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Jiang T, Su H, Xu J, Li C, Zhang N, Li Y, Wu Y, Ni R, Ming Y, Li Z, Li L, Liu Y. Drug-induced interstitial lung disease: a real-world pharmacovigilance study of the FDA Adverse Event Reporting System from 2004 to 2021. Ther Adv Drug Saf 2024; 15:20420986231224227. [PMID: 38293566 PMCID: PMC10823853 DOI: 10.1177/20420986231224227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/15/2023] [Indexed: 02/01/2024] Open
Abstract
Background Drug-induced interstitial lung disease (DILD) is an increasingly common cause of morbidity and mortality. However, due to the lack of specificity, DILD detection remains an unsolved public health challenge. Objectives For the first time, we aimed to examine DILD reports submitted to the Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) to identify demographic characteristics and top drugs associated with DILD at a group level (including age, sex, drug class, and country stratification) and individual drug level. Design A retrospective analysis of the FAERS database was examined by disproportionality analysis. Methods We reviewed the FAERS database from 2004 to 2021, using search terms 'interstitial lung disease' and sorting cases by generic drug name. The reporting odds ratio, proportional reporting ratio, and Bayesian confidence propagation neural network were calculated as the measure of strength of association. Results There were 32,821 DILD reports in the FAERS. After excluding reports without age, sex, or country data according to the specific measurement, the median age of patients was 68 (interquartile range: 59), 54.77% were male, and 46.00% of reports came from Japan. The top drug classes related to DILD in the FAERS were antineoplastic, followed by cardiovascular and antirheumatic agents, in varying order in different sexes. Fam-trastuzumab deruxtecan-nxki, ramucirumab, and eribulin were the top three drugs with the highest strength of association. We also found some drugs without DILD in the labels, such as amiodarone, temsirolimus, and ursodiol. There are significant differences in DILD reports in various countries. For example, the United States and France reported more cardiovascular agents, whereas Canada reported more antirheumatic agents. Conclusion We found the top drugs and drug classes that were associated with DILD in the FAERS, which provides a real-world window for different ages, sexes, and countries to formulate precise pharmacovigilance policies.
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Affiliation(s)
- Tingting Jiang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Hui Su
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Jing Xu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Chen Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Ni Zhang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yanping Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yuanlin Wu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Rui Ni
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yue Ming
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Ziwei Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Li Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yao Liu
- Department of Pharmacy, Daping Hospital, Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing 400042, China
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Jin D, Le J, Yang Q, Cai Q, Dai H, Luo L, Tong J, Shu W. Pneumocystis jirovecii with high probability detected in bronchoalveolar lavage fluid of chemotherapy-related interstitial pneumonia in patients with lymphoma using metagenomic next-generation sequencing technology. Infect Agent Cancer 2023; 18:80. [PMID: 38057898 DOI: 10.1186/s13027-023-00556-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Previous studies achieved low microbial detection rates in lymphoma patients with interstitial pneumonia (IP) after chemotherapy. However, the metagenomic next-generation sequencing (mNGS) is a comprehensive approach that is expected to improve the pathogen identification rate. Thus far, reports on the use of mNGS in lymphoma patients with chemotherapy-related IP remain scarce. In this study, we summarized the microbial detection outcomes of lymphoma patients with chemotherapy-related IP through mNGS testing of bronchoalveolar lavage fluid (BALF). METHODS Fifteen lymphoma patients with chemotherapy-related IP were tested for traditional laboratory microbiology, along with the mNGS of BALF. Then, the results of mNGS and traditional laboratory microbiology were compared. RESULTS Of the 15 enrolled patients, 11 received rituximab and 8 were administered doxorubicin hydrochloride liposome. The overall microbial yield was 93.3% (14/15) for mNGS versus 13.3% (2/15) for traditional culture methods (P ≤ 0.05). The most frequently detected pathogens were Pneumocystis jirovecii (12/15, 80%), Cytomegalovirus (4/15, 26.7%), and Epstein-Barr virus (3/15, 20%). Mixed infections were detected in 10 cases. Five patients recovered after the treatment with antibiotics alone without glucocorticoids. CONCLUSION Our findings obtained through mNGS testing of BALF suggested a high microbial detection rate in lymphoma patients with IP after chemotherapy. Notably, there was an especially high detection rate of Pneumocystis jirovecii. The application of mNGS in patients with chemotherapy-related IP was more sensitive.
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Affiliation(s)
- Dian Jin
- Department of Hematology, Ningbo Medical Treatment Center Li Huili Hospital, No.1111, Jiangnan road, Ningbo, 315010, China
| | - Jing Le
- Department of Hematology, Ningbo Medical Treatment Center Li Huili Hospital, No.1111, Jiangnan road, Ningbo, 315010, China
| | - Qianqian Yang
- Department of Hematology, Ningbo Medical Treatment Center Li Huili Hospital, No.1111, Jiangnan road, Ningbo, 315010, China
| | - Qianqian Cai
- Department of Hematology, Ningbo Medical Treatment Center Li Huili Hospital, No.1111, Jiangnan road, Ningbo, 315010, China
| | - Hui Dai
- Department of Hematology, Ningbo Medical Treatment Center Li Huili Hospital, No.1111, Jiangnan road, Ningbo, 315010, China
| | - Liufei Luo
- Department of Hematology, Ningbo Medical Treatment Center Li Huili Hospital, No.1111, Jiangnan road, Ningbo, 315010, China
| | - Jiaqi Tong
- Department of Hematology, Ningbo Medical Treatment Center Li Huili Hospital, No.1111, Jiangnan road, Ningbo, 315010, China
| | - Wenxiu Shu
- Department of Hematology, Ningbo Medical Treatment Center Li Huili Hospital, No.1111, Jiangnan road, Ningbo, 315010, China.
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Adverse effects of biologic anti-inflammatory agents on the respiratory system: A review. Afr J Thorac Crit Care Med 2021; 27. [PMID: 34430870 PMCID: PMC8327682 DOI: 10.7196/ajtccm.2021.v27i2.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
The therapy of autoimmune rheumatological conditions has undergone significant changes with the introduction of biologic antiinflammatory agents including cytokine antagonists and agents that interfere with the function of T and B cells or those that inhibit
intracellular enzymes such as Janus kinase (JAK). Although useful to control inflammation, these agents may be associated with druginduced lung disease, which may be difficult to differentiate from pulmonary disorders caused by the underlying autoimmune diseases.
This review aims to provide a description of lung disease, both infectious and non-infectious, that may be induced by the administration of
biologic anti-inflammatory agents with emphasis on inhibitors of tumour necrosis factor, interleukin-1, interleukin-6 and JAK.
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Zhao Z, He Z, Huang H, Chen J, He S, Yilihamu A, Nie Y. Drug-induced Interstitial Lung Disease in Breast Cancer Patients: A Lesson We Should Learn From Multi-Disciplinary Integration. BIO INTEGRATION 2020. [DOI: 10.15212/bioi-2020-0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Abstract Taxanes represented by paclitaxel and targeted therapy including trastuzumab are two common agents for human epidermal growth factor receptor-2 (HER-2)-positive breast cancer patients. Effectiveness, however, usually comes at the cost of many side effects, some of
which are even fatal. Drug-induced interstitial lung diseases (DILDs) comprise a group of drug-induced pulmonary injuries usually caused by using these medications. For DILDs, systemic therapy can be harmful to lung tissues and rapidly threaten the lives of some breast cancer patients. Through
the cases from our hospital and related studies in medical databases, we hope readers can learn a lesson from an angle of multi-disciplinary integration based on clinical practice and pharmacological mechanisms to make anti-cancer agents less harmful and reduce the incidence of DILD in breast
cancer patients during systemic therapy.
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Affiliation(s)
- Zijun Zhao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, P.R. China
| | - Zhanghai He
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, P.R. China
| | - Hongyan Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, P.R. China
| | - Jiewen Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, P.R. China
| | - Shishi He
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, P.R. China
| | - Ailifeire Yilihamu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, P.R. China
| | - Yan Nie
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang West Road, Guangzhou 510120, P.R. China
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Distefano G, Fanzone L, Palermo M, Tiralongo F, Cosentino S, Inì C, Galioto F, Vancheri A, Torrisi SE, Mauro LA, Foti PV, Vancheri C, Palmucci S, Basile A. HRCT Patterns of Drug-Induced Interstitial Lung Diseases: A Review. Diagnostics (Basel) 2020; 10:diagnostics10040244. [PMID: 32331402 PMCID: PMC7236658 DOI: 10.3390/diagnostics10040244] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022] Open
Abstract
Interstitial Lung Diseases (ILDs) represent a heterogeneous group of pathologies, which may be related to different causes. A low percentage of these lung diseases may be secondary to the administration of drugs or substances. Through the PubMed database, an extensive search was performed in the fields of drug toxicity and interstitial lung disease. We have evaluated the different classes of drugs associated with pulmonary toxicity. Several different high resolution computed tomography (HRCT) patterns related to pulmonary drug toxicity have been reported in literature, and the most frequent ILDs patterns reported include Nonspecific Interstitial Pneumonia (NSIP), Usual Interstitial Pneumonia (UIP), Hypersensitivity Pneumonitis (HP), Organizing Pneumonia (OP), Acute Respiratory Distress Syndrome (ARDS), and Diffuse Alveolar Damage (DAD). Finally, from the electronic database of our Institute we have selected and commented on some cases of drug-induced lung diseases related to the administration of common drugs. As the imaging patterns are rarely specific, an accurate evaluation of the clinical history is required and a multidisciplinary approach—involving pneumologists, cardiologists, radiologists, pathologists, and rheumatologists—is recommended.
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Affiliation(s)
- Giulio Distefano
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (L.F.); (M.P.); (F.T.); (S.C.); (C.I.); (F.G.); (L.A.M.); (P.V.F.); (C.V.); (S.P.); (A.B.)
- Correspondence: ; Tel.: +39-338-5020-778
| | - Luigi Fanzone
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (L.F.); (M.P.); (F.T.); (S.C.); (C.I.); (F.G.); (L.A.M.); (P.V.F.); (C.V.); (S.P.); (A.B.)
| | - Monica Palermo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (L.F.); (M.P.); (F.T.); (S.C.); (C.I.); (F.G.); (L.A.M.); (P.V.F.); (C.V.); (S.P.); (A.B.)
| | - Francesco Tiralongo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (L.F.); (M.P.); (F.T.); (S.C.); (C.I.); (F.G.); (L.A.M.); (P.V.F.); (C.V.); (S.P.); (A.B.)
| | - Salvatore Cosentino
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (L.F.); (M.P.); (F.T.); (S.C.); (C.I.); (F.G.); (L.A.M.); (P.V.F.); (C.V.); (S.P.); (A.B.)
| | - Corrado Inì
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (L.F.); (M.P.); (F.T.); (S.C.); (C.I.); (F.G.); (L.A.M.); (P.V.F.); (C.V.); (S.P.); (A.B.)
| | - Federica Galioto
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (L.F.); (M.P.); (F.T.); (S.C.); (C.I.); (F.G.); (L.A.M.); (P.V.F.); (C.V.); (S.P.); (A.B.)
| | - Ada Vancheri
- Department of Clinical and Experimental Medicine, University of Catania, Regional Referral Centre for Rare Lung Disease, 95123 Catania, Italy; (A.V.); (S.E.T.)
| | - Sebastiano E. Torrisi
- Department of Clinical and Experimental Medicine, University of Catania, Regional Referral Centre for Rare Lung Disease, 95123 Catania, Italy; (A.V.); (S.E.T.)
| | - Letizia A. Mauro
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (L.F.); (M.P.); (F.T.); (S.C.); (C.I.); (F.G.); (L.A.M.); (P.V.F.); (C.V.); (S.P.); (A.B.)
| | - Pietro V. Foti
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (L.F.); (M.P.); (F.T.); (S.C.); (C.I.); (F.G.); (L.A.M.); (P.V.F.); (C.V.); (S.P.); (A.B.)
| | - Carlo Vancheri
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (L.F.); (M.P.); (F.T.); (S.C.); (C.I.); (F.G.); (L.A.M.); (P.V.F.); (C.V.); (S.P.); (A.B.)
| | - Stefano Palmucci
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (L.F.); (M.P.); (F.T.); (S.C.); (C.I.); (F.G.); (L.A.M.); (P.V.F.); (C.V.); (S.P.); (A.B.)
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-Vittorio Emanuele”, University of Catania, 95123 Catania, Italy; (L.F.); (M.P.); (F.T.); (S.C.); (C.I.); (F.G.); (L.A.M.); (P.V.F.); (C.V.); (S.P.); (A.B.)
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Lu Y, Li A, Lai X, Jiang J, Zhang L, Zhong Z, Zhao W, Tang P, Zhao H, Ren X. Identification of differentially expressed genes and signaling pathways using bioinformatics in interstitial lung disease due to tyrosine kinase inhibitors targeting the epidermal growth factor receptor. Invest New Drugs 2018; 37:384-400. [PMID: 30203136 DOI: 10.1007/s10637-018-0664-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Abstract
Interstitial lung disease (ILD) is a rare but lethal adverse effect of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) treatment. The specific mechanism of this disease is not fully understood. To systematically analyze genes associated with EGFR-TKI induced ILD, gene data of EGFR-TKI induced ILD were extracted initially using text mining, and then the intersection between genes from text mining and Gene Expression Omnibus (GEO) dataset was taken for further protein-protein interaction (PPI) analysis using String-bd database. Go ontology (GO) and pathway enrichment analysis was also conducted based on Database of Annotation, Visualization and Integrated Discovery (DAVID) platform. The PPI network generated by STRING was visualized by Cytoscape, and the topology scores, functional regions and gene annotations were analyzed using plugins of CytoNCA, molecular complex detection (MCODE) and ClueGo. 37 genes were identified as EGFR-TKI induced ILD related. Gene enrichment analysis yield 18 enriched GO terms and 12 associated pathways. A PPI network that included 199 interactions for a total of 35 genes was constructed. Ten genes were selected as hub genes using CytoNCA plugin, and four highly connected clusters were identified using MCODE plugin. GO and pathway annotation analysis for the cluster one revealed that five genes were associated with either response to dexamethasone or with lung fibrosis, including CTGF, CCL2, IGF1, EGFR and ICAM1. Our data might be useful to reveal the pathological mechanisms of EGFR-TKI induced ILD and provide evidence for the diagnosis and treatment in the future.
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Affiliation(s)
- Yuan Lu
- Department of Respiratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Xueyuan AVE 1098, Xili University Town, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Ang Li
- The State Key Laboratory of Cancer Biology, Department of Immunology, Air Force Military Medical University (Fourth Military Medical University), 169 Changle West Road, Xi'an, 710032, People's Republic of China
| | - Xiaofeng Lai
- Department of Clinical Genetics and Experimental Medicine, Fuzhou General Hospital, Xiamen University School of Medicine, Fuzhou, Fujian, 350025, People's Republic of China
| | - Jun Jiang
- Department of Respiratory, Xijing Hospital, Air Force Military Medical University (Fourth Military Medical University), Changle, West Road 127, Xi'an, 710032, People's Republic of China
| | - Lihong Zhang
- Department of Respiratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Xueyuan AVE 1098, Xili University Town, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Zhicheng Zhong
- Department of Respiratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Xueyuan AVE 1098, Xili University Town, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Wen Zhao
- Department of Respiratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Xueyuan AVE 1098, Xili University Town, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Ping Tang
- Department of Respiratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Xueyuan AVE 1098, Xili University Town, Shenzhen, 518055, Guangdong, People's Republic of China
| | - Hu Zhao
- Department of Urology, Fuzhou Dongfang Hospital, Xiamen University, Xierhuan Northern Road 156, Fuzhou, 350025, People's Republic of China.
| | - Xinling Ren
- Department of Respiratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Xueyuan AVE 1098, Xili University Town, Shenzhen, 518055, Guangdong, People's Republic of China.
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Abravan A, Eide HA, Knudtsen IS, Løndalen AM, Helland Å, Malinen E. Assessment of pulmonary 18F-FDG-PET uptake and cytokine profiles in non-small cell lung cancer patients treated with radiotherapy and erlotinib. Clin Transl Radiat Oncol 2017; 4:57-63. [PMID: 29594209 PMCID: PMC5833916 DOI: 10.1016/j.ctro.2017.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/31/2017] [Accepted: 04/01/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose To investigate effects of radiotherapy (RT) and erlotinib on pulmonary glucose uptake using 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) positron emission tomography (PET) during and after treatment of non-small cell lung cancer (NSCLC) and to identify associations between serum cytokine levels and lung glucose uptake. Material and methods Twenty-seven patients with advanced NSCLC, receiving RT alone or concomitant RT and erlotinib therapy, were examined by 18F-FDG PET before, during, and after treatment. A total of 57 18F-FDG PET scans were analyzed. Pulmonary 18F-FDG uptake and radiotherapy dose mapping were used to acquire dose-response curves for each patient, where subsequent linear regression gave a glucose uptake level in the un-irradiated parts of the lungs (SUV0) and a response slope (ΔSUV). Serum cytokine levels at corresponding time points were assessed using a multiplex bioassay. Correlations between the most robust cytokines and lung 18F-FDG dose response parameters were further investigated. Results From the dose response analysis, SUV0 at post-therapy was significantly higher (P < 0.001) than at mid- and pre-therapy (45% and 58%, respectively) for the group receiving RT + erlotinib. Also, SUV0 at post-therapy was higher for patients receiving RT + erlotinib compared to RT alone (42%; P < 0.001). No differences in ΔSUV were seen with treatments or time. SUV0 was positively associated (r = 0.47, P = 0.01) with serum levels of the chemokine C-C motif ligand 21 (CCL21) for patients receiving RT + erlotinib. Conclusions Concomitant RT and erlotinib causes an elevation in pulmonary 18F-FDG uptake post treatment compared to RT alone. Pulmonary glucose uptake is associated with an upregulation of a chemokine (CCL21) involved in inflammatory reactions.
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Key Words
- 18F-FDG
- 18F-FDG, 2-deoxy-2-(18F)fluoro-D-glucose
- CCL, Chemokine (CC motif) ligand
- CT, Computed tomography
- EGFR, Epidermal growth factor receptor
- EORTC QLQ-C30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30
- EORTC QLQ-LC13, EORTC QLQ Lung Cancer 13
- Erlotinib
- GTV, Gross tumor volume
- HU, Hounsfield Unit
- IL, Interleukin
- Lung cancer
- MMP, Matrix metalloproteinase
- NSCLC, Non-small cell lung cancer
- PET, Positron emission tomography
- Positron emission tomography
- RILT, Radiation induced lung toxicity
- RT, Radiotherapy
- SUV, Standard uptake value
- Standardized uptake value
- Thoracic radiotherapy
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Affiliation(s)
- Azadeh Abravan
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway.,Department of Physics, University of Oslo, Oslo, Norway
| | - Hanne Astrid Eide
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Ingerid Skjei Knudtsen
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway.,Department of Physics, University of Oslo, Oslo, Norway
| | | | - Åslaug Helland
- Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.,Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Eirik Malinen
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway.,Department of Physics, University of Oslo, Oslo, Norway
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Holguin F, Rubió-Casadevall J, Saigi M, Marruecos J, Taberna M, Tobed M, Maños M, Mesía R. Cetuximab as treatment for head and neck cancer patients with a previous liver transplant: report of two cases. J Chemother 2016; 29:310-313. [PMID: 27380218 DOI: 10.1080/1120009x.2016.1187360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cetuximab is a monoclonal antibody against epidermal growth factor receptor useful in the treatment of patients with Head and Neck Squamous Cell Carcinoma combined with radiotherapy or chemotherapy. Its pharmacokinetics are not influenced by hepatic status and there are no specific warnings concerning its indication in patients with impaired hepatic function. Patients with a previous liver transplant are at risk for hepatic toxicity and use immunosupressants to avoid rejection that can interact with other drugs. We present two cases of patients with a previous liver transplant in which cetuximab was administered to treat head and neck cancer.
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Affiliation(s)
- Francia Holguin
- a Deparment of Medical Oncology, Catalan Institute of Oncology , Hospital JosepTrueta , Girona , Spain
| | - Jordi Rubió-Casadevall
- a Deparment of Medical Oncology, Catalan Institute of Oncology , Hospital JosepTrueta , Girona , Spain.,b Descriptive Epidemiology, Genetics and Cancer Prevention Group , Biomedical Research Institute (IDIBGI) , Girona , Spain
| | - Maria Saigi
- c Deparment of Medical Oncology, Catalan Institute of Oncology , Hospital Duran I Reynalds , L'Hospitalet de LLobregat, Barcelona , Spain
| | - Jordi Marruecos
- d Deparment of Radiotherapy, Catalan Institute of Oncology , Hospital JosepTrueta , Girona , Spain
| | - Miren Taberna
- c Deparment of Medical Oncology, Catalan Institute of Oncology , Hospital Duran I Reynalds , L'Hospitalet de LLobregat, Barcelona , Spain
| | - Marc Tobed
- e Deparment of Otorhinolaringology , Hospital Universitari JosepTrueta , Servei Català de la Salut, Girona , Spain
| | - Manuel Maños
- f Deparment of Otorhinolaringology , Hospital Universitari de Bellvitge, University of Barcelona , Servei Català de la Salut, Barcelona , Spain.,g Medical Oncology Department , Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) , Hospitalet de LLobregat, Barcelona , Spain
| | - Ricard Mesía
- c Deparment of Medical Oncology, Catalan Institute of Oncology , Hospital Duran I Reynalds , L'Hospitalet de LLobregat, Barcelona , Spain.,g Medical Oncology Department , Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) , Hospitalet de LLobregat, Barcelona , Spain
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Effect of rituximab on pulmonary function in patients with rheumatoid arthritis. Pulm Pharmacol Ther 2016; 37:24-9. [PMID: 26869014 DOI: 10.1016/j.pupt.2016.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/07/2016] [Accepted: 02/06/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rituximab (RTX), a B-cell depleting monoclonal antibody is increasingly used in several antibody-mediated diseases. It has been reported to cause pulmonary toxicity, though mainly during polychemotherapy of malignant lymphoma. Prospective data on RTX-induced pulmonary complications in patients with rheumatoid arthritis (RA) are lacking. METHODS AND METHODS Serial spirometries and measurements of diffusion capacity of the lung for carbon monoxide (DLCO) in patients with RA before and 2, 4, 8, and 26 weeks after treatment with RTX were performed. A reduction from baseline of forced vital capacity (FVC) of ≥10%, or ≥15% of DLCO was defined as indicative for pulmonary toxicity. RESULTS Thirty-three patients (mean (SD) age 59 (12) years, 27% males) were included. Mean (SD) FVC predicted and DLCO predicted at baseline were 108% (18%) and 88% (18%), respectively. In contrast to FVC, DLCO showed a progressive decline during follow-up with a maximum reduction of 6.1% (95%CI 2.5%, 9.7%; p = 0.001) at 26 weeks compared with baseline. After 26 weeks, 22% of the patients had a ≥15% DLCO decline. None of the patients reported increased dyspnea during follow-up. Risk factors for pulmonary function changes after treatment with RTX were cigarette smoking, repeated administration of the drug, and co-medication with Prednisone. CONCLUSION Although no cases of symptomatic lung injury were observed, the progressive DLCO decline seems to indicate the presence of subclinical RTX-induced pulmonary toxicity.
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Gharwan H, Groninger H. Kinase inhibitors and monoclonal antibodies in oncology: clinical implications. Nat Rev Clin Oncol 2015; 13:209-27. [PMID: 26718105 DOI: 10.1038/nrclinonc.2015.213] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Molecularly targeted cancer therapies, such as small-molecule kinase inhibitors and monoclonal antibodies, constitute a rapidly growing and an important part of the oncology armamentarium. Unlike conventional (cytotoxic) chemotherapeutics, targeted therapies were designed to disrupt cancer cell pathogenesis at specific biological points essential for the development and progression of the tumour. These agents were developed to disrupt specific targets with the aim of minimizing treatment burden compared with conventional chemotherapy. Nevertheless the increasingly common use of targeted therapies has revealed some unanticipated, often clinically significant toxic effects, as well as compromising effective palliative and end-of-life management approaches. Although patients and clinicians welcome improvements in cancer prognosis, these changes can also impact patient quality-of-life. Therefore, as demand for oncology expertise increases, physicians need to apprise themselves of targeted therapies and their clinical implications, including drug-specific side effects, impact on quality of life, and cost issues, especially in relation to end-of-life care. This Review provides a useful summary and guide for professionals treating patients with malignant diseases.
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Affiliation(s)
- Helen Gharwan
- Medical Oncology, National Cancer Institute, National Institutes of Health, 10 Center Drive, Building 10, Room 12N226, Bethesda, Maryland 20892-1906, USA
| | - Hunter Groninger
- Section of Palliative Care, Department of Medicine, MedStar Washington Hospital Center, 110 Irving Street NW, Room 2A-68, Washington, District of Columbia 20008, USA
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Zaglool SS, Zickri MB, Abd El Aziz DH, Mabrouk D, Metwally HG. Effect of stem cell therapy on amiodarone induced fibrosing interstitial lung disease in albino rat. Int J Stem Cells 2013; 4:133-42. [PMID: 24298346 DOI: 10.15283/ijsc.2011.4.2.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2011] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The fibrosing forms of interstitial lung disease (ILD) are associated with significant morbidity and mortality. ILD may be idiopathic, secondary to occupational, infection, complicate rheumatic diseases or drug induced. Efficacy of antifibrotic agents is as far as, limited and uncertain. No effective treatment was confirmed for pulmonary fibrosis except lung transplantation. The present study aimed at investigating the possible effect of human cord blood mesenchymal stem cell (MSC) therapy on fibrosing ILD. This was accomplished by using amiodarone as a model of induced lung damage in albino rat. METHODS AND RESULTS Seventeen adult male albino rats were divided into 3 groups. Rats of amiodarone group were given 30 mg/kg of amiodarone orally 6 days/ week for 6 weeks. Rats of stem cell therapy group were injected with stem cells in the tail vein following confirmation of lung damage and left for 4 weeks before sacrifice. Obstructed bronchioles, thickened interalveolar septa and thickened wall of pulmonary vessels were found and proved morphometrically. Reduced type I pneumocytes and increased area% of collagen fibers were recorded. All findings regressed on stem cell therapy. CONCLUSIONS Cord blood MSC therapy proved definite amelioration of fibrosing interstitial lung disease provided therapy starts early in the development of the pathogenesis.
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Hart PA, Topazian MD, Witzig TE, Clain JE, Gleeson FC, Klebig RR, Levy MJ, Pearson RK, Petersen BT, Smyrk TC, Sugumar A, Takahashi N, Vege SS, Chari ST. Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: the Mayo Clinic experience. Gut 2013; 62:1607-15. [PMID: 22936672 DOI: 10.1136/gutjnl-2012-302886] [Citation(s) in RCA: 244] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is a paucity of data on long-term management of type 1 autoimmune pancreatitis (AIP), a relapsing steroid-responsive disorder. OBJECTIVE We describe our experience with treatment of relapses and maintenance of remission using steroid-sparing immunomodulators (IMs) and induction of remission using rituximab (RTX). METHODS We obtained details of disease relapse and treatment in 116 type 1 AIP patients from clinic visits, medical records and telephone interviews. We compared relapse free survival in those treated with IMs versus those treated with steroids alone, assessed patients' response to RTX, and identified treatment-related complications. RESULTS During a median follow-up of 47 months, 52/116 AIP patients experienced 76 relapse episodes. The first relapse was treated with another course of steroids in 24 patients, and with steroids plus IM in another 27 patients; subsequent relapse-free survival until a second relapse was similar in the two groups (p=0.23). 38 patients received an IM for >2 months; failure or intolerance of IM therapy occurred in 17 (45%). 12 patients with steroid or IM intolerance/resistance were treated with RTX, an antiCD20 antibody; 10 (83%) experienced complete remission and had no relapses while on maintenance therapy. Treatment-limiting side effects related to RTX were uncommon. CONCLUSIONS In type 1 AIP relapses are common. Relapse-free survival is similar in those treated with steroids plus IM compared to those treated with steroids alone. Nearly half the patients on IMs will relapse during treatment. RTX is effective in the treatment of both IM resistant and steroid intolerant patients.
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Affiliation(s)
- Phil A Hart
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Yamada T, Moriwaki T, Matsuda K, Yamamoto Y, Sugaya A, Akutsu D, Murashita T, Endo S, Hyodo I. Panitumumab-induced interstitial lung disease in a case of metastatic colorectal cancer. ACTA ACUST UNITED AC 2013; 36:209-12. [PMID: 23548971 DOI: 10.1159/000349959] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A Japanese postmarketing survey of panitumumab revealed that panitumumab-associated interstitial lung disease (ILD) occurred in approximately 1% (19/1767) of patients, causing death in 36.8% of these cases. CASE REPORT We report the case of a 60-year-old Japanese man who developed ILD associated with panitumumab therapy (third-line therapy) for metastatic sigmoid colon cancer involving the liver, lymph nodes, and lungs. 2 months after the initiation of panitumumab therapy, he developed a progressive nonproductive cough, dyspnea, and a fever, and was diagnosed with ILD. Intravenous pulse methylprednisolone treatment led to quick recovery. The patient had some risk factors for ILD associated with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors. CONCLUSION Further studies are required to elucidate the association between anti-EGFR antibodies and ILD.
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Affiliation(s)
- Takeshi Yamada
- Division of Gastroenterology, Tsukuba University Hospital, Ibaraki, Japan
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15
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Vargas HM, Amouzadeh HR, Engwall MJ. Nonclinical strategy considerations for safety pharmacology: evaluation of biopharmaceuticals. Expert Opin Drug Saf 2012; 12:91-102. [DOI: 10.1517/14740338.2013.745851] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schwaiblmair M, Behr W, Haeckel T, Märkl B, Foerg W, Berghaus T. Drug induced interstitial lung disease. Open Respir Med J 2012; 6:63-74. [PMID: 22896776 PMCID: PMC3415629 DOI: 10.2174/1874306401206010063] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/06/2012] [Accepted: 07/06/2012] [Indexed: 01/15/2023] Open
Abstract
With an increasing number of therapeutic drugs, the list of drugs that is responsible for severe pulmonary disease also grows. Many drugs have been associated with pulmonary complications of various types, including interstitial inflammation and fibrosis, bronchospasm, pulmonary edema, and pleural effusions. Drug-induced interstitial lung disease (DILD) can be caused by chemotherapeutic agents, antibiotics, antiarrhythmic drugs, and immunosuppressive agents. There are no distinct physiologic, radiographic or pathologic patterns of DILD, and the diagnosis is usually made when a patient with interstitial lung disease (ILD) is exposed to a medication known to result in lung disease. Other causes of ILD must be excluded. Treatment is avoidance of further exposure and systemic corticosteroids in patients with progressive or disabling disease.
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Affiliation(s)
- Martin Schwaiblmair
- Department of Internal Medicine I, Klinikum Augsburg, Ludwig-Maximilians-University of Munich, Germany
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Zaidan M, Mariotte E, Galicier L, Arnulf B, Meignin V, Vérine J, Mahr A, Azoulay É. Vasculitic emergencies in the intensive care unit: a special focus on cryoglobulinemic vasculitis. Ann Intensive Care 2012; 2:31. [PMID: 22812447 PMCID: PMC3488028 DOI: 10.1186/2110-5820-2-31] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 06/24/2012] [Indexed: 12/25/2022] Open
Abstract
Vasculitis is characterized by the infiltration of vessel walls by inflammatory leukocytes with reactive damage and subsequent loss of vessel integrity. The clinical course of systemic vasculitis may be punctuated by acute life-threatening manifestations that require intensive care unit (ICU) admission. Furthermore, the diagnosis may be established in the ICU after admission for a severe inaugural symptom, mostly acute respiratory failure. Among the systemic vasculitides, cryoglobulinemic vasculitis (CV) has been rarely studied in an ICU setting. Severe CV-related complications may involve the kidneys, lungs, heart, gut, and/or central nervous system. The diagnosis of CV in the ICU may be delayed or completely unrecognized. A high level of suspicion is critical to obtain a timely and accurate diagnosis and to initiate appropriate treatment. We describe severe acute manifestations of CV based on six selected patients admitted to our ICU. That all six patients survived suggests the benefit of prompt ICU admission of patients with severe CV.
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Affiliation(s)
- Mohamad Zaidan
- Department of Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
| | - Eric Mariotte
- Department of Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
| | - Lionel Galicier
- Department of Clinical Immunology, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
| | - Bertrand Arnulf
- Department of Immuno-Hematology, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
| | - Véronique Meignin
- Department of Pathology, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
| | - Jérôme Vérine
- Department of Pathology, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
| | - Alfred Mahr
- Department of Internal Medicine, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
| | - Élie Azoulay
- Department of Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris-7 Diderot, Paris, France
- AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, France
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Bugelski PJ, Martin PL. Concordance of preclinical and clinical pharmacology and toxicology of therapeutic monoclonal antibodies and fusion proteins: cell surface targets. Br J Pharmacol 2012; 166:823-46. [PMID: 22168282 PMCID: PMC3417412 DOI: 10.1111/j.1476-5381.2011.01811.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 10/14/2011] [Accepted: 11/28/2011] [Indexed: 12/20/2022] Open
Abstract
Monoclonal antibodies (mAbs) and fusion proteins directed towards cell surface targets make an important contribution to the treatment of disease. The purpose of this review was to correlate the clinical and preclinical data on the 15 currently approved mAbs and fusion proteins targeted to the cell surface. The principal sources used to gather data were: the peer reviewed Literature; European Medicines Agency 'Scientific Discussions'; and the US Food and Drug Administration 'Pharmacology/Toxicology Reviews' and package inserts (United States Prescribing Information). Data on the 15 approved biopharmaceuticals were included: abatacept; abciximab; alefacept; alemtuzumab; basiliximab; cetuximab; daclizumab; efalizumab; ipilimumab; muromonab; natalizumab; panitumumab; rituximab; tocilizumab; and trastuzumab. For statistical analysis of concordance, data from these 15 were combined with data on the approved mAbs and fusion proteins directed towards soluble targets. Good concordance with human pharmacodynamics was found for mice receiving surrogates or non-human primates (NHPs) receiving the human pharmaceutical. In contrast, there was poor concordance for human pharmacodynamics in genetically deficient mice and for human adverse effects in all three test systems. No evidence that NHPs have superior predictive value was found.
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Affiliation(s)
- Peter J Bugelski
- Biologics Toxicology, Janssen Research & Development, division of Johnson & Johnson Pharmaceutical Research & Development, LLC, Radnor, PA 19087, USA
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Shen T, Braude S. Obliterative bronchiolitis after rituximab administration: a new manifestation of rituximab-associated pulmonary toxicity. Intern Med J 2012; 42:597-9. [DOI: 10.1111/j.1445-5994.2012.02778.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kim MJ, Lee GW, Seo JW, Kim HJ, Lim SN, Suh C. Fatal interstitial pneumonitis in a patient with relapsed diffuse large B cell lymphoma following yttrium-90 ibritumomab tiuxetan. Invest New Drugs 2010; 29:1098-101. [PMID: 20490611 DOI: 10.1007/s10637-010-9460-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 05/12/2010] [Indexed: 12/15/2022]
Abstract
There is no previous report of fatal interstitial pneumonitis related to the administration of yttirum-90 ibritumomab tiuxetan. We report first case of fatal interstitial pneumonitis in a 35-year-old female patient with relapsed diffuse large B cell lymphoma following yttrium-90 ibritumomab tiuxetan. A pathological evaluation through a surgical lung biopsy demonstrated a "interstitial pneumonitis" pattern. Although high-dose methylprednisolone was administered, she died due to acute respiratory distress syndrome, secondary to radioimmunotherapy-induced interstitial pneumonitis. In this report, we discuss the etiology, diagnosis, and management of radioimmunotherapy-induced interstitial pneumonitis.
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Affiliation(s)
- Moon Jin Kim
- Department of Internal Medicine, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea
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