Pulmonary Fibrosis Secondary to Oxaliplatin Treatment: From Rarity to Reality: A Case Study and Literature Review

Abstract

Oxaliplatin-based chemotherapy has been widely used to treat colorectal cancer. Here, we report a case of a 71-year-old man, former smoker (40 pack-years), with no history of relevant exposures such as occupational, environmental or drug exposure. The patient developed acute partial respiratory insufficiency concomitant with the eighth cycle of adjuvant chemotherapy with oxaliplatin and capecitabine for stage IIIA colorectal adenocarcinoma. After the exclusion of other causes, namely pulmonary thromboembolism, high-resolution chest computed tomography (CT) showed a usual interstitial pneumonia (UIP) pattern. After the discussion at the multidisciplinary meeting on interstitial lung diseases and considering the temporal association between clinical and imaging findings and chemotherapy treatment, along with exclusion of other potential causes, the most likely hypothesis was pulmonary fibrosis secondary to oxaliplatin. A literature review on this scope was also performed. We conclude that pulmonary fibrosis is a rare complication of oxaliplatin, but with the widespread use of oxaliplatin combinations in colorectal cancer, active assessment for interstitial lung disease is recommended.

Case report: Interstitial lung disease of XELOEX chemotherapy with cetuximab in advanced colon cancer induced

“…The DILD toxicity of cetuximab might be dose-dependent, and the biweekly regimen is now approved for use, but the concerns over the development of DILD should remain. [3,5–8]…”

“…The DILD toxicity of cetuximab might be dosedependent, and the biweekly regimen is now approved for use, but the concerns over the development of DILD should remain. [3,[5][6][7][8] Interstitial pneumonia and pulmonary fibrosis are the most common manifestations of DILD in a lung CT scan. The clinical manifestations of cetuximab-induced DILD are similar to those of general drug-induced lung injury, i.e., dyspnea (in approximately 90% of patients), cough, and fever.…”

“…In the case reported here, ILD seemed to change from chronic to acute exacerbation triggered by a common cold, as previously observed. [ 5 ] Of note, the patient was negative for COVID-19 (nucleic acid test), which was a mandatory test in 2021 after hospital admission. Finally, the Naranjo Algorithm Assessment score was 6, meaning that the probability that the adverse event was related to cetuximab was classified as probable (Table S1, Supplemental Digital Content, http://links.lww.com/MD/K923 ).…”

“…There may be ethnic differences in the occurrence of DILD, with Japan reporting higher numbers than other countries. [ 5 ] This paper presents a case of a DILD in a Chinese patient with advanced colon cancer treated with cetuximab combined with XELOX.…”