0
Communications to the Editor |

Gemcitabine Toxicity Gemcitabine Toxicity FREE TO VIEW

Almerico Marruchella, MD; Maurizio Tondini, MD
Author and Funding Information

Affiliations: Ospedale “E. Morelli” Sondalo, Italy,  Memorial Sloan-Kettering Cancer Center, New York, NY

Correspondence to: Almerico Marruchella, MD, Divisione di Broncopneumologia, Ospedale “E. Morelli,” 23039 Sondalo (SO), Italy



Chest. 1999;116(5):1491. doi:10.1378/chest.116.5.1491
Text Size: A A A
Published online

To the Editor:

We read with great interest the report by Vander Els and Miller (December 1998),1 regarding a patient with diffuse infiltrative lung disease during chemotherapy with gemcitabine that showed a favorable response to corticosteroids.

Pavlakis et al2 described severe pulmonary toxicity in three patients treated with gemcitabine: two of them died, and autopsy revealed diffuse alveolar damage. In a third patient, the results of transbronchial biopsy showed a pattern of nonspecific interstitial pneumonia, and corticosteroids allowed a clinical improvement.

We reported a similar case of a man who died due to progressive respiratory failure, despite the administration of high-dose IV corticosteroids.3 In our patient, autopsy revealed a pattern of diffuse alveolar damage.

We suggest that different patterns of lung injury may be related to gemcitabine, as has been described for other drugs.4 In the case reported by Vander Els and Miller,1 the patient’s rapid response, following the administration of corticosteroids, makes it likely a hypersensitivity reaction.

We think that BAL may be of value in elucidating mechanisms involved in drug toxicity, and that it should be used more extensively in clinical practice because it is safe for use in treating critical-care patients. A cellular profile suggestive of hypersensitivity reaction may help in excluding other causes and probably predicts a good response to corticosteroid therapy.

Vander Els, NJ, Miller, V (1998) Successful treatment of gemcitabine toxicity with a brief course of oral corticosteroid therapy.Chest114,1779-1781. [PubMed] [CrossRef]
 
Pavlakis, N, Bell, DR, Millward, MJ, et al Fatal pulmonary toxicity resulting from treatment with gemcitabine.Cancer1997;80,286-291. [PubMed]
 
Maruchella, A, Fiorenzano, G, Merizzi, A, et al Diffuse alveolar damage in a patient treated with gemcitabine.Eur Respir J1998;11,504-506. [PubMed]
 
Foucher, P, Biour, M, Blayac, JP, et al Drugs that may injure the respiratory system.Eur Respir J1997;10,265-279. [PubMed]
 

Gemcitabine Toxicity

To the Editor:

We thank Drs. Maruchella and Tondini for their comments on our study (December 1998).1In addition to the reports cited, there have been several patient deaths in Japan that were attributable to gemcitabine pulmonary toxicity.23

The pathophysiology of gemcitabine pulmonary toxicity can be inferred only from the present data. We agree with Drs. Maruchella and Tondini on the importance of collecting BAL as well as biopsy material. Autopsies, although helpful, are limited in that they show the end stage of the injury rather than the path of progression.

References
Vander Els, NJ, Miller, V Successful treatment of gemcitabine toxicity with a brief course of oral corticosteroid therapy.Chest1998;114,1779-1781. [PubMed] [CrossRef]
 
Takada, M, Negoro, S, Kudo, S, et al Activity of gemcitabine in non-small-cell lung cancer: results of the Japan gemcitabine group (A) phase II study.Cancer Chemother Pharmacol1998;41,217-222. [PubMed]
 
Fukuoka, M, Takada, M, Yokoyama, A, et al Phase II studies of gemcitabine for non-small cell lung cancer in Japan.Semin Oncol1997;24(2 suppl 7),S7-42–S7–46
 

Figures

Tables

References

Vander Els, NJ, Miller, V (1998) Successful treatment of gemcitabine toxicity with a brief course of oral corticosteroid therapy.Chest114,1779-1781. [PubMed] [CrossRef]
 
Pavlakis, N, Bell, DR, Millward, MJ, et al Fatal pulmonary toxicity resulting from treatment with gemcitabine.Cancer1997;80,286-291. [PubMed]
 
Maruchella, A, Fiorenzano, G, Merizzi, A, et al Diffuse alveolar damage in a patient treated with gemcitabine.Eur Respir J1998;11,504-506. [PubMed]
 
Foucher, P, Biour, M, Blayac, JP, et al Drugs that may injure the respiratory system.Eur Respir J1997;10,265-279. [PubMed]
 
Vander Els, NJ, Miller, V Successful treatment of gemcitabine toxicity with a brief course of oral corticosteroid therapy.Chest1998;114,1779-1781. [PubMed] [CrossRef]
 
Takada, M, Negoro, S, Kudo, S, et al Activity of gemcitabine in non-small-cell lung cancer: results of the Japan gemcitabine group (A) phase II study.Cancer Chemother Pharmacol1998;41,217-222. [PubMed]
 
Fukuoka, M, Takada, M, Yokoyama, A, et al Phase II studies of gemcitabine for non-small cell lung cancer in Japan.Semin Oncol1997;24(2 suppl 7),S7-42–S7–46
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543