Organizing Pneumonia Associated with Oxaliplatin-Combined Chemotherapy: A Case Report

Abstract

Objective: To report a case of oxaliplatin-combined chemotherapy-induced interstitial lung disease. Clinical Presentation and Intervention: A 57-year-old man was referred complaining of dyspnea and fever after treatment with an oxaliplatin-combined chemotherapeutic agent for metastatic colorectal cancer. Fever development and spontaneous subsidence were observed during the chemotherapeutic course repeatedly until the 9th cycle. A computer-tomographic (CT) scan revealed bilateral, peripherally distributed, patchy consolidation suggestive of an interstitial lung disease. As a confirmative step, video-assisted thoracoscopic surgical biopsy was attempted; the characteristic intraluminal organizing fibrous plug in the bronchioles and alveoli was seen. Corticosteroid therapy was administered, which rapidly improved the patient’s symptoms and chest CT findings. Conclusion: This case showed that oxaliplatin may be implicated in the etiology of interstitial lung disease, since withdrawal of the drug resulted in improvement of interstitial lung disease.

Cryptogenic Organizing Pneumonia During Adjuvant Chemotherapy With Oxaliplatin, 5-Fluorouracil, and Leucovorin (FOLFOX) for Colon Cancer

“…13 In the second reported case, the patient received FOLFOX for treatment of metastatic colorectal cancer and developed organizing pneumonia after 8 cycles. 14 The patient showed rapid improvement in symptoms with oral prednisolone therapy at 1 mg/kg per d and discontinuation of FOLFOX chemotherapy. 14 Our patient case was unique from the others reported in literature in that it occurred early, after only 2 cycles of mFOL-FOX6, and responded only to higher dose intravenous steroid therapy at 3 mg/kg per d. This case highlights the importance of suspecting COP early on in FOLFOX therapy and the need to consider higher dose steroid therapy in patients without prompt improvement to usual starting doses of 1 mg/kg per d. This improves our understanding of FOLFOX-induced COP and how the management may differ among patients based on the potential severity of this adverse event.…”

“…3 The incidence in clinical studies was <1% and there have been case reports of different types of ILD associated with FOLFOX chemotherapy. 2,[5][6][7][8][9][10][11][12][13][14] However, to our knowledge, only 2 cases of cryptogenic organizing pneumonia (COP) associated with this regimen have been reported in the English language literature. 13,14 COP is a type of ILD, formerly known as bronchiolitis obliterans organizing pneumonia.…”

Pulmonary Fibrosis Secondary to FOLFOX Chemotherapy: A Case Report

“…A previous case report of FOLFOX-associated ILD noted that the patient improved following the discontinuation of oxaliplatin [8]. A case series of 26 patients with various lung diseases, who had received oxaliplatin therapy, identified 3 patients who had a radiological diagnosis of ILD prior to the commencement of oxaliplatin.…”

Sarcoidosis Associated with Oxaliplatin-Based Chemotherapy for Colorectal Cancer

“…Pulmonary complications by this regimen had been described as heterogeneous clinical course, histopathologic features, and prognosis. The presumed diagnosis of lung toxicities included organizing pneumonia [5–9], diffuse alveolar damage [6, 10–12], nonspecific interstitial pneumonia [7], eosinophilic pneumonia [13], and usual interstitial pneumonia. The interval from the initial chemotherapy to the lung injury varied from one day [6] to more than 6 months [7], and the overall mortality was around 30%.…”