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.
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.
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.
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
AuthorsGiovenzio 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
- • Accepted on 02/10/2014
- • Available online on 09/04/2015
- • Published online on 25/06/2015
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- Genestreti, Giovenzio [PubMed] [Google Scholar] 1, * Corresponding Author (firstname.lastname@example.org)
- Battista, Monica Di [PubMed] [Google Scholar] 1
- Trisolini, Rocco [PubMed] [Google Scholar] 2
- Denicolò, Fabio [PubMed] [Google Scholar] 3
- Valli, Mirca [PubMed] [Google Scholar] 4
- Lazzari-Agli, Luigi Arcangelo [PubMed] [Google Scholar] 5
- Piaz, Giorgia Dal [PubMed] [Google Scholar] 6
- Biase, Dario De [PubMed] [Google Scholar] 7
- Bartolotti, Marco [PubMed] [Google Scholar] 1
- Cavallo, Giovanna [PubMed] [Google Scholar] 1
- Brandes, Alba A. [PubMed] [Google Scholar] 1
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