Interstitial Pneumonitis after Treatment with Pemetrexed: A Rare Event?

Abstract

Background: Pneumonitis after pemetrexed has been rarely reported in conjunction with radiation therapy. Methods: Two cases of pemetrexed-induced pneumonitis in different clinical settings and with unequal outcomes are discussed with a review of the literature. Results: Two patients with stage IIIB non-small cell lung cancer developed interstitial lung disease after chemotherapy with pemetrexed. The first patient was previously treated with thoracic radiotherapy, and radiation pneumonitis was initially suspected. He died shortly after pemetrexed reexposition. The second patient developed pemetrexed-induced interstitial lung disease despite no prior radiotherapy. After discontinuation of pemetrexed and administration of steroids, pneumonitis resolved completely. Conclusion: Interstitial lung disease is a rare but potentially fatal side effect of pemetrexed. It occurs more often after radiotherapy but can also be encountered in the absence of radiotherapy. Reexposition to pemetrexed may lead to severe interstitial lung disease and even death and should be strictly avoided.

Immune-checkpoint inhibitors associated with interstitial lung disease in cancer patients

“…Consequently, we anticipate that, due to the large diffusion of these treatments, most clinicians will have to deal with this side-effect. ICI-ILD appears to be more frequent than is observed with other drugs used to treat NSCLC, such as pemetrexed, erlotinib, gefitinib, docetaxel, gemcitabine or crizotinib [21][22][23][24][25][26][27].…”

Successful Everolimus Treatment in a Patient with Advanced Pancreatic Neuroendocrine Tumor Who Developed Everolimus-Induced Interstitial Lung Disease on Two Occasions: A Case Report

“…The frequency of ILD induced by everolimus has been reported to be 13-64% [2,3,6,7,8,9,10] (table 1), and the time to occurrence of ILD ranges from 24 to 257 days [2,11]. Although severe ILD can be a life-threatening complication, and patients treated with everolimus should be closely monitored, numerous features of everolimus-associated ILD are distinctive from those of ILD associated with traditional chemotherapy [12,13]. The most common radiographic changes observed with everolimus-induced ILD are ground-glass opacities and focal consolidation, predominantly in the lower lobes [14].…”

“…Previous studies have demonstrated elevated serum KL-6 levels in a variety of ILDs, such as idiopathic pulmonary fibrosis, radiation pneumonitis, pulmonary sarcoidosis and drug-induced pneumonitis [13,14]. Furthermore, KL-6 has been reported to be a useful marker for evaluation of the disease activity as well as for the clinical diagnosis of ILD [15,16].…”

Targeting the immune system to treat lung cancer: rationale and clinical experience

“…It is unknown whether immune-related pneumonitis relates to other forms of described pneumonitis or how it should best be managed [Chow, 2013]. Other forms of severe or even fatal drug-related pneumonitis have been described in patients with NSCLC treated with erlotinib (1.6-4.5%) [Liu et al 2007], gefıtinib (3.5%) [Konishi et al 2005], docetaxel (4.6%) [Grande et al 2007], and gemcitabine (1-2%) [Roychowdhury et al 2002], with two case reports of pemetrexed-related pneumonitis [Hochstrasser et al 2012].…”