Mitsuboshi Satoru, Kozakai Hiromi, Yamada Hitoshi, Nagai Kazuhiko, Furukawa Tomoyasu, Aizawa Kikuo
1 Department of Pharmacy, Kaetsu Hospital, Niigata-shi, Niigata, Japan.
2 Department of Pharmaceuticals, Niitsu Medical Center Hospital, Niigata-shi, Niigata, Japan.
J Oncol Pharm Pract. 2018 Oct;24(7):540-543. doi: 10.1177/1078155217718616. Epub 2017 Jul 11.
Chemotherapy-induced interstitial lung disease in colorectal cancer patients is rare but represents a life-threatening adverse reaction. We report here a case of interstitial lung disease following chemotherapy for metastatic colorectal cancer and the interesting results of the drug-induced lymphocyte stimulation test and leukocyte migration test. After chemotherapy with oxaliplatin plus infusional 5-fluorouracil and leucovorin (FOLFOX) plus bevacizumab followed by irinotecan plus infusional 5-fluorouracil and leucovorin (FOLFIRI), the patient was hospitalized with fever and chills. Laboratory data showed neutropenia and eosinophilia. Computed tomography revealed ground-glass opacities in both lungs; therefore, we diagnosed chemotherapy-induced interstitial lung disease. Steroid therapy was effective. We suspected irinotecan to be the etiological drug for interstitial lung disease in this patient because interstitial lung disease developed after switching the regimen from FOLFOX to FOLFIRI. However, drug-induced lymphocyte stimulation test and leukocyte migration test results were positive for only leucovorin and negative for irinotecan and 5-fluorouracil. This is the first case to show positive results on the drug-induced lymphocyte stimulation test and leukocyte migration test for only leucovorin and negative results for antineoplastic drugs. Our findings suggest that all drugs included in chemotherapy regimens have the potential to induce interstitial lung disease, and if rechallenge chemotherapy is considered, the drug-induced lymphocyte stimulation test and leukocyte migration test are expected to be useful for determining the drug that needs to be excluded.
化疗引起的结直肠癌患者间质性肺病较为罕见，但却是一种危及生命的不良反应。我们在此报告一例转移性结直肠癌化疗后发生间质性肺病的病例，以及药物诱导淋巴细胞刺激试验和白细胞迁移试验的有趣结果。在用奥沙利铂加持续输注5-氟尿嘧啶和亚叶酸钙（FOLFOX）加贝伐单抗化疗后，接着用伊立替康加持续输注5-氟尿嘧啶和亚叶酸钙（FOLFIRI），患者因发热和寒战住院。实验室数据显示中性粒细胞减少和嗜酸性粒细胞增多。计算机断层扫描显示双肺磨玻璃影；因此，我们诊断为化疗引起的间质性肺病。类固醇治疗有效。我们怀疑伊立替康是该患者间质性肺病的致病药物，因为在将治疗方案从FOLFOX改为FOLFIRI后出现了间质性肺病。然而，药物诱导淋巴细胞刺激试验和白细胞迁移试验结果仅亚叶酸钙呈阳性，伊立替康和5-氟尿嘧啶呈阴性。这是首例药物诱导淋巴细胞刺激试验和白细胞迁移试验仅亚叶酸钙呈阳性、抗肿瘤药物呈阴性的病例。我们的研究结果表明，化疗方案中的所有药物都有可能诱发间质性肺病，如果考虑再次进行化疗，药物诱导淋巴细胞刺激试验和白细胞迁移试验有望有助于确定需要排除的药物。
