Successful treatment of gemcitabine-induced acute interstitial pneumonia with imatinib mesylate: a case report

English version České info

Background:
Gemcitabine is currently the standard chemotherapy for the adjuvant treatment of pancreatic cancer. This chemotherapeutic agent is generally well-tolerated, myelosuppression and gastrointestinal toxicity being common side effects. Nevertheless, gemcitabine-induced pulmonary toxicity has been rarely reported. Despite its low incidence, the spectrum of pulmonary injury is wide, including potentially fatal conditions.

We report a case of acute interstitial pneumonia related to gemcitabine, completely solved with Imatinib Mesylate (IM).

Case presentation:
The patient was a 69-year-old man, who developed a hypoxemic respiratory distress during adjuvant treatment with gemcitabine for stage IIA pancreatic cancer. The nonspecific diffuse alveolar involvement found on computed tomography (CT), together with the negative tests for infectious aetiology and the continuing severe respiratory failure despite a long course of broad-spectrum therapy, suggested gemcitabine-induced acute pneumonia as the most likely diagnosis.

Thus, after the failure of steroids and all other conventional therapies, the patient was treated with imatinib mesylate on the basis of its activity in the management of graft-versus-host-induced lung fibrosis. A follow-up CT scan of chest one month later showed complete resolution of pneumonia.

Conclusion:
Despite the low frequency of serious pulmonary toxicity, gemcitabine widespread use warns clinicians to consider this life-threatening toxicity. The favourable clinical outcome with IM treatment was remarkable, warranting additional study of IM in the treatment of lung fibrosis.

Keywords:
Gemcitabine, Pancreatic cancer, Pulmonary toxicity, Imatinib mesylate, Treatment outcome

Autoři: Elisabetta Fenocchio ¹; Ilaria Depetris ¹; Delia Campanella ²; Lucia Garetto ¹; Fabrizio Carnevale Schianca ¹; Danilo Galizia ¹; Giovanni Grignani ¹; Massimo Aglietta ¹; Francesco Leone ^1*
Působiště autorů: Department of Medical Oncology, University of Turin Medical School, Candiolo Cancer Institute, FPO, IRCCS, Str. Prov. le 14 Km 3. 95, 10060 Candiolo, Turin, Italy. ¹; Radiology Department, Candiolo Cancer Institute, FPO, IRCCS, Candiolo, Italy. ²
Vyšlo v časopise: BMC Cancer 2016, 16:793
Kategorie: Case report
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12885-016-2833-9

© 2016 The Author(s).

Open access
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmccancer.biomedcentral.com/articles/10.1186/s12885-016-2833-9

Souhrn

Keywords:
Gemcitabine, Pancreatic cancer, Pulmonary toxicity, Imatinib mesylate, Treatment outcome

Zdroje

1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29.

2. Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, Niedergethmann M, Zülke C, Fahlke J, Arning MB, Sinn M, Hinke A, Riess H. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310(14):1473–81.

3. Gupta N, Ahmed I, Steinberg H, Patel D, Nissel-Horowitz S, Mehrotra B. Gemcitabine-induced pulmonary toxicity: case report and review of the literature. Am J Clin Oncol. 2002;25(1):96–100.

4. Carnevale-Schianca F, Gallo S, Rota-Scalabrini D, Sangiolo D, Fizzotti M, Caravelli D, Capaldi A, Anselmetti G, Palesandro E, D’Ambrosio L, Coha V, Obert R, Aglietta M, Grignani G. Complete resolution of life-threatening bleomycin-induced pneumonitis after treatment with imatinib mesylate in a patient with Hodgkin’s lymphoma: hope for severe chemotherapy-induced toxicity? J Clin Oncol. 2011;29(24):e691–3.

5. Barlési F, Villani P, Doddoli C, Gimenez C, Kleisbauer JP. Gemcitabineinduced severe pulmonary toxicity. Fundam Clin Pharmacol. 2004;18:85–91.

6. Umemura S, Yamane H, Suwaki T, Katoh T, Yano T, Shiote Y, Takigawa N, Kiura K, Kamei H. Interstitial lung disease associated with gemcitabine treatment in patients with non-small-cell lung cancer and pancreatic cancer. J Cancer Res Clin Oncol. 2011;137(10):1469–75.

7. Vahid B, Marik PE. Pulmonary complications of novel antineoplastic agents for solid tumors. Chest. 2008;133:528–38.

8. Roychowdhury DF, Cassidy CA, Peterson P, Arning M. A report on serious pulmonary toxicity associated with gemcitabine-based therapy. Invest New Drugs. 2002;20:311–5.

9. Belknap SM, Kuzel TM, Yarnold PR, Slimack N, Lyons EA, Raisch DW, Bennett CL. Clinical features and correlates of gemcitabine-associated lung injury: findings from the RADAR project. Cancer. 2006;106(9):2051–7.

10. Hiraya D, Kagohashi K, Sakamoto N, Kondo T, Satoh H. Gemcitabine-induced pulmonary toxicity in a patient with pancreatic cancer. JOP. 2010;11(2):186–8.

11. Rübe CE, Wilfert F, Uthe D, König J, Liu L, Schuck A, Willich N, Remberger K, Rübe C. Increased expression of pro-inflammatory cytokines as a cause of lung toxicity after combined treatment with gemcitabine and thoracic irradiation. Radiother Oncol. 2004;72(2):231–41.

12. Aono Y, Kishi M, Yokota Y, Azuma M, Kinoshita K, Takezaki A, Sato S, Kawano H, Kishi J, Goto H, Uehara H, Izumi K, Nishioka Y. Role of platelet-derived growth factor/platelet-derived growth factor receptor axis in the trafficking of circulating fibrocytes in pulmonary fibrosis. Am J Respir Cell Mol Biol. 2014;51(6):793–801.

13. Rockey DC, Bell PD, Hill JA. Fibrosis–a common pathway to organ injury and failure. N Engl J Med. 2015;372(12):1138–49.

14. Azuma M, Nishioka Y, Aono Y, Inayama M, Makino H, Kishi J, Shono M, Kinoshita K, Uehara H, Ogushi F, Izumi K, Sone S. Role of alpha1-acid glycoprotein in therapeutic antifibrotic effects of imatinib with macrolides in mice. Am J Respir Crit Care Med. 2007;176:1243–50.

15. Daniels CE, Lasky JA, Limper AH, Mieras K, Gabor E, Schroeder DR. Imatinib-IPF Study Investigators. Imatinib treatment for idiopathic pulmonary fibrosis: randomized placebo-controlled trial results. Am J Respir Crit Care Med. 2010;181:604–10.

16. Galvão FH, Pestana JO, Capelozzi VL. Fatal gemcitabine-induced pulmonary toxicity in metastatic gallbladder adenocarcinoma. Cancer Chemother Pharmacol. 2010;65(3):607–10.