Interstitial pneumonitis as a late complication of high dose therapy with cyclophosphamide/thiotepa and peripheral blood progenitor cell rescue for carcinoma of the breast

Mahendra, Prem; Hood, I. M.; Lee, M.A.; Mewar, Devesh; Bass, G.; Flower, C. D. R.; Wilson, Charles B.; Marcus, Robert

doi:10.1016/s0936-6555(96)80046-x

Cited by 5 publications

(3 citation statements)

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“…A case similar to ours of interstitial pneumonitis has been described by Mahendra et al 10 with severe interstitial pneumonitis developing 10 weeks after high-dose thiotepa (800 mg/m 2 ) and cyclophosphamide (6 g/m 2 ). The interstitial pneumonitis was also reversible with steroids.…”

Section: Discussionsupporting

confidence: 85%

Severe interstitial pneumonitis following high-dose cyclophosphamide, thiotepa and docetaxel: two case reports and a review of the literature

Mileshkin

Prince

Rischin

et al. 2001

Bone Marrow Transplant

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The use of high-dose chemotherapy for metastatic breast cancer has been an area of recent interest and the role of such treatment in the management of metastatic breast cancer is still to be defined. Multiple studies have suggested that such treatment can be given with minimal morbidity and mortality. We describe two cases of life-threatening interstitial pneumonitis, following high-dose chemotherapy (HDT) with cyclophosphamide, thiotepa and docetaxel with stem cell rescue given for metastatic breast cancer. The available relevant literature is reviewed.

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Section: Discussionsupporting

confidence: 85%

Severe interstitial pneumonitis following high-dose cyclophosphamide, thiotepa and docetaxel: two case reports and a review of the literature

Mileshkin

Prince

Rischin

et al. 2001

Bone Marrow Transplant

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“…24 Taken together, we felt that the cause of the interstitial pneumonitis was most likely related to the thiotepa/docetaxel combination, although it is not possible to exclude an interaction with cyclophosphamide. 25 We subsequently modified the protocol and reduced the dose of docetaxel (back to 100 mg/m 2 ) for the next cohort. Given the potential interaction of thiotepa with docetaxel in the development of interstitial pneumonitis, and the development of grade 4 mucositis in three of the nine patients in the first two dose levels, we simultaneously reduced the thiotepa dose (back to 300 mg/m 2 ).…”

Section: Discussionmentioning

confidence: 99%

Repetitive high-dose therapy with cyclophosphamide, thiotepa and docetaxel with peripheral blood progenitor cell and filgrastim support for metastatic and locally advanced breast cancer: results of a phase I study

Prince

Rischin

Toner

et al. 2000

Bone Marrow Transplant

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Summary:This phase I study was designed to determine the optimal dosages of a novel repetitive high-dose therapy regimen for patients with metastatic breast cancer (MBC). The planned treatment was three cycles of high-dose cyclophosphamide, thiotepa and docetaxel delivered every 35 days with progressive dose-escalation in successive cohorts. Each cycle was supported by peripheral blood progenitor cells (PBPC) and filgrastim. Eighteen patients were entered into this trial. Of the planned 54 treatment cycles, 44 were delivered and 11 patients completed all three cycles. The dose-limiting toxicities were interstitial pneumonitis and mucositis with moderately severe diarrhea (n = 3) and rash (n = 3). There were no treatment-related deaths. Of the 17 patients with evaluable disease, 16 patients responded with six patients achieving a complete remission and an additional four patients achieving no detectable disease (negative restaging including PET scan) but a persistently abnormal bone scan. At a median follow-up of 12 months, median progression-free survival was 11 months with the median overall survival not reached. must still be considered investigational. 6-8 Nonetheless, one approach considered worthy of further investigation is the use of repeated cycles of HDT. 6 We have been interested in developing protocols utilizing repetitive cycles of HDT for patients with MBC, based on administering three cycles of HDT, with each cycle supported by PBPCs.9-11 The primary objective of this study was to develop a suitable regimen that could be delivered largely on an out-patient basis (ie not requiring parenteral nutrition or opiate analgesia for gastrointestinal toxicity) that could subsequently be tested in a randomized trial in patients with MBC.We have previously reported our results of repetitive cycles of HDT using a combination of ifosfamide, thiotepa and paclitaxel (ITP). 9 However, in that study, two patients developed grade 3 renal tubular acidosis (RTA) and we later recognized a further case of RTA in the subsequent phase II study of this regimen.12 Consequently, it was considered that this ifosfamide-related side-effect was unacceptable and in the current study we substituted cyclophosphamide for ifosfamide. Furthermore, as the planned randomized study was to utilize docetaxel in the conventionaldose therapy (CDT) arm, we have substituted docetaxel for paclitaxel in this high-dose therapy regimen. Materials and methods Eligibility criteriaPatients with histologically proven metastatic or locally advanced breast cancer were eligible for entry into this prospective trial. Sufficient PBPCs to support these three cycles of HDT were collected prior to the initiation of HDT (see below). Patients were ineligible if they had a history of prior docetaxel therapy, ventricular arrhythmia, myocardial infarction within 6 months of enrolment, congestive heart failure, hypersensitivity to any of the study drugs, were pregnant or lactating, had an ECOG performance status Ͼ2, life expectancy of less than 2 months, absolute ne...

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“…Bevacizumab + [101] Bleomycin + + + [102,103] Busulfan + + [12,104] Cyclophosfamide + + + [105,106] Docetaxel + + [107] Erlotinib + + [108] Everolimus + [109,110] Gefinitib + + [111,112] Gemcitabine + +…”

Section: Medical Historymentioning

confidence: 99%

Antineoplastic therapy-induced pulmonary toxicity

Sadowska¹,

Specenier²,

Germonpré

et al. 2013

Expert Review of Anticancer Therapy

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Pulmonary complications of antineoplastic therapy are common and are an important cause of respiratory morbidity. The pulmonary toxicity should be taken into account in every patient with respiratory problems who is or has been treated with antineoplastic agents. The diagnosis of drug-induced pulmonary toxicity is complex and should be based on the medical history, clinical, radiological and pathological findings. None of them are specific but they can guide the diagnostic process. The treatment of pulmonary abnormalities caused by chemotherapy is mostly supportive and based on cessation of the causative agent. However, the therapeutic options in oncology setting are usually limited thus the decision about changing the treatment should be taken with caution.

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Interstitial pneumonitis as a late complication of high dose therapy with cyclophosphamide/thiotepa and peripheral blood progenitor cell rescue for carcinoma of the breast

Cited by 5 publications

References 1 publication

Severe interstitial pneumonitis following high-dose cyclophosphamide, thiotepa and docetaxel: two case reports and a review of the literature

Severe interstitial pneumonitis following high-dose cyclophosphamide, thiotepa and docetaxel: two case reports and a review of the literature

Repetitive high-dose therapy with cyclophosphamide, thiotepa and docetaxel with peripheral blood progenitor cell and filgrastim support for metastatic and locally advanced breast cancer: results of a phase I study

Antineoplastic therapy-induced pulmonary toxicity

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