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Cyclophosphamide-induced late-onset lung disease
Kunio Hamada1, Sonoko Nagai, Masanori Kitaichi
1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 53 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507.
Internal Medicine (Tokyo, Japan)
|February 14, 2003
Summary
Cyclophosphamide (CPA) can cause late-onset lung disease years after treatment for breast cancer. This case highlights the importance of monitoring for pulmonary complications in patients receiving CPA chemotherapy.
Area of Science:
- Oncology
- Pulmonology
- Toxicology
Background:
- Breast cancer treatment often involves chemotherapy agents like cyclophosphamide (CPA).
- Tamoxifen is commonly used in conjunction with CPA for hormone-sensitive breast cancers.
- Late-onset pulmonary complications following chemotherapy are a recognized but infrequent occurrence.
Observation:
- A 58-year-old woman developed progressive cough and dyspnea 6 years after completing 2 years of CPA and tamoxifen therapy for breast cancer.
- Chest imaging showed diffuse infiltrates and pleural thickening, with significantly reduced vital capacity.
- Corticosteroid treatment provided no relief, and the condition rapidly worsened, leading to pneumothoraces and death.
Findings:
- Autopsy revealed pulmonary fibrosis with significant elastosis, consistent with CPA-induced lung injury.
- The histological findings suggest a chronic fibrotic process initiated by cyclophosphamide exposure.
- The late onset and severity of the lung disease were notable.
Implications:
- This case underscores the potential for delayed pulmonary toxicity from cyclophosphamide, even years after cessation of therapy.
- Clinicians should maintain a high index of suspicion for drug-induced lung disease in patients with a history of CPA treatment presenting with respiratory symptoms.
- Further research into long-term pulmonary surveillance strategies for cancer survivors treated with CPA may be warranted.