Taxane-induced acute interstitial pneumonitis in patients with breast cancer and outcome of taxane rechallenge

Abstract

Background: Although rare, taxane-induced interstitial pneumonitis is a well-recognized toxicity following chemotherapy. Data on taxane rechallenge in patients who developed taxane-induced interstitial pneumonitis following chemotherapy are limited. Here, we share our experience of acute interstitial pneumonitis following taxane chemotherapy for breast cancer and its clinical outcome following steroids and subsequent rechallenge with taxanes in selected patients without residual lung abnormalities on imaging following steroid treatment. Objectives: To study the taxane-induced acute interstitial pneumonitis in patients with breast cancer receiving chemotherapy and outcome of taxane rechallenge in these patients. Materials and Methods: Patients with breast cancer who developed taxane-induced acute interstitial pneumonitis following chemotherapy either with paclitaxel or docetaxel were included. Results: Among 1240 patients with breast cancer, who received chemotherapy with either docetaxel or paclitaxel, 41 patients developed taxane-induced acute interstitial lung disease (ILD) during the study period. The interstitial pneumonitis was more seen with docetaxel. Among paclitaxel regimens, weekly schedules showed more cases of ILD than 2 weekly paclitaxel. After steroid pulse/maintenance treatment, complete resolution of lung abnormalities was seen in 76%, but residual interstitial pattern on imaging was noted in 24% of patients. Taxane rechallenge was done in 20 (49%) patients. Agents used were paclitaxel, nab-paclitaxel, or docetaxel. All rechallenged patients received short-course oral steroids for one week following taxane rechallenge as a safety measure. Rechallenge was not done in 51% either due to patient unwillingness for rechallenge (27%) or patient with residual interstitial pattern on imaging (24%). None of the patients experienced any recurrence of pneumonitis or any mortality following taxane rechallenge. Conclusion: Acute interstitial pneumonitis is a well-known toxicity following taxanes in breast cancer and taxane rechallenge is an option in those patients without any residual pneumonitis following steroid pulse/maintenance. We also advise short-course oral steroids for 1 week following taxane rechallenge as a safety measure. We strongly do not recommend rechallenge in patients with residual lung abnormalities after steroids.

Paclitaxel-Induced Pneumonitis in Trinidad: A Case Report

“…The first case series described three patients in which paclitaxel was switched to an alternate agent, nanoparticle albumin-bound paclitaxel, known to be the least likely taxane to cause severe pneumonitis [8,9]. However, a more recent case series of 19 patients described 17 patients being rechallenged with the same inciting taxane and two switched to docetaxel, similar to our patient [6]. Notably, our patient was not put on short-course oral steroids during and following the rechallenge for one week as a safety measure in contrast to the latter [6].…”

“…However, a more recent case series of 19 patients described 17 patients being rechallenged with the same inciting taxane and two switched to docetaxel, similar to our patient [ 6 ]. Notably, our patient was not put on short-course oral steroids during and following the rechallenge for one week as a safety measure in contrast to the latter [ 6 ].…”

“…Of note, one study reported resolution of pneumonitis symptoms without the use of steroids in two cases [ 7 ]. In contrast to previous case reports, our patient was not placed on maintenance steroid therapy over months [ 1 , 4 , 6 ].…”

“…These findings gave sufficient evidence to consider the temporal relationship between the patient’s first exposure to paclitaxel and the start of her symptoms. Hence, a diagnosis of PIP was made based on clinical presentation, radiographic pattern, exposure history, and exclusion of other causes of diffuse pulmonary infiltrates [ 6 ].…”

Docetaxel induced subacute interstitial lung disease in a patient with prostate cancer

“…They reported that 49% subjects did not have any recurrence of pneumonia and oral steroids were given to the subjects as a safety measure. 8 The study also advised against re-challenge of drugs in patients with residual lung abnormalities after steroids. A study conducted by Hoshina et al and Takei et al showed an occurrence of case of ild in a patient undergoing treatment with anthracycline induced chemotherapy.…”