J Korean Surg Soc.  2011 Dec;81(6):414-418. 10.4174/jkss.2011.81.6.414.

Interstitial lung disease caused by TS-1: a case of long-term drug retention as a fatal adverse reaction

• Park JM
• Hwang IG
• Suh SW
• Chi KC

• KMID: 1445771
• DOI: http://doi.org/10.4174/jkss.2011.81.6.414

Abstract

TS-1 is an oral anti-cancer agent for gastric cancer with a high response rate and low toxicity. We report a case of long-term drug retention of TS-1 causing interstitial lung disease (ILD) as a fatal adverse reaction. A 65-year-old woman underwent a total gastrectomy with pathologic confirmation of gastric adenocarcinoma. She received 6 cycles of TS-1 and low-dose cisplatin for post-operative adjuvant chemotherapy followed by single-agent maintenance therapy with TS-1. After 8 months, the patient complained of a productive cough with sputum and mild dyspnea. A pulmonary evaluation revealed diffuse ILD in the lung fields, bilaterally. In spite of discontinuing chemotherapy and the administration of corticosteroids, the pulmonary symptoms did not improve, and the patient died of pulmonary failure. TS-1-induced ILD can be caused by long-term drug retention that alters the lung parenchyma irreversibly, the outcome of which can be life-threatening. Pulmonary evaluation for early detection of disease is recommended.

Keyword

TS-1; Interstitial lung diseases; Stomach neoplasms; Adverse reaction

MeSH Terms

Adenocarcinoma
Adrenal Cortex Hormones
Aged
Chemotherapy, Adjuvant
Cisplatin
Cough
Dyspnea
Early Diagnosis
Female
Gastrectomy
Humans
Lung
Lung Diseases, Interstitial
Retention (Psychology)
Silicates
Sputum
Stomach Neoplasms
Titanium
Adrenal Cortex Hormones
Cisplatin
Silicates
Titanium

Figure

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  Fig. 1 Chest X-ray and chest computed tomography scan showing reticular infiltration and ground glass opacities in both lower lung fields, suggesting diffuse interstitial lung disease, such as idiopathic pulmonary fibrosis or bronchiolitis obliterans with organizing pneumonia.

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  Fig. 2 A chest X-ray showed increased interstitial shadows in both lungs and a chest computed tomography scan also revealed aggravated ground glass opacities and reticular honeycomb lesions in both lower lung fields.

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