Interstitial lung disease associated with oxaliplatin: description of two cases

Alvarez, C.; Oh, Hae Jin; Rodríguez, Andrea Sáenz de Miera; Arroyo, Francisco Ramon Garcia; Rúa, Marta Covela; Boquete, Laura Salgado; Clemente, Pedro Miguel López; Figueiras, Manuel Constenla

doi:10.1007/s12094-009-0364-4

Cited by 7 publications

(3 citation statements)

References 6 publications

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“…The most frequently reported side effects in this and other studies utilising FOLFOX have been cytopenias, peripheral neuropathy and diarrhoea 1,10. Pulmonary toxicity associated with this regimen has been infrequently described in a small number of case reports 4–8,13–15. In cases where a tissue diagnosis was obtained, DAD was the most frequent histopathological pattern obtained, although organising pneumonia has also been described 16.…”

Section: Discussionmentioning

confidence: 59%

Interstitial lung disease in a patient treated with oxaliplatin, 5-fluorouracil and leucovorin (FOLFOX) for metastatic colorectal cancer

Hannan¹,

Yoong²,

Chong³

et al. 2012

Radiology and Oncology

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BackgroundOxaliplatin in combination with 5-fluorouracil (5-FU) and leucovorin (FOLFOX) is a common chemotherapeutic regimen for advanced colorectal cancer. Here, we present a case of interstitial lung disease associated with FOLFOX therapy.Case reportA 74-year-old man with a history of metastatic colorectal cancer was admitted with a four week history of progressive dyspnoea and evidence of severe respiratory failure. He had recently completed six cycles of FOLFOX chemotherapy in the months prior to presentation. Investigations did not reveal convincing evidence of infection or pulmonary embolism. CT chest demonstrated widespread pulmonary infiltrates and interlobular septal thickening. The patient was commenced on both broad spectrum antibiotic therapy and high dose corticosteroid treatment however his respiratory failure continued to progress. The patient died four days after admission due to progressive respiratory failure. Subsequent post-mortem examination demonstrated evidence of diffuse alveolar damage without evidence of tumour infiltration, infection or pulmonary embolism.ConclusionsAlthough infrequent, pulmonary toxicity can occur in association with FOLFOX therapy. Cessation of therapy and prompt initiation of corticosteroids may improve outcomes.

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Section: Discussionmentioning

confidence: 59%

Interstitial lung disease in a patient treated with oxaliplatin, 5-fluorouracil and leucovorin (FOLFOX) for metastatic colorectal cancer

Hannan¹,

Yoong²,

Chong³

et al. 2012

Radiology and Oncology

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“…In addition, pulmonary toxicity, including pulmonary fibrosis, has been noted in less than 1% of colorectal cancer patients treated with the FOLFOX regimen during clinical trials (see manufacturer's comments at http://www.eloxatin.com). Several types of pulmonary complications associated with oxaliplatin-based treatment have been reported in colorectal cancer patients, including acute lung injury [5], eosinophilic lung disease [6], cryptogenic organizing pneumonia [7], and IP or pulmonary fibrosis [8][9][10][11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Fatal interstitial pneumonia associated with oxaliplatin-based therapy in a patient with metastatic rectal cancer

Ishizone

Koide

Akita

et al. 2011

Clin J Gastroenterol

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Oxaliplatin in combination with 5-fluorouuacil and leucovorin (FOLFOX) is one of the most commonly used first-line chemotherapies for patients with advanced or metastatic colorectal cancer. Pulmonary toxicity, including interstitial pneumonia (IP)/peumonitis, is a very rare complication. We report a case of fatal IP associated with FOLFOX therapy in a patient with metastatic rectal cancer. A 74-year-old man with rectal adenocarcinoma and associated liver metastases underwent palliative surgery and 21 cycles of modified FOLFOX6 therapy. After starting the 22nd therapy cycle, the patient developed a high fever with non-productive cough. Chest X-ray demonstrated diffuse ground-glass opacities in both lungs, and computed tomography showed severe disorder of the bilateral lung architecture. On the basis of a lymphocyte stimulation test (DLST), oxaliplatin-induced IP was diagnosed. Intravenous administration of high-dose methylprednisolone was started, but the symptoms and radiological findings were not improved. The patient died of respiratory failure 16 days after the last administration of oxaliplatin. Although IP is a rare but potentially fatal complication of oxaliplatin-based treatment in colorectal cancer patients, clinicians should pay careful attention to the clinical respiratory symptoms and radiographic findings in colorectal cancer patients receiving FOLFOX therapy.

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“…Additionally, interstitial lung disease has been reported. In the majority of cases, the noxious pulmonary effects occur rather late in the course of therapy [ 4 – 9 ], although there have been exceptions to this rule [ 10 – 14 ]. Although pulmonary toxicity in conjunction with FOLFOX therapy is uncommon (≤ 1.5%) [ 15 ], it can be lethal despite the immediate discontinuation of the chemotherapeutic drugs and the initiation of immunotherapy (i.e., corticosteroids).…”

Section: Introductionmentioning

confidence: 99%

Prognosis and treatment of FOLFOX therapy related interstitial pneumonia: a plea for multimodal immune modulating therapy in the respiratory insufficient patient

et al. 2017

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Background: The FOLFOX regimen, i.e., folinic acid (FOL), fluorouracil (F) and oxaliplatin (OX), is a drug cocktail that is used to treat gastric and colorectal cancers. Despite the concomitant improvements in response rate, duration of response and patient survival, reports of serious toxic pulmonary side effects have progressively emerged. Case presentation: We describe a patient who was treated with FOLFOX as an adjuvant to a rectosigmoidal resection of a rectosigmoidal carcinoma and who developed respiratory insufficiency requiring mechanical ventilation. Computed tomography (CT) imaging and open lung biopsy findings were compatible with interstitial pneumonia (IP). She received multimodal combination treatment (acetylcysteine, corticosteroids, immune globulins and cyclophosphamide) and survived. We performed a systematic literature search and reviewed all 45 reported cases of FOLFOX-related lung toxicity and/or pulmonary fibrosis for their clinical characteristics and their outcomes related to therapy. Conclusions: We found that for the 45 cases with available data, the median age was 70 years, and the male-female ratio was 3.5: 1. In the patients exhibiting only mild respiratory symptoms, discontinuation of the culprit drug (oxaliplatin) resulted in a 100% regression of the symptoms. However the prognosis of the respiratory insufficient patient proved to be grim: death occurred in 76.9% of the cases despite conventional treatment with corticosteroids. We therefore urge oncologists and critical care specialists not to limit their interventions to the discontinuation of chemotherapy, artificial ventilation, corticosteroids and glutathione replenishment and to consider the gradual introduction of additional immune-modulating agents whenever life-threatening respiratory symptoms in oxaliplatin-treated patients do not subside; all the more so considering the fact that our analysis showed that every patient who survived intubation and mechanical ventilation experienced a full clinical recovery.

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Interstitial lung disease associated with oxaliplatin: description of two cases

Cited by 7 publications

References 6 publications

Interstitial lung disease in a patient treated with oxaliplatin, 5-fluorouracil and leucovorin (FOLFOX) for metastatic colorectal cancer

Interstitial lung disease in a patient treated with oxaliplatin, 5-fluorouracil and leucovorin (FOLFOX) for metastatic colorectal cancer

Fatal interstitial pneumonia associated with oxaliplatin-based therapy in a patient with metastatic rectal cancer

Prognosis and treatment of FOLFOX therapy related interstitial pneumonia: a plea for multimodal immune modulating therapy in the respiratory insufficient patient

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