Gefitinib is a low-molecular-weight epidermal growth factor receptor tyrosine kinase inhibitor. To date, gefitinib has been administered to over 65,000 people worldwide. The most commonly reported adverse events were diarrhea, acne-like skin rash, nausea, vomiting and asthenia. Most of them were transient and mild in severity. Interstitial lung disease in patients who have been treated with gefitinib is uncommon and has recently been described with an estimated incidence rate of around 1%. We present here a case of fatal drug-induced pulmonary toxicity after therapy with gefitinib for metastatic non-small cell lung cancer. The patient had been treated with gemcitabine and cisplatin, and developed drug-induced hemolytic-uremic syndrome 6 months before gefitinib use.
From October 1982 to August 1984, 30 previously untreated patients with biopsy-proven carcinoma of the nasopharynx, stage III (26.5%) and stage IV (73.5%), received combined radiotherapy (6,000 to 7,000 cGy over a period of 7 to 7.5 weeks) and chemotherapy (mitomycin-C 10 mg/M2, IV; 5-fluorouracil 750 mg/M2, IV; and methotrexate 30 mg/M2, IV) concomitantly. There were 20 males and 10 females, with a median age of 40 years. Minimal follow-up duration was 24 months. Actuarial overall survival rate at 48 months was 49%. Complete local response was achieved in 75% of the patients, with 31% of the cases failing distantly. The complication rate was high and included severe mucositis, xerostomia, and septicemia (fatal in two cases). Despite high local disease control, survival rate did not increase. A randomized trial is urgently needed to establish whether or not combined treatment is of value in advanced carcinoma of the nasopharynx.
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