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Baig J, Shokouh-Amiri M, Chan J, Chowdhery R, Danthurthy S, Venepalli NK. The Spectrum of Pulmonary Toxicity in Pancreatic Cancer Patients Receiving Gemcitabine Combination Chemotherapy. Case Rep Oncol 2019; 12:506-512. [PMID: 31341464 PMCID: PMC6639581 DOI: 10.1159/000500242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 11/19/2022] Open
Abstract
Gemcitabine is widely utilized in the treatment of pancreatic, ovarian, and non small cell lung cancers. Gemcitabine is associated with a wide spectrum of lung toxicities, ranging from dyspnea 25% of patients to severe pulmonary toxicity in up to 5% of patients. There is a dearth of information specific to pulmonary toxicity in the setting of gemcitabine combination chemotherapy. Given the potential severity, it is important to identify it early by excluding more common etiologies. We share two case reports of patients with pancreatic cancer who developed severe pulmonary toxicity during gemcitabine combination chemotherapy. Both cases emphasize the heightened risk of pulmonary toxicity in patients receiving gemcitabine chemotherapy combinations, and a need to be vigilant to initiate appropriate therapies immediately.
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Affiliation(s)
- Jalal Baig
- Department of Medicine, Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mohammad Shokouh-Amiri
- Department of Medicine, Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Juliana Chan
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Rozina Chowdhery
- Department of Medicine, Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Samaya Danthurthy
- Department of Medicine, Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Neeta K Venepalli
- Department of Medicine, Division of Hematology/Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
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The combination of HLA-B*15:01 and DRB1*15:01 is associated with gemcitabine plus erlotinib-induced interstitial lung disease in patients with advanced pancreatic cancer. Cancer Chemother Pharmacol 2016; 77:1165-70. [PMID: 27100735 PMCID: PMC4882349 DOI: 10.1007/s00280-016-3026-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/28/2016] [Indexed: 11/17/2022]
Abstract
Purpose In a phase III study of gemcitabine plus erlotinib for advanced pancreatic cancer conducted in Canada, the incidence of interstitial lung disease (ILD) was 3.5 %. However, the incidence of ILD was reported as high as 8.5 % in a Japanese phase II study. These results suggest the influence of ethnic factors in the association of the use of gemcitabine plus erlotinib with the incidence of ILD. Here, we conducted a prospective study to analyze the relationship between human leukocyte antigen (HLA) alleles and ILD in Japanese patients with advanced pancreatic cancer receiving gemcitabine plus erlotinib. Methods Patients were treated with gemcitabine (1000 mg/m2; administered by intravenous infusion on days 1, 8, and 15 every 4 weeks) and erlotinib (given orally at 100 mg/day). We compared the frequencies of HLA alleles in patients who did and did not develop ILD. Results A total of 57 patients were treated, and 4 patients (7.0 %) developed ILD. The combination of HLA-B*15:01 and DRB1*15:01 was observed in 2 of 4 patients (50 %) with ILD and in only 1 of 53 patients without ILD (2 %) resulting in odds ratio of 52.0 (95 % CI 3.2–842.5; p = 0.011). Conclusion These results suggest that the combination of HLA-B*15:01 and DRB1*15:01 is associated with ILD in Japanese patients with advanced pancreatic cancer receiving gemcitabine plus erlotinib. Electronic supplementary material The online version of this article (doi:10.1007/s00280-016-3026-6) contains supplementary material, which is available to authorized users.
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Hamada T, Yasunaga H, Nakai Y, Isayama H, Matsui H, Fushimi K, Koike K. Interstitial lung disease associated with gemcitabine: A Japanese retrospective cohort study. Respirology 2015; 21:338-43. [PMID: 26775618 DOI: 10.1111/resp.12665] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/29/2015] [Accepted: 07/31/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Interstitial lung disease (ILD) is a widely recognized adverse consequence of gemcitabine administration, but data on gemcitabine-associated ILD are limited. This study aimed to elucidate the incidence and risk factors for this adverse event. METHODS Patients who underwent gemcitabine-based chemotherapy between July 2010 and March 2013 were retrospectively identified using a Japanese nationwide administrative database. ILD was defined according to the International Classification of Diseases and Related Health Problems 10th Revision, codes: J70.2-70.4, J84.1 and J84.9. The cumulative incidence and risk factors for ILD were evaluated using a competing risk analysis. RESULTS In total, 25 924 patients who underwent gemcitabine-based chemotherapy were identified from 331 hospitals (primary cancer; pancreatic, urothelial, biliary tract, lung, ovarian and breast, in 9070, 5578, 4803, 4388, 1339 and746 patients, respectively). ILD was observed in 428 patients (1.7%), and the cumulative incidence was estimated at 1.1% (95% CI: 1.0-1.2%), 1.5% (95% CI: 1.4-1.7%) and 1.9% (95% CI: 1.7-2.1%) at 3, 6 and 12 months, respectively. In the multivariable regression model, age >80 years and lung cancer were the strongest predictors for ILD (subdistribution hazard ratio (SHR), 2.61; 95% CI: 1.69-4.02 and SHR, 2.81; 95% CI: 2.16-3.65, respectively). Other significant risk factors included heavy smoking, prior chemotherapy and advanced cancer stage. CONCLUSION This study successfully demonstrated the clinical course of gemcitabine-associated ILD. Clinical oncologists should stratify individual patients for risk of ILD based on identified risk factors and fully consider the indication for gemcitabine-based chemotherapy.
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Affiliation(s)
- Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Care Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Sahin IH, Geyer AI, Kelly DW, O'Reilly EM. Gemcitabine-Related Pneumonitis in Pancreas Adenocarcinoma--An Infrequent Event: Elucidation of Risk Factors and Management Implications. Clin Colorectal Cancer 2015; 15:24-31. [PMID: 26395520 DOI: 10.1016/j.clcc.2015.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 07/28/2015] [Accepted: 08/10/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Gemcitabine-related pneumonitis (GRP) has been reported relatively frequently for pancreas cancer in the literature; however, underlying risk factors and optimal management remain to be defined. We studied a cohort of patients with GRP and investigated potential predisposing factors in pancreatic cancer patients. PATIENTS AND METHODS A total 2440 patients at Memorial Sloan Kettering Cancer Center were identified between January 1, 2000, and December 31, 2012, and were screened for grade 2 or higher GRP in an institutional tumor registry and using an ICD billing code database. Demographic and clinical information was extracted by electronic chart review. RESULTS A total of 28 patients (1.1%) with GRP were identified. Incidence of grade 2, 3, and 4 reactions were 7 (25%), 18 (64%), and 3 (11%), respectively. No GRP-related mortality was observed. Twenty-one patients (75%) reported a history of cigarette smoking. Seventeen patients (61%) were alcohol users. Six patients (21%) were either regular or heavy drinkers. Most patients (93%) had either locally advanced or metastatic disease. Three patients (11%) underwent a diagnostic bronchoscopy, and in 1 patient a diagnosis of organizing pneumonia was established. Morbidity was significant; 3 patients (11%) required treatment in the intensive care unit. All hospitalized patients received steroid treatment. CONCLUSION GRP is relatively uncommon but incurs significant morbidity. Potential risk factors include advanced-stage disease, along with smoking and alcohol consumption and possibly underlying lung disease. We recommend a high level of clinical alertness regarding the diagnosis, early pulmonary referral, and cessation of gemcitabine on suspicion of GRP.
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Affiliation(s)
- Ibrahim Halil Sahin
- Mount Sinai Icahn School of Medicine, St Luke's Roosevelt Hospital Center, New York, NY
| | - Alexander I Geyer
- Memorial Sloan Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY
| | - Daniel W Kelly
- Memorial Sloan Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY
| | - Eileen Mary O'Reilly
- Memorial Sloan Kettering Cancer Center, Weill Medical College of Cornell University, New York, NY.
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Erlotinib-associated interstitial lung disease in advanced pancreatic carcinoma: a case report and literature review. TUMORI JOURNAL 2015; 101:e122-7. [PMID: 25953445 DOI: 10.5301/tj.5000327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 12/25/2022]
Abstract
The combination of erlotinib and gemcitabine is a recognized option for patients with metastatic pancreatic cancer whose common adverse events such as skin rash, diarrhea, or fatigue are usually easily manageable. Interstitial lung disease (ILD) is a life-threatening toxicity reported in patients with non-small-cell lung cancers treated with epidermal growth factor receptor-tyrosine kinase inhibitors or gemcitabine. This side effect is extremely rare in patients with pancreatic cancer. We report fatal treatment-related ILD that occurred in a 67-year-old patient with metastatic pancreatic cancer. Risk factors and pathophysiology of ILD need further investigation but caution is highly recommended for patients with an underlying pulmonary disease when using erlotinib in monotherapy or combination therapy.
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Sherrod AM, Brufsky A, Puhalla S. A case of late-onset gemcitabine lung toxicity. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2011; 5:171-6. [PMID: 21695101 PMCID: PMC3117630 DOI: 10.4137/cmo.s6643] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Gemcitabine is a chemotherapeutic agent used for the treatment of a number of malignancies. Although its major dose-limiting side effect is myelosuppression, many pulmonary toxicities have been described with its use. Severe pulmonary toxicity is rare, but symptoms tend to be rapid in onset and potentially deadly. The average time from initiation of chemotherapy to onset of symptoms is less than two months. The most effective therapy is steroid administration, the efficacy of which has been variable. In this report, we describe a unique case of gemcitabine pulmonary toxicity in a patient who did not experience symptoms of pulmonary dysfunction until after 1 year of treatment. Her symptoms did not improve rapidly with steroids, nor did she rapidly decompensate as has been frequently described. To our knowledge, this is one of the first reported descriptions of late-onset gemcitabine lung toxicity.
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Affiliation(s)
- Amanda M Sherrod
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Azoulay E. Pleuropulmonary Changes Induced by Drugs in Patients with Hematologic Diseases. PULMONARY INVOLVEMENT IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES 2011. [PMCID: PMC7123804 DOI: 10.1007/978-3-642-15742-4_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patients with hematologic diseases who are being treated with therapy drugs, or receive radiation therapy or blood transfusions may develop a host of potentially fatal infectious and noninfectious pulmonary complications [1]. The increased complexity of multimodality and high-dose treatment regimens with the intended benefit of augmented antineoplastic efficacy and prolonged disease-free survival, the use of a panel of novel drugs to treat malignant and nonmalignant hematologic conditions (e.g., azacytidine, bortezomib, cladribine, dasatinib, fludarabine, imatinib, lenalidomide, rituximab, and thalidomide), total body irradiation (TBI) and hematopietic stem cell transplantation (HSCT) have increased the incidence of severe sometimes life-threatening pulmonary complications.
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Affiliation(s)
- Elie Azoulay
- Service de Réanimation Médicale, Hôpital Saint Louis, Avenue Claude Vellefaux 1, Paris, 75010 France
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Okusaka T, Furuse J, Funakoshi A, Ioka T, Yamao K, Ohkawa S, Boku N, Komatsu Y, Nakamori S, Iguchi H, Ito T, Nakagawa K, Nakachi K. Phase II study of erlotinib plus gemcitabine in Japanese patients with unresectable pancreatic cancer. Cancer Sci 2010; 102:425-31. [PMID: 21175992 DOI: 10.1111/j.1349-7006.2010.01810.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Erlotinib combined with gemcitabine has not been evaluated in Japanese patients with unresectable pancreatic cancer. This two-step phase II study assessed the safety and pharmacokinetics of erlotinib 100 mg/day (oral) plus gemcitabine 1000 mg/m(2) (i.v. days 1, 8, 15) in a 28-day cycle in the first step, and efficacy and safety in the second step. The primary end-point was safety. One hundred and seven patients were enrolled (first step, n = 6; second step, n = 101). The most common adverse event was RASH (compiled using the preferred terms rash, acne, exfoliative rash, dermatitis acneiform, erythema, eczema, dermatitis and pustular rash) in 93.4% of patients. One treatment-related death occurred. While interstitial lung disease-like events were reported in nine patients (8.5%; grade 1/2/3, 3.8/2.8/1.9%), all patients recovered or improved. The median overall survival, the 1-year survival rate and median progression-free survival were 9.23 months, 33.0% and 3.48 months, respectively. The overall response and disease control rates were 20.3% and 50.0%, respectively. In Japanese patients with unresectable pancreatic cancer, erlotinib plus gemcitabine had acceptable toxicity and efficacy that was not inferior to that seen in Western patients.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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