A case series of patients on chemotherapy with dyspnoea and pulmonary infiltrates

Ullah, Khalil; O’Reilly, Aine; Power, Derek G.; O’Connor, Terence M.

doi:10.1136/bcr-2013-009105

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…Gemcitabine is a chemotherapy drug used in the treatment of multiple types of cancers including non-small cell lung cancer, pancreatic cancer, bladder cancer, breast cancer and esophageal cancer. It is a pyrimidine analogue which replaces cytidine during DNA replication thereby halting tumor growth by inducing apoptosis [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Gemcitabine induced pneumonitis: a case report and review of literature

Thalambedu

El-Habr

2020

Journal of Community Hospital Internal Medicine Perspectives

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Section: Discussionmentioning

confidence: 99%

Gemcitabine induced pneumonitis: a case report and review of literature

Thalambedu

El-Habr

2020

Journal of Community Hospital Internal Medicine Perspectives

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“…The median delay from first and last gemcitabine injection to diagnosis of PAH were 7 (4-50) and 1 (0,5-16) months, respectively. The median number of total chemotherapy injections was 16 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), with a usual gemcitabine dose of 1000 mg/m 2 . At the time of PH diagnosis, 5 patients (55%) had a partial response to treatment or were in remission, 3 patient (33%) had tumor progression and one patient (11%) had stable neoplastic disease.…”

Section: Gemcitabine Exposurementioning

confidence: 99%

“…No patient had evidence of thromboembolic disease or tumor embolism on CT and ventilation/perfusion lung scans. RHC showed severe precapillary PH with a median mPAP of 40 mmHg (26-47), PAWP of 8 mmHg (7)(8)(9)(10)(11)(12)(13)(14), RAP of 7 mmHg (4-19), CI of 2.4 (1.6-3.9) L/min/m 2 and PVR of 6.3 UW (3.1-12.6) (Table 2). An acute vasodilator test was performed in four patients, all of whom tested negative, thereby confirming the absence of a post-capillary PH component.…”

Section: Ph Assessment At Diagnosismentioning

confidence: 99%

“…Pulmonary toxicities have been described in 2-40% of patients exposed to gemcitabine (9)(10)(11). This toxicity may be reversible for dyspnea, acute non-cardiogenic pulmonary edema (12), hypersensitivity pneumonitis (13), eosinophilic pneumonitis (14), acute or chronic fibrosing interstitial lung disease (15,16), pleural effusion, bronchospasm, and diffuse alveolar hemorrhage. However, in all these reports the causality of gemcitabine is difficult to assess, particularly in the suspected hypersensitivity pneumonitis.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and outcomes of gemcitabine-associated pulmonary hypertension

Mouillot,

Favrolt,

Khouri

et al. 2024

ERJ Open Res

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BackgroundDespite 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.ObjectivesTo assess the association between gemcitabine and PH.MethodsWe identified incident cases of precapillary PH confirmed by right heart catheterisation in patients treated with gemcitabine from the French PH Registry between January 2007 to December 2022. The etiology, clinical, functional, radiologic, and hemodynamic characteristics of PH were reviewed at baseline and during follow-up. A pharmacovigilance disproportionality analysis was conducted using the WHO pharmacovigilance database.ResultsWe identified nine cases of PAH, 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 (min-max 26–47) mmHg, a cardiac index of 2.4 (1.6–3.9) L·min−1·m−2, and pulmonary vascular resistance of 6.3 (3.1–12.6) WU. 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.ConclusionBoth 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 dyspnea.

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Gemcitabine-Related Pneumonitis in Pancreas Adenocarcinoma—An Infrequent Event: Elucidation of Risk Factors and Management Implications

Şahin

Geyer

Kelly

et al. 2016

Clinical Colorectal Cancer

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A total of 2440 pancreatic cancer patients who received gemcitabine treatment were screened for gemcitabine-related pneumonitis (GRP). The observed rate of GRP was 1.1%. History of smoking, alcohol use, and history of underlying lung disease were identified as possible risk factors of GRP. Early pulmonary consult and cessation of gemcitabine is recommended once clinical suspicion arises. 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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A case series of patients on chemotherapy with dyspnoea and pulmonary infiltrates

Cited by 3 publications

References 8 publications

Gemcitabine induced pneumonitis: a case report and review of literature

Gemcitabine induced pneumonitis: a case report and review of literature

Characteristics and outcomes of gemcitabine-associated pulmonary hypertension

Gemcitabine-Related Pneumonitis in Pancreas Adenocarcinoma—An Infrequent Event: Elucidation of Risk Factors and Management Implications

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