Anoop T M, Joseph Rona, Unnikrishnan P, Thomas Flowerlit, Venugopal M
Department of Medical Oncology, Regional Cancer Center, Thiruvananthapuram, Kerala, India.
Department of Medical Oncology, Malabar Cancer Center, Thalassery, Kerala, India.
Lung India. 2022 Mar-Apr;39(2):158-168. doi: 10.4103/lungindia.lungindia_126_21.
Although rare, taxane-induced interstitial pneumonitis is a well-recognized toxicity following chemotherapy. Data on taxane rechallenge in patients who developed taxane-induced interstitial pneumonitis following chemotherapy are limited. Here, we share our experience of acute interstitial pneumonitis following taxane chemotherapy for breast cancer and its clinical outcome following steroids and subsequent rechallenge with taxanes in selected patients without residual lung abnormalities on imaging following steroid treatment.
To study the taxane-induced acute interstitial pneumonitis in patients with breast cancer receiving chemotherapy and outcome of taxane rechallenge in these patients.
Patients with breast cancer who developed taxane-induced acute interstitial pneumonitis following chemotherapy either with paclitaxel or docetaxel were included.
Among 1240 patients with breast cancer, who received chemotherapy with either docetaxel or paclitaxel, 41 patients developed taxane-induced acute interstitial lung disease (ILD) during the study period. The interstitial pneumonitis was more seen with docetaxel. Among paclitaxel regimens, weekly schedules showed more cases of ILD than 2 weekly paclitaxel. After steroid pulse/maintenance treatment, complete resolution of lung abnormalities was seen in 76%, but residual interstitial pattern on imaging was noted in 24% of patients. Taxane rechallenge was done in 20 (49%) patients. Agents used were paclitaxel, nab-paclitaxel, or docetaxel. All rechallenged patients received short-course oral steroids for one week following taxane rechallenge as a safety measure. Rechallenge was not done in 51% either due to patient unwillingness for rechallenge (27%) or patient with residual interstitial pattern on imaging (24%). None of the patients experienced any recurrence of pneumonitis or any mortality following taxane rechallenge.
Acute interstitial pneumonitis is a well-known toxicity following taxanes in breast cancer and taxane rechallenge is an option in those patients without any residual pneumonitis following steroid pulse/maintenance. We also advise short-course oral steroids for 1 week following taxane rechallenge as a safety measure. We strongly do not recommend rechallenge in patients with residual lung abnormalities after steroids.
尽管紫杉烷诱导的间质性肺炎较为罕见，但它是化疗后一种公认的毒性反应。关于化疗后发生紫杉烷诱导的间质性肺炎的患者再次使用紫杉烷的数据有限。在此，我们分享乳腺癌患者紫杉烷化疗后急性间质性肺炎的经验以及在部分患者中使用类固醇治疗后影像学上无残留肺部异常的情况下随后再次使用紫杉烷的临床结果。
研究接受化疗的乳腺癌患者中紫杉烷诱导的急性间质性肺炎以及这些患者再次使用紫杉烷的结果。
纳入化疗后因紫杉醇或多西他赛发生紫杉烷诱导的急性间质性肺炎的乳腺癌患者。
在1240例接受多西他赛或紫杉醇化疗的乳腺癌患者中，41例在研究期间发生了紫杉烷诱导的急性间质性肺病（ILD）。多西他赛导致的间质性肺炎更为常见。在紫杉醇治疗方案中，每周给药方案的ILD病例比每两周一次的紫杉醇方案更多。类固醇冲击/维持治疗后，76%的患者肺部异常完全消退，但24%的患者影像学上仍有残留的间质影像。20例（49%）患者再次使用了紫杉烷。使用的药物为紫杉醇、白蛋白结合型紫杉醇或多西他赛。作为安全措施，所有再次使用紫杉烷的患者在再次使用后接受了为期一周的短疗程口服类固醇治疗。51%的患者未再次使用紫杉烷，原因要么是患者不愿意再次使用（27%），要么是影像学上有残留间质影像（24%）。再次使用紫杉烷后，无一例患者发生肺炎复发或死亡。
急性间质性肺炎是乳腺癌患者使用紫杉烷后已知的毒性反应，对于类固醇冲击/维持治疗后无残留肺炎的患者，再次使用紫杉烷是一种选择。作为安全措施，我们还建议在再次使用紫杉烷后给予为期1周的短疗程口服类固醇治疗。我们强烈不建议对类固醇治疗后有残留肺部异常的患者再次使用紫杉烷。
