Department of Medical Oncology (452), Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands,
Target Oncol. 2014 Sep;9(3):287-91. doi: 10.1007/s11523-014-0310-4. Epub 2014 Mar 5.
Everolimus has important clinical activity in various malignancies, but its use can be complicated by respiratory adverse events. Important everolimus-induced respiratory adverse events are interstitial lung disease (ILD) and infections, either typical or opportunistic. Furthermore, non-everolimus-related respiratory events can occur. Due to the non-specific presentation of most of these respiratory disorders, it is often not possible to differentiate between these causes on clinical and radiological grounds only. Considering the potential fatal nature of opportunistic infections, these are especially important to recognize. To be able to distinguish between ILD and (opportunistic) infections as the underlying cause, an aggressive diagnostic workup, including bronchoalveolar lavage, should be performed in patients treated with everolimus who develop respiratory disease. We report three cases of severe opportunistic pulmonary infections during everolimus treatment, concerning two Pneumocystis jirovecii pneumonia infections. These cases illustrate the diagnostic challenges of respiratory adverse events and the importance of a thorough diagnostic workup for correct diagnosis and treatment.
依维莫司在各种恶性肿瘤中有重要的临床活性，但它的使用可能会因呼吸不良事件而变得复杂。重要的依维莫司引起的呼吸不良事件是间质性肺病（ILD）和感染，包括典型和机会性感染。此外，还可能发生与依维莫司无关的呼吸事件。由于大多数这些呼吸疾病的表现是非特异性的，因此仅根据临床和影像学标准通常无法区分这些原因。考虑到机会性感染的潜在致命性质，这些感染尤其需要识别。为了能够区分ILD 和（机会性）感染作为潜在原因，应在接受依维莫司治疗的患者中出现呼吸疾病时进行积极的诊断性检查，包括支气管肺泡灌洗。我们报告了三例依维莫司治疗期间发生的严重机会性肺部感染，涉及两例卡氏肺孢子虫肺炎感染。这些病例说明了呼吸不良事件的诊断挑战以及彻底的诊断性检查对于正确诊断和治疗的重要性。
