Cetuximab‐associated pulmonary toxicity in concurrent chemoradiation for the treatment of a squamous cell carcinoma of the head and neck

Abstract

Background Cetuximab is a common EGFR monoclonal antibody used with radiotherapy to treat head‐and‐neck cancer. Severe pulmonary toxicity, including interstitial lung disease (ILD), caused by cetuximab is rare. Methods We describe a patient who developed ILD and acute respiratory failure after concurrent chemoradiation with cetuximab for oropharyngeal squamous cell carcinoma, and review the literature. Results A patient developed acute respiratory failure 2 months after starting concurrent chemoradiation with cetuximab and was hospitalized in intensive care after a procedure for progressive respiratory distress. Cultures and serology were negative for infection and radiologic findings were consistent with drug associated pneumonitits. Steroids were administered until the patient was stabilized. The patient fully recovered 1 month after the onset of respiratory distress, although he died of recurrent disease 10 months after completing treatment. Conclusion Although severe pulmonary toxicity caused by EGFR inhibitors has been well described in the literature, ILD caused by cetuximab, an EGFR monoclonal antibody, is rare and not well‐documented. Given its life‐threatening effects, awareness of this potential side effect and early diagnosis is critical.

Severe interstitial pneumonia caused by cetuximab: a case report and review of the literature

“…Reviewing the literature reports on interstitial pneumonia caused by cetuximab [11][12][13][14][15][16], there is no certain trend in the onset time of interstitial pneumonia caused by cetuximab. A Japanese study has reported that the incidence of cetuximab-related lung injury occurring in patients with metastatic colorectal cancer was 1.2% (24/2006), the incidence of grade 3 or higher was 0.7% (15/2006) and the median time of onset was 101 days (17-431 days).…”

Radiotherapy plus cetuximab for locally advanced squamous cell head and neck cancer in patients with cisplatin‑ineligible renal dysfunction: A retrospective study

“…Furthermore, a Phase II clinical study found that acute toxicity was increased and adherence was reduced in patients who received radiotherapy plus cetuximab (22). The toxicity of cetuximab is generally manageable (30)(31)(32), but severe toxicity has been observed (33,34). Therefore, guidelines recommend that the use of cetuximab instead of cisplatin must be carefully considered (35).…”