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A commentary on interstitial pneumonitis induced by docetaxel: clinical cases and systematic review of the literature

Abstract

Background

Pulmonary toxicity is a well-known complication observed with several anticancer drugs. Docetaxel, a taxane chemotherapy drug widely used in the treatment of many types of solid tumors including non-small cell lung cancer (NSCLC), rarely causes infiltrative pneumonitis. The exact mechanism by which docetaxel develops this side effect is not well understood; probably it is produced by type I and IV hypersensitivity responses. Here we describe 2 cases of infiltrative pneumonitis induced by docetaxel as second-line chemotherapy in advanced NSCLC.

Materials and Methods

Two patients with advanced NSCLC were treated with weekly docetaxel as second-line chemotherapy. After 3 courses of chemotherapy, restaging computed tomography (CT) of the chest revealed bilateral diffuse ground-glass opacities with a peribronchial distribution possibly indicative of hypersensitivity pneumonitis. No evidence of pulmonary embolus or pleural effusion was found. Fiberoptic bronchoscopy showed normal bronchi without lymphangitis; biopsies showed interstitial fibrosis without tumor cells. Bronchial tissue laboratory tests for fungi or bacilli were negative. No malignant cells were found at bronchoalveolar lavage. The patients were given high-dose corticosteroid therapy with prednisone 0.7 mg per kilogram per day.

Results

After 1 month of therapy, contrast-enhanced chest CT showed complete disappearance of the pulmonary changes in both patients. Spirometry and blood gas analysis revealed complete recovery of pulmonary function. The patients continued their oncological follow-up program.

Conclusions

Pulmonary injury is a rare adverse event during docetaxel chemotherapy. Prompt treatment with high-dose corticosteroids is needed to avoid worsening of respiratory performance.

Tumori 2015; 101(3): e92 - e95

Article Type: CASE REPORT

DOI:10.5301/tj.5000275

Authors

Giovenzio Genestreti, Monica Di Battista, Rocco Trisolini, Fabio Denicolò, Mirca Valli, Luigi Arcangelo Lazzari-Agli, Giorgia Dal Piaz, Dario De Biase, Marco Bartolotti, Giovanna Cavallo, Alba A. Brandes

Article History

Disclosures

Financial support: None.
Conflict of interest: The authors declare no conflict of interest.

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Authors

Affiliations

  • Department of Clinical Oncology, AUSL Bologna, Bologna - Italy
  • Department of Pneumology, AUSL Bologna, Bologna - Italy
  • Department of Radiology, AUSL Rimini, Cervesi Hospital, Cattolica, Rimini - Italy
  • Department of Pathology, AUSL Rimini, Infermi Hospital, Rimini - Italy
  • Department of Pneumology, AUSL Rimini, Ceccarini Hospital, Riccione - Italy
  • Department of Radiology, AUSL Bologna, Bologna - Italy
  • Department of Medicine, Anatomic Pathology Unit, AUSL Bologna, Bologna - Italy

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