Transtuzumab induced organizing pneumonia: a case report

Drug-induced Interstitial Lung Disease in Breast Cancer Patients: A Lesson We Should Learn From Multi-Disciplinary Integration

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.

Organizing pneumonia secondary to lung cancer of unknown primary site

BACKGROUND

Secondary organizing pneumonia (OP) is associated with other pathological conditions, such as infections, drugs, cancers and radiotherapy. Lung cancer-associated secondary OP has rarely been reported.

CASE REVIEW

In this study, we reported on a case of secondary OP caused by lung cancer. The patient was initially diagnosed with community-acquired pneumonia and then cryptogenic organizing pneumonia by CT scan-guided and transbronchial lung biopsy. Poor response to anti-infection or corticosteroid therapy prompted us to search for underlying disease. A TBNA biopsy of the 4R mediastinal lymph node revealed the diagnosis of lung cancer.

CONCLUSION

OP secondary to lung cancer of unknown primary site are rare. When OP patients have lymphadenopathy or poor response to glucocorticoid, a more differential diagnosis should be considered, especially for avoiding the misdiagnosis of a malignancy.

Organizing pneumonia after pancreatic cancer treatment with nab-paclitaxel and gemcitabine: a case report

The incidence of pancreatic cancer is increasing. Most patients have advanced disease at diagnosis, and therapeutics is limited in this setting. Gemcitabine and nab-paclitaxel combination is indicated as first-line treatment in patients with metastatic cancer of pancreas. The most common adverse events of Grade 3 or higher gemcitabine and nab-paclitaxel combination are neutropenia, fatigue and neuropathy. In this report, we describe a rare case of organizing pneumonia associated with the use of nab-paclitaxel and gemcitabine in metastatic pancreatic cancer. A 68-year-old female underwent total splenopancreatectomy for ductal adenocarcinoma of the neck of the pancreas, followed by adjuvant chemoradiation therapy. Afterwards she relapsed and received first-line chemotherapy with gemcitabine plus nab-paclitaxel combination for 12 cycles. Following the administration of the 12th cycle of gemcitabine plus nab-paclitaxel, the patient experienced low-grade pyrexia, effort dyspnoea, persistent non-productive cough and malaise. High-resolution CT scan of chest revealed new-onset bilateral peripheral ground-glass opacities, smooth interlobular septal thickening and patchy subpleural consolidation areas, findings consistent with organizing pneumonia. A thorough microbiological workup was negative. Treatment with steroids resulted in prompt clinical and radiological improvement. Organizing pneumonia closely mimics infection or progressive disease and can be difficult to diagnose in the setting of malignancy. Correct diagnosis is of primary importance since delay in treatment can result in significantly adverse patient outcomes.