Reactions 1347 - 16 Apr 2011

SAntineoplastics

Fatal interstitial lung disease: case reportA 64-year-old man with metastatic gastric cancer

developed interstitial lung disease during treatment withFOLFOX-4* [details not stated]; he subsequently died.

The man was partially responsive to FOLFOX-4chemotherapy, which was well tolerated with theexception of grade 1-2 peripheral neuropathy and grade 2thrombocytopenia. Following his eighth cycle ofFOLFOX-4, he developed a dry cough with progressivedyspnoea on exertion. Bilateral interstitial infiltrates wereseen on a chest x-ray, and arterial blood gas analysisshowed mild hypoxaemia.

The man was hospitalised and received oxygensupplementation. Pneumonia was suspected, but he failedto respond to broad-spectrum antibiotics, and no infectioncould be identified on bronchoscopy or bronchoalveolarlavage. His symptoms worsened despite empiricalantibiotic therapy with ciprofloxacin, cefepime andvancomycin. A CT scan revealed interstitial lunginvolvement predominantly affecting the peripheral lung,with thickening of interlobular septa, a ground-glassappearance and minor pleural effusion in both lungs.Interstitial lung disease was suspected. Despite treatmentwith high-dose corticosteroids, his symptoms worsenedand he required intubation. He later died from refractoryrespiratory failure after 10 days of mechanical ventilation.His family declined an autopsy request.

* FOLFOX-4 usually consists of fluorouracil, folinic acid[leucovorin] and oxaliplatin.

Lim JH, et al. Interstitial lung disease associated with FOLFOX chemotherapy.Journal of Cancer Research and Therapeutics 6: 546-548, No. 4, Oct-Dec 2010.Available from: URL: http://dx.doi.org/10.4103/0973-1482.77066 - SouthKorea 803052701

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Reactions 16 Apr 2011 No. 13470114-9954/10/1347-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved