Acute Interstitial Pneumopathy Associated with Docetaxel Hypersensitivity

Abstract

Background: Acute pulmonary toxicity in cancer patients treated with docetaxel has been reported in previous phase II studies and case reports. Unlike transient pulmonary infiltrates, it is demonstrated that docetaxel-induced interstitial pneumopathy is a severe clinical condition that generally leads to respiratory failure. Case Report: We report a patient with breast cancer who received 2 cycles of docetaxel in 3-week intervals and developed respiratory failure. The clinical, pathologic, and radiographic data supported pulmonary toxicity caused by a hypersensitivity reaction to docetaxel as the most likely etiology. The patient developed the same symptoms and radiological findings after 1 cycle of paclitaxel administration. Unlike other more severe examples in the literature, this patient’s condition did not require mechanical ventilation, and she recovered after corticosteroid treatment. Conclusion: The present case raises the possibility that taxanes, as a group of chemotherapeutic agents, may cause the same type of adverse reaction in the pulmonary parenchyma. The authors recommend that any patient who develops a taxane- induced pulmonary toxic reaction, not be rechallenged or treated with another agent of the same class.

Interstitial Lung Disease Associated with Docetaxel in a Patient Treated for Breast Cancer—A Case Report

“…The docetaxel-induced lung toxicity in the cases that have been reported usually occurred after the second to fourth course of chemotherapy, and was usually relieved with corticosteroid therapy. Therefore, the involvement of a cytotoxic T-cell-mediated mechanism is very likely [1,2,4,8,15].…”

“…Initially the symptoms may be non-specific. There may be cough, fever, acute bronchiolitis, dyspnoea initially on exertion then at rest, or sudden dyspnoea as in non-cardiogenic pulmonary oedema [3,15]. Respiratory failure may develop, being at times lethal [8].…”

“…The clinical, pathologic, and radiographic data supported pulmonary toxicity caused by a hypersensitivity reaction to docetaxel as the most likely etiology. The authors recommend, that any patient who develops a taxane-induced pulmonary toxic reaction, must not be rechallenged or treated with another agent of the same class [15].…”

Paclitaxel induced chronic fibrosing interstitial pneumonitis: a case report and review of the literature

“…Pulmonary toxicities including acute bilateral infiltrates have been rarely reported, with a prevalence of grade 3 or more severe chronic fibrosing interstitial lung disease of approximately 0.7% [2]. Docetaxel has also been incriminated as a cause of severe chronic fibrosing interstitial lung disease that may lead to respiratory failure [3,4].…”

Risk Analysis of Pneumonitis in Taxane Therapy After Chemoradiotherapy for Patients With Metastatic or Recurrent Esophageal Cancer

“…Several studies of taxane-induced pneumonitis or interstitial pneumonitis reported a risk of 3.8% in cases of esophageal cancer 5 and 1% to 9% in cases involving other malignancies, [6][7][8][9][10][11][12][13] some of which result in death. 10,[14][15][16][17][18][19][20][21] Moreover, anticancer agents may cause radiation recall, which is an uncommon and unpredictable phenomenon characterized by an acute inflammatory reaction confined to previously irradiated areas that is triggered by the administration of precipitating systemic agents, such as anticancer agents, some antibiotics, antituberculosis drugs, and the cholesterol-lowering medication simvastatin. [22][23][24][25][26] Taxane may evoke radiation recall pneumonitis with previous exposure to radiation therapy (RT), according to the drug package inserts (Taxotere; Sanofi, Tokyo, Japan; and Taxol; Bristol Myers Squibb, Tokyo, Japan).…”