Trail Allison, Rogers Jane, Ajani Jaffer
From The University of Texas MD Anderson Cancer Center, Houston, Texas.
J Adv Pract Oncol. 2023 Jul;14(5):440-443. doi: 10.6004/jadpro.2023.14.5.8. Epub 2023 Jul 1.
Mr. B is a 56-year-old man diagnosed with metastatic HER2-positive gastroesophageal adenocarcinoma. He received front-line leucovorin, 5-fluorouracil, and oxaliplatin (FOLFOX) and trastuzumab for 10 months before restaging imaging revealed progressive disease. He then received second-line trastuzumab deruxtecan. His treatment was complicated by several admissions felt to be unrelated to his cancer therapy. He was discharged after an episode of pneumonia on a steroid taper with prophylactic trimethoprim/sulfamethoxazole. Once he recovered, he was given a fourth dose of chemotherapy. About a week later, wheezes were noticed on physical exam, and he was given a 5-day course of levofloxacin. Around the same time, he also finished his steroid taper. Twelve days after his dose of chemotherapy, he presented to the emergency room with 3 to 4 days of progressive shortness of breath and dry cough following the completion of levofloxacin without symptom improvement. A CT scan showed increasing airspace opacities and multifocal areas of consolidation. Blood, nasal, and sputum cultures were negative. A bronchoscopy was performed that did not reveal findings concerning for capillaritis. He was ultimately diagnosed with drug-induced pneumonitis/interstitial lung disease (ILD). Mr. B continued to experience worsening hypoxic respiratory failure despite continuous IV steroids. He was discharged to an inpatient hospice facility where he passed away 2 weeks later. Drug-induced pneumonitis/ILD should be considered in all patients receiving trastuzumab deruxtecan who develop progressive shortness of breath or other respiratory complaints.
B先生是一名56岁男性，被诊断为转移性HER2阳性胃食管腺癌。他接受了一线亚叶酸钙、5-氟尿嘧啶和奥沙利铂（FOLFOX）以及曲妥珠单抗治疗10个月，之后重新分期成像显示疾病进展。然后他接受了二线曲妥珠单抗德鲁替康治疗。他的治疗因几次住院而变得复杂，这些住院被认为与他的癌症治疗无关。他在一次肺炎发作后出院，当时正在逐渐减少类固醇用量，并服用预防性甲氧苄啶/磺胺甲恶唑。一旦康复，他接受了第四剂化疗。大约一周后，体检时发现有哮鸣音，他接受了为期5天的左氧氟沙星治疗。大约在同一时间，他也完成了类固醇减量。在他化疗给药12天后，他因左氧氟沙星治疗结束后出现3至4天逐渐加重的呼吸急促和干咳且症状无改善而前往急诊室。CT扫描显示气腔实变增加和多灶性实变区域。血液、鼻腔和痰培养均为阴性。进行了支气管镜检查，未发现与毛细血管炎相关的异常。他最终被诊断为药物性肺炎/间质性肺疾病（ILD）。尽管持续静脉注射类固醇，B先生的低氧性呼吸衰竭仍持续恶化。他被转至住院临终关怀机构，两周后在那里去世。对于所有接受曲妥珠单抗德鲁替康治疗且出现进行性呼吸急促或其他呼吸道症状的患者，都应考虑药物性肺炎/ILD。
