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Mouillot P, Favrolt N, Khouri C, Grandvuillemin A, Chaumais MC, Schenesse D, Seferian A, Jais X, Savale L, Beltramo G, Sitbon O, Cracowski JL, Humbert M, Georges M, Bonniaud P, Montani D. Characteristics and outcomes of gemcitabine-associated pulmonary hypertension. ERJ Open Res 2024; 10:00654-2023. [PMID: 38770007 PMCID: PMC11103709 DOI: 10.1183/23120541.00654-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/18/2023] [Indexed: 05/22/2024] Open
Abstract
Background Despite its known cardiac and lung toxicities, the chemotherapy drug gemcitabine has only rarely been associated with pulmonary hypertension (PH), and the underlying mechanism remains unclear. The objective of the present study was to assess the association between gemcitabine and PH. Methods We identified incident cases of precapillary PH confirmed by right heart catheterisation in patients treated with gemcitabine from the French PH Registry between January 2007 and December 2022. The aetiology, clinical, functional, radiological and haemodynamic characteristics of PH were reviewed at baseline and during follow-up. A pharmacovigilance disproportionality analysis was conducted using the World Health Organization (WHO) pharmacovigilance database. Results We identified nine cases of pulmonary arterial hypertension, either induced (in eight patients) or exacerbated (in one patient) by gemcitabine. Patients exhibited severe precapillary PH, with a median mean pulmonary arterial pressure of 40 (range 26-47) mmHg, a cardiac index of 2.4 (1.6-3.9) L·min-1·m-2 and a pulmonary vascular resistance of 6.3 (3.1-12.6) Wood units. The median time from the initiation of gemcitabine to the onset of PH was 7 (4-50) months, with patients receiving a median of 16 (6-24) gemcitabine injections. Six patients showed clinical improvement upon discontinuation of gemcitabine. In the WHO pharmacovigilance database, we identified a significant signal with 109 cases reporting at least one adverse event related to PH with gemcitabine. Conclusion Both clinical cases and pharmacovigilance data substantiate a significant association between gemcitabine use and the onset or worsening of precapillary PH. The observed improvement following the discontinuation of treatment underscores the importance of PH screening in gemcitabine-exposed patients experiencing unexplained dyspnoea.
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Affiliation(s)
- Pierre Mouillot
- Department of Pneumology and Intensive Care, Reference Center for Rare Lung Diseases, François Mitterrand Hospital, Dijon, France
- Faculty of Medicine, INSERM 1231, University of Burgundy, Dijon, France
| | - Nicolas Favrolt
- Department of Pneumology and Intensive Care, Reference Center for Rare Lung Diseases, François Mitterrand Hospital, Dijon, France
- Faculty of Medicine, INSERM 1231, University of Burgundy, Dijon, France
| | - Charles Khouri
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
- Clinical Pharmacology Department INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France
| | | | - Marie-Camille Chaumais
- Faculty of Pharmacy, Université Paris-Saclay, Orsay, France
- Assistance Publique – Hôpitaux de Paris (AP-HP), Pharmacy Department, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
| | - Déborah Schenesse
- Department of Pneumology and Intensive Care, Reference Center for Rare Lung Diseases, François Mitterrand Hospital, Dijon, France
- Faculty of Medicine, INSERM 1231, University of Burgundy, Dijon, France
| | - Andrei Seferian
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- AP-HP, Department of Pneumology and Intensive Care, Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Xavier Jais
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- AP-HP, Department of Pneumology and Intensive Care, Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Laurent Savale
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- AP-HP, Department of Pneumology and Intensive Care, Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Guillaume Beltramo
- Department of Pneumology and Intensive Care, Reference Center for Rare Lung Diseases, François Mitterrand Hospital, Dijon, France
- Faculty of Medicine, INSERM 1231, University of Burgundy, Dijon, France
| | - Olivier Sitbon
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- AP-HP, Department of Pneumology and Intensive Care, Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean-Luc Cracowski
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France
| | - Marc Humbert
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- AP-HP, Department of Pneumology and Intensive Care, Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marjolaine Georges
- Department of Pneumology and Intensive Care, Reference Center for Rare Lung Diseases, François Mitterrand Hospital, Dijon, France
- Faculty of Medicine, INSERM 1231, University of Burgundy, Dijon, France
| | - Philippe Bonniaud
- Department of Pneumology and Intensive Care, Reference Center for Rare Lung Diseases, François Mitterrand Hospital, Dijon, France
- Faculty of Medicine, INSERM 1231, University of Burgundy, Dijon, France
- P. Bonniaud and D. Montani contributed equally
| | - David Montani
- INSERM UMR_S 999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Hospital Marie Lannelongue, Le Plessis-Robinson, France
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- AP-HP, Department of Pneumology and Intensive Care, Pulmonary Hypertension Reference Centre, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- P. Bonniaud and D. Montani contributed equally
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Zhou XM, Wu C, Gu X. Intravesically instilled gemcitabine-induced lung injury in a patient with invasive urothelial carcinoma: A case report. World J Clin Cases 2020; 8:4652-4659. [PMID: 33083430 PMCID: PMC7559683 DOI: 10.12998/wjcc.v8.i19.4652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/28/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gemcitabine is a chemotherapy agent with relatively low toxicities, as a valid option for elderly patients with underlying diseases. Gemcitabine-induced pulmonary toxicities are rare and various, ranging from self-limited episodes of bronchospasm to fatal, progressive, severe, interstitial pneumonitis and respiratory failure. Intravesical gemcitabine instillations are commonly used to reduce recurrence or progression for non–muscle-invasive bladder cancer or urothelial cancer. Few severe toxicities have been reported for the intravesical instillation is assumed to be completely separated from the systemic circulation.
CASE SUMMARY A 67-year-old patient received 30 cycles of intravesical gemcitabine instillation after transurethral resection and developed a 1-wk fever, cough, hemoptysis, and dyspnea. After a thorough checkup, bilateral consolidation and infiltration of the lungs were documented and a percutaneous lung biopsy confirmed organizing pneumonia after treatment with broad-spectrum empirical antibiotics failed. Tapered corticosteroids were administered, and pulmonary toxicity gradually resolved.
CONCLUSION Gemcitabine-induced pulmonary toxicities present with various manifestations. In spite of the rare pulmonary involvement by the intravesical gemcitabine instillation, health care professionals who administer gemcitabine chemotherapy in this way should monitor for gemcitabine-induced pulmonary toxicities, particularly in patients with high-risk factors.
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Affiliation(s)
- Xiao-Ming Zhou
- Department of Respiratory and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
- Department of Respiratory and Critical Care Medicine, Fourth Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Cen Wu
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xiu Gu
- Department of Respiratory and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
- Department of Respiratory and Critical Care Medicine, Fourth Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Shen J, Chung SY, Azimi-Nekoo E, Jose J, Saif MW. A Rare Case of Gemcitabine-Induced Pulmonary Hypertension. ACTA ACUST UNITED AC 2020; 5:1-3. [PMID: 32104721 PMCID: PMC7043207 DOI: 10.17140/prrmoj-5-139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Context Gemcitabine is the backbone of systemic treatment of locally advanced and metastatic intrahepatic cholangiocarcinoma. In recent literature, gemcitabine has been linked to various pulmonary side effects. Case Report We report a case of an 82-year-old male who developed acute pulmonary hypertension after receiving one cycle of gemcitabine for metastatic cholangiocarcinoma. His symptoms began with fatigue associated with shortness of breath and cough that worsened despite dose reduction. He developed new onset bilateral pulmonary effusions and an echocardiogram revealed findings consistent with pulmonary hypertension. A computed tomography (CT) angiogram was negative for pulmonary thromboembolism. Although he was promptly treated with diuretics and steroids, the patient could not tolerate any further therapy. Conclusion Gemcitabine-induced pulmonary hypertension is rare and can be challenging to diagnose, as it remains a diagnosis of exclusion. However, physicians should be vigilant of new pulmonary symptoms, as delayed treatment can cause significant patient morbidity and mortality.
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Affiliation(s)
- Janice Shen
- Division of Hematology-Oncology, Department of Medicine, Northwell Health, Manhasset, NY, USA.,Northwell Health Cancer Institute, Monter Cancer Center, Lake Success, NY, USA
| | - Su Yun Chung
- Division of Hematology-Oncology, Department of Medicine, Northwell Health, Manhasset, NY, USA.,Northwell Health Cancer Institute, Monter Cancer Center, Lake Success, NY, USA
| | - Elham Azimi-Nekoo
- Division of Hematology-Oncology, Department of Medicine, Northwell Health, Manhasset, NY, USA.,Northwell Health Cancer Institute, Monter Cancer Center, Lake Success, NY, USA
| | - Jyothi Jose
- Northwell Health Cancer Institute, Monter Cancer Center, Lake Success, NY, USA
| | - Muhammad W Saif
- Division of Hematology-Oncology, Department of Medicine, Northwell Health, Manhasset, NY, USA.,Northwell Health Cancer Institute, Monter Cancer Center, Lake Success, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Abstract
Isolated lung perfusion (ILP) is a surgical technique developed to treat pulmonary metastases. During ILP, high-dose chemotherapy is delivered into the pulmonary vasculature, minimizing systemic exposure and delivering the chemotherapeutic agent directly to the lung. ILP has been studied extensively in a variety of animal models and in humans in phase I trials. The most frequently studied chemotherapeutic agents used in ILP are doxorubicin, 5-flurodeoxyuridine, tumor necrosis factor-α, paclitaxel, melphalan, gemcitabine, and cisplatin. Phase I clinical trials with ILP have shown that ILP can be safely performed in humans but with mixed clinical results and poor long-term survival.
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Affiliation(s)
- Alison Ward
- Department of Cardiothoracic Surgery, NYU Langone Medical Center, 530 First Avenue, New York, NY 10016, USA
| | - Kirill Prokrym
- Department of Cardiothoracic Surgery, NYU Langone Medical Center, 530 First Avenue, New York, NY 10016, USA
| | - Harvey Pass
- Department of Cardiothoracic Surgery, NYU Langone Medical Center, 530 First Avenue, New York, NY 10016, USA.
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Krüger M, Zinne N, Biancosino C, Höffler K, Rajab TK, Waldmann KH, Jonigk D, Avsar M, Haverich A, Hoeltig D. Porcine pulmonary auto-transplantation for ex vivo therapy as a model for new treatment strategies. Interact Cardiovasc Thorac Surg 2016; 23:358-66. [PMID: 27230537 DOI: 10.1093/icvts/ivw160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/01/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Lung auto-transplantation is the surgical key step in experiments involving ex vivo therapy of severe or end-stage lung diseases. Ex vivo therapy has become a clinical reality because of systems such as the Organ Care System (OCS) Lung, which is the only commercially available portable lung perfusion system. However, survival experiments involving porcine lung auto-transplantation pose special surgical and anaesthesiological challenges. This current study was designed to describe the development of surgical techniques and aneasthesiological management strategies that facilitate lung auto-transplantation survival surgery including a follow-up period of 4 days. METHODS Left pneumonectomy was performed in 12 Mini-Lewe miniature pigs. After ex vivo treatment of the harvested lungs within the OCS Lung for 2 h, the lungs were retransplanted into the same animal (auto-transplantation). Four animals were used to develop the optimal techniques and establish an experimental protocol. According to the final protocol, eight additional animals were operated. The follow-up period was 4 days. RESULTS There were four severe intraoperative surgical complications [anatomical variant of the superior vena cava (two times), a complication related to the bronchial anastomosis and a complication related to the pulmonary arterial anastomosis]. The major postoperative problems were hyperkalaemia, prolonged recovery from anaesthesia and pulmonary oedema after reperfusion. Establishment of the surgical technique showed that using a pericardial tube to facilitate the anastomosis of the thin left superior pulmonary vein should be considered to prevent thrombosis. However, routine use of the patch technique to construct venous and arterial anastomoses is not necessary. Furthermore, traction on the venous anastomoses can be avoided by performing the bronchial anastomosis first. CONCLUSIONS Lung auto-transplantation is a feasible experimental model for ex vivo therapy of lung diseases and is applicable for experimental questions concerning human lung transplantation.
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Affiliation(s)
- Marcus Krüger
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Norman Zinne
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Biancosino
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Klaus Höffler
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Taufiek K Rajab
- Division of Cardiac Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Karl-Heinz Waldmann
- Clinic for Swine and Small Ruminants, Forensic Medicine and Ambulatory Service, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Danny Jonigk
- Department of Pathology, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Doris Hoeltig
- Clinic for Swine and Small Ruminants, Forensic Medicine and Ambulatory Service, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
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