ONE MORE FEATHER IN THE CAP (DECITABINE): YET ANOTHER CASE OF CHEMOTHERAPY-INDUCED LUNG INJURY
Chest
; 162(4):A1780, 2022.
Article
in English
| EMBASE | ID: covidwho-2060861
ABSTRACT
SESSION TITLE Drug-Induced and Associated Critical Care Cases Posters 2 SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 0145 pm INTRODUCTION:
Lung toxicity due to antineoplastic therapy is reported with both cytotoxic and molecularly targeted agents [1]. We present one such case of lung injury induced by capecitabine. CASE PRESENTATION A 79-year-old female with history of triple negative infiltrating duct carcinoma of the right breast (status post mastectomy and adjuvant chemotherapy with docetaxel and cyclophosphamide 3 years prior) presented to the hospital with dyspnea on exertion following her fourth cycle of capecitabine therapy for breast cancer recurrence. Patient developed nausea, vomiting, and malaise with cycles 1, 2, and 3 of capecitabine therapy with onset of severe dyspnea on exertion, cough, and hypoxia following cycle 4. Computed tomography (CT) scan of the chest on admission showed consolidative opacities in the right upper, right middle, and anterior right lower lobe along with smaller opacities in the left lung apex and small subcentimeter nodules;no pulmonary embolism. Antibiotics were given for a short duration for suspected pneumonia without improvement. Capecitabine was held on discharge. She presented again to the emergency room with worsening shortness of breath, diarrhea, fatigue, and dizziness. COVID test was negative. Chest x-ray redemonstrated patchy airspace disease involving the right apical, lateral, mid lower lung field. Oral steroids were recommended for suspected organizing pneumonia, but the patient refused due to concerns about side effects. Her hospital course was complicated by Clostridium difficile infection (treated with oral vancomycin) and left lower extremity deep venous thrombosis (treated with anticoagulation). Subsequently she followed up with pulmonology outpatient. Repeat imaging showed evolving infiltrates in the same areas with elevated aspergillus IgG level (18.0 mcg/ml) and IgE (178 kU/L) but negative galactomannan and sputum bacterial/fungal/acid fast cultures. Oral steroids were initiated with clinical and symptomatic improvement.DISCUSSION:
Capecitabine is a prodrug of fluorouracil (antimetabolite). It is used as a chemotherapy agent in multiple types of cancer including breast cancer. Respiratory side effects include cough (<7%) and bronchitis (<5%). Lung injury/pneumonitis is a rare complication with only a few cases reported to date [2,3]. The timing of symptoms with chemotherapy administration and the negative infectious work-up supports capecitabine as the inciting etiology of lung injury. Withholding chemotherapy and starting systemic steroids were effective treatments in this case of chemotherapy induced lung toxicity.CONCLUSIONS:
Capecitabine induced lung injury is a rare but important entity and should always be kept in mind while evaluating dyspnea in cancer patients. Reference #1 Capri G, Chang J, et al. An open-label expanded access study of lapatinib and capecitabine in patients with HER2-overexpressing locally advanced or metastatic breast cancer. Ann Oncol. 2010;21(3)474. Epub 2009 Oct 8. DOI 10.1093/annonc/mdp373 Reference #2 C. J. Benthin, G. Allada. Capecitabine-Induced Lung Injury. American Journal of Respiratory and Critical Care Medicine 2016;193A1653. Reference #3 Andrew K Chan, Bok A Choo, John Glaholm. Pulmonary toxicity with oxaliplatin and capecitabine/5-Fluorouracil chemotherapy a case report and review of the literature. Onkologie. 2011;34(8-9)443-6. doi 10.1159/000331133. Epub 2011 Aug 19. DISCLOSURES No relevant relationships by William Karkowsky No relevant relationships by Chahat Puri No relevant relationships by Sahib Singh
antibiotic agent; antiinfective agent; antimetabolite; capecitabine; cyclophosphamide; decitabine; docetaxel; endogenous compound; epidermal growth factor receptor 2; fluorouracil; galactomannan; immunoglobulin E; immunoglobulin G; lapatinib; oxaliplatin; prodrug; steroid; unclassified drug; vancomycin; adjuvant chemotherapy; advanced breast cancer; advanced cancer; aged; anticoagulation; Aspergillus; bacterium culture; breast cancer; breast cancer recurrence; bronchitis; cancer patient; cancer surgery; case report; chemotherapy; clinical article; clinical evaluation; Clostridium difficile infection; compassionate use; complication; computer assisted tomography; conference abstract; coronavirus disease 2019; coughing; diarrhea; dizziness; drug combination; drug therapy; drug toxicity; dyspnea; emergency ward; exertional dyspnea; fatigue; feather; female; gene expression; gene overexpression; human; hypoxia; immunoglobulin blood level; intensive care; intensive care medicine; invasive ductal carcinoma; left lung; lower extremity deep vein thrombosis; lung embolism; lung injury; lung toxicity; malaise; mastectomy; metastatic breast cancer; nausea and vomiting; nonhuman; organizing pneumonia; outpatient; pneumonia; protein expression; pulmonology; side effect; sputum; surgery; thorax radiography
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EMBASE
Language:
English
Journal:
Chest
Year:
2022
Document Type:
Article
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