Oxaliplatin
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Pulmonary fibrosis resulting in death: 2 case reports Two patients with colorectal cancer developed fatal pulmonary fibrosis during treatment with oxaliplatin [dosages and routes not stated]. A 55-year-old man with a metastatic recto-sigmoid colon tumour received treatment with the FOLFOX-4 regimen, with oxaliplatin, fluorouracil and leucovorin. He experienced intermittent grade 3 neutropenia during treatment. Two weeks after the end of his 13th cycle of treatment, he developed dyspnoea and a dry cough. His symptoms worsened and he was admitted to hospital 2 weeks later. He had dyspnoea on exertion and inspiratory crackles were audible in both lungs. Chest X-ray and high resolution CT scan showed bilateral fibrosis, parenchymal distortion, and multiple ground-glass opacities. Oxaliplatininduced pulmonary toxicity was suspected. Bronchoscopy and biopsy excluded other disease processes. He initially received broad-spectrum antibiotics and corticosteroids; however, after 2 days of hospitalisation, his dyspnoea and radiographic findings worsened. He was transferred to the ICU and received methylprednisolone, but died on the 23rd day of hospitalisation from respiratory and multiple organ failure. A 73-year-old man with hepatic flexure colon cancer received adjuvant chemotherapy, including the FOLFOX-4 regimen with oxaliplatin, fluorouracil and leucovorin. Immediately after administration of oxaliplatin during the 9th cycle, he developed dyspnoea and fever. He exhibited inspiratory crackles in both lungs and had marked leucocytosis with 94.5% neutrophils. Chest X-ray and high resolution CT scan showed ground-glass opacities in both lower lobes and the left upper lobe. Tests for infective causes were negative. He received oxygen therapy, corticosteroids and broad-spectrum antibiotics. He developed progressive respiratory failure and he was transferred to the ICU; however, his symptoms worsened, and he died on the 18th day of hospitalisation. Author comment: ". . . [T]he main cause of FOLFOXregimen-induced interstitial pneumonitis is thought to be oxaliplatin." Ryu C-G, et al. Oxaliplatin-induced pulmonary fibrosis: Two case reports. Journal of the Korean Society of Coloproctology 27: 266-269, No. 5, Oct 2011. Available from: URL: http://dx.doi.org/10.3393/jksc.2011.27.5.266 - South 803066804 Korea
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Reactions 11 Feb 2012 No. 1388
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