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[Radiation recall pneumonitis induced by Gefitinib (Iressa): a case report]
Toshimichi Miya1, Yoko Ono, Hozumi Tanaka
1Department of Surgery II, Kyorin University School of Medicine, Shinkawa 6-20-2, Mitaka, Tokyo 181-8611, Japan.
Abstract:
Gefitinib is a newly developed molecular-target drug with selective inhibitory activity for tyrosine kinase of the epidermal growth factor receptor and has an encouraging effect on non-small cell lung cancer in an advanced stage. The adverse drug reactions including diarrhea, skin eruptions and liver dysfunction have been considered mild. However, cases of severe acute lung injuries were reported after approval of the drug in Japan in July, 2002. We report a case of recurrent large cell carcinoma of the lung in a 73-year-old man who suffered from radiation recall pneumonitis induced by Gefitinib. Two months after radiation therapy to the mediastinal and right hilar lesions was completed, he started to take Gefitinib at a dose of 250 mg/day. Six weeks later, he complained acutely of a dry cough, slight fever and effort dyspnea, and his chest CT demonstrated ground-glass opacity corresponding to the previous radiation field. In administering Gefitinib, as well as other cytotoxic drugs, meticulous monitoring for acute lung injury and radiation recall reaction is required.
Insights
Gefitinib, a targeted therapy for advanced lung cancer, can cause severe lung injury. This case highlights radiation recall pneumonitis, emphasizing the need for careful monitoring during treatment.
Area of Science:
- Oncology
- Pulmonology
- Pharmacology
Background:
- Gefitinib is a targeted therapy for advanced non-small cell lung cancer (NSCLC).
- It selectively inhibits the epidermal growth factor receptor (EGFR) tyrosine kinase.
- Mild adverse effects like diarrhea and skin rash are common, but severe lung injury has been reported.
Observation:
- A 73-year-old man with recurrent large cell lung carcinoma received Gefitinib after radiation therapy.
- Within six weeks of starting Gefitinib, he developed acute symptoms of cough, fever, and dyspnea.
- Chest CT revealed ground-glass opacity within the prior radiation field.
Findings:
- The patient's symptoms and imaging findings were consistent with radiation recall pneumonitis.
- This adverse event was attributed to Gefitinib administration following radiation therapy.
- Gefitinib can trigger severe lung injury, including radiation recall pneumonitis.
Implications:
- Clinicians must be vigilant for acute lung injury in patients receiving Gefitinib.
- Radiation recall pneumonitis is a potential severe adverse effect requiring careful monitoring.
- This case underscores the importance of monitoring for lung toxicity with targeted cancer therapies.
