Briasoulis E, Froudarakis M, Milionis H J, Peponis I, Constantopoulos S, Pavlidis N
Department of Medical Oncology, Ioannina University Hospital, Ioannina, Greece.
Respiration. 2000;67(6):680-3. doi: 10.1159/000056300.
Several cancer therapeutic agents have been associated with pulmonary toxicity. Herein, we describe the case of a 73-year-old woman with breast cancer metastatic to the liver, who developed noncardiogenic pulmonary edema (NPE) while on treatment with gemcitabine plus docetaxel combination with granulocyte colony-stimulating factor (G-CSF) support. Gemcitabine, a deoxycytidine analogue, is reported to produce mild self-limiting and only occasionally severe pulmonary toxicity. The microtubule stabilizer docetaxel has been associated with water retention complications. The combination of these two agents has shown promising activity in several solid tumors and is in a phase of clinical development with prophylactic G-CSF in most of the trials due to the high rate of dose-limiting neutropenia observed with this combination. In our case pulmonary toxicity resolved rapidly following the administration of corticosteroids. A possible deleterious synergy of the compounds involved in this case is discussed and the medical literature on NPE related to cancer therapy is shortly reviewed. We conclude that NPE should always be considered in patients with respiratory function deterioration while on therapy with the gemcitabine-docetaxel combination and G-CSF. Corticosteroids can provide maximum benefit if started early upon diagnosis coupled with withdrawal of the causative drugs.
几种癌症治疗药物都与肺部毒性有关。在此，我们描述了一名73岁的乳腺癌肝转移女性患者的病例，她在接受吉西他滨加多西他赛联合粒细胞集落刺激因子（G-CSF）支持治疗时发生了非心源性肺水肿（NPE）。吉西他滨是一种脱氧胞苷类似物，据报道会产生轻度的自限性肺部毒性，仅偶尔会出现严重的肺部毒性。微管稳定剂多西他赛与水潴留并发症有关。这两种药物的联合在几种实体瘤中显示出有前景的活性，并且由于观察到该联合方案剂量限制性中性粒细胞减少的发生率较高，在大多数试验中处于临床开发阶段，并联合预防性使用G-CSF。在我们的病例中，使用皮质类固醇后肺部毒性迅速缓解。本文讨论了该病例中所涉及化合物可能存在的有害协同作用，并简要回顾了与癌症治疗相关的NPE的医学文献。我们得出结论，在使用吉西他滨 - 多西他赛联合方案及G-CSF治疗的患者中，若出现呼吸功能恶化，应始终考虑NPE的可能性。如果在诊断后早期开始使用皮质类固醇并停用致病药物，可带来最大益处。
