Palbociclib
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Pneumonitis: case report A 57-year-old woman developed pneumonitis during treatment with palbociclib for ductal breast cancer. The ex-smoker woman was diagnosed with high-grade infiltrating ductal breast cancer (stage IV, due to confirmed bone involvement). She started receiving palbociclib 125 mg/day in 4-week cycles (3 weeks on and 1 week off) along with letrozole. Concurrently, she received zoledronic acid. After 3 months of palbociclib therapy, she presented to the emergency department with a 1-week history of progressive dyspnoea accompanied by non-productive cough and fever. Physical examination showed that she was afebrile and eupnoeic. Pulmonary auscultation was unremarkable. Pulse oximetry was found to be normal; however, it dropped below 90% with minimum effort. Blood analysis demonstrated elevation of acute-phase reactants. A chest X-ray demonstrated bilateral pulmonary infiltrates. The woman was empirically treated with ceftriaxone and levofloxacin, without significant improvement. Blood culture and urine antigen test for S. pneumoniae and L. pneumophila were found to be negative. A CT-scan of the chest revealed extensive ground glass opacities throughout both the lungs without any signs of pulmonary embolism. She was hospitalised for further analysis. Bronchoalveolar lavage (BAL) revealed lymphocytosis (55%) with a CD4/CD8 ratio of 0.18. Cultures for fungus, mycobacteria, bacteria and virus in BAL and bronchial aspirates showed negative results. Cytology did not show malignancies. Based upon the clinical presentation, she was diagnosed with palbociclib-related pneumonitis. The Spanish Pharmacovigilance System Algorithm showed a probable (score of 6) causal relation between palbociclib and pneumonitis. A modification of the Karch and Lasagna algorithm also indicated palbociclib-related pneumonitis [exact score not stated]. Therefore, palbociclib was discontinued. Simultaneously, she started receiving prednisolone, which showed clinical improvement within 72 hours. After 6 weeks, a complete radiologic resolution was noted. Her prednisolone was slowly reduced, and her pneumonitis did not recur thereafter. Due to the grade 4 pneumonitis, palbociclib was not restarted. Further, she received letrozole monotherapy for 6 months with no disease progression or toxicity. Felip E, et al. New Drugs, Old Toxicities: Pneumonitis Related to Palbociclib - A Case Report. Breast Care 15: 548-552, No. 5, Oct 2020. Available from: URL: http:// 803516301 doi.org/10.1159/000504618
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Reactions 21 Nov 2020 No. 1831
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