and clinical tests enable many of the alternative causes of symptoms in advanced NSCLC to be excluded. In lung cancer patients, high-resolution computed tomography (HRCT) is more sensitive than a chest radiograph in evaluating the severity and progression of parenchymal lung disease. Indeed, the use of HRCT imaging has led to the recognition of many distinct patterns of lung involvement and, along with clinical signs and symptoms, helps to predict both outcome and response to treatment. This manuscript outlines the radiology of drug-associated ILD and its differential diagnosis in NSCLC. An algorithm that uses clinical tests to exclude alternative diagnoses is also described.

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“…The incidence of grade 4 lung toxicity ranges from 0.06%, as reported by an industry study based on commercial exposure, to 8%, as reported in several case study reviews, and the mortality rate is 20% [7,8]. In addition, gemcitabine-induced eosinophilic pneumonia has been reported previously [9,10].…”

Section: Case Presentationmentioning

confidence: 99%

Severe eosinophilic pneumonia presenting during gemcitabine adjuvant chemotherapy

et al. 2013

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Gemcitabine is widely accepted as the standard treatment for pancreatic cancer, but it can cause unpredictable side effects. Acute respiratory distress syndrome is a rare complication with gemcitabine, but is sometimes fatal. We describe a cured case of acute, severe gemcitabine-induced pulmonary toxicity. The patient was a 76-year-old man with pancreatic cancer who was receiving adjuvant gemcitabine chemotherapy after surgery. The patient received gemcitabine 1,000 mg/m2 on days 1, 8, and 15 for three 4-week cycles, with intervals of 1 week. He developed severe general fatigue on day 1 of the third cycle. Computed tomography showed diffuse ground-glass opacity with pleural effusion. There was no increase in β-D-glucan, and cytomegalovirus antigenemia assays were negative. No bacteria or acid-fast bacilli were found. The number of eosinophils in bronchoalveolar lavage fluid was increased. Considering these data, we diagnosed eosinophilic pneumonia induced by gemcitabine. The patient was immediately treated with a steroid and neutrophil elastase inhibitor under respiratory supportive therapy. After 4 weeks, his pulmonary symptoms were markedly improved. Physicians should be cognizant of the possible association of serious pulmonary toxicity with gemcitabine treatment. A delay in diagnosis and treatment could lead to a fatal outcome.

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Gemcitabine-Induced Pulmonary Toxicity

Cited by 75 publications

References 15 publications

Clinical features, diagnostic challenges, and management strategies in checkpoint inhibitor-related pneumonitis

Clinical features, diagnostic challenges, and management strategies in checkpoint inhibitor-related pneumonitis

Diagnosis and management of drug-associated interstitial lung disease

Severe eosinophilic pneumonia presenting during gemcitabine adjuvant chemotherapy

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