The incidence and clinical features of PEGylated filgrastim-induced acute aortitis in patients with breast cancer

Abstract

Although PEGylated filgrastim-induced aortitis is very rare and unknown clinically, some cases were reported and increasing, especially in breast cancer patients. The present study investigated the prevalence, clinical features and treatment of aortitis induced by PEGylated filgrastim in patients with breast cancer. A total of 2068 consecutive patients who underwent neoadjuvant/adjuvant chemotherapy with PEGylated filgrastim for breast cancer were enrolled. From the medical record, clinical, laboratory, medication, and imaging evaluation findings were collected. PEGylated filgrastim-induced aortitis was established in 0.3% of the study population. Common clinical presentations included extremely high fever and chest/back pain with high levels of inflammatory markers without any signs of infection. Contrast-enhanced computed tomography scans revealed typical enhancing wall thickening and periaortic soft tissue infiltration at various levels of aorta. All patients improved rapidly after treatment with modest doses of prednisolone (0.5 mg/kg/day) without any complications. Clinicians should be aware of aortitis as a possible complication of granulocyte-colony stimulating factor therapy, especially PEGylated filgrastim, given the frequent misdiagnoses in neutropenic patients undergoing chemotherapy.

Drug-induced aortitis of the subclavian artery caused by pegfilgrastim: a case report

“…This report describes our experience with a case of aortitis localized to the subclavian artery where fever was exhibited 8 days after pegfilgrastim administration. The onset of this disease is known to usually occur within 2 weeks after the first administration of pegfilgrastim [ 3 ]. G-CSF-induced aortitis can occur in the thoracic to abdominal aorta and its branches, but the most frequent site is the aortic arch, reported to occur in approximately 70% of cases (11 of 16) [ 3 – 12 ].…”

“…G-CSF-related aortitis is a rare side effect of G-CSF treatment, with an incidence rate of 0.0014% in the United States and 0.47% in Japan, indicating a slightly higher incidence in Asian patients [ 2 ]. It is also known to occur more frequently in women [ 2 , 3 ]. The key findings for diagnosis are the presence of aortic wall thickening and surrounding soft tissue infiltration on contrast-enhanced CT scan [ 2 – 5 ].…”

“…The key findings for diagnosis are the presence of aortic wall thickening and surrounding soft tissue infiltration on contrast-enhanced CT scan [ 2 – 5 ]. There are no specific markers for G-CSF-associated aortitis and general markers for autoimmune disease, such as PR3-ANCA (proteinase3-anti-neutrophil cytoplasmic antibody), MPO (myeloperoxidase)-ANCA, antinuclear antibodies and IgG, are usually negative [ 2 , 3 ]. Therefore, C-reactive protein (CRP) is currently used to assess disease activity in clinical practice.…”

“…Reports of G-CSF-associated aortitis have been increasing in recent years, probably due to PEGylation [ 2 , 3 , 6 ]. Here, we report a case who developed pegfilgrastim-induced aortitis, localized to the right subclavian artery, during adjuvant chemotherapy.…”

Pegfilgrastim-induced large vessel vasculitis

“…Pegfilgrastim-associated aortitis is very rare; its incidence in patients with breast cancer treated by chemotherapy including pegfilgrastim is 0.3%. 1 However, severe side effects, such as aortic dissection, have been reported and clinicians should be aware of this. 2 In previous reports, most cases presented with high-grade fever and high CRP levels, and CT, MRI and positron emission tomography were used for diagnosis.…”