Tuberc Respir Dis.  2009 Nov;67(5):445-448.

Recurrent Erlotinib-Induced Interstitial Lung Disease on Non-Small Cell Lung Cancer

• Park SD
• Kim A
• Park JS
• Shin CH
• Nam HS
• Kim L
• Cho JW
• Ryu JS
• Kwak SM

Abstract

Erlotinib (Tarceva(R)) has been considered to be a new, promising oral chemotherapy agent for local advanced or metastatic non-small cell lung cancer (NSCLC). Erlotinib is regarded as relatively safe, but interstitial lung disease (ILD) related to erlotinib has been reported on an infrequent basis in Asia. We report an histologically confirmed case of recurrent erlotinib-induced ILD. Although, the patient was highly responsive to the first erlotinib treatment, the therapy was discontinued due to erlotinib-induced ILD. After intravenous high dose methylpredinisolone treatment, ILD was improved rapidly by radiologic studies, but the particular lung cancer re-emerged. We restarted the patient erlotinib on low-dose oral methylpredinisolone, resulting in a recurrence of erlotinib-induced ILD. Our case suggests that re-administration of erlotinib should be performed on a limited basis in patients that have developed ILD on previous use, even if a therapeutic effect can be estimated.

Keyword

Erlotinib; Lung Diseases, Interstitial; Carcinoma, Non-Small-Cell Lung

MeSH Terms

Asia
Carcinoma, Non-Small-Cell Lung
Humans
Lung Diseases, Interstitial
Lung Neoplasms
Quinazolines
Recurrence
Erlotinib Hydrochloride
Quinazolines

Figure

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  Figure 1 Low dose chest computed tomography (CT) before (A) and after (B) the first interstitial lung disease (ILD) episode. Multiple metastatic lesions on (A) are markedly decreased on (B) but diffuse GGO newly appeared. (C) After high dose methylpredinisolone IV treatment, the extent of ILD is decreased on following low dose chest CT. Second episode (D) represented more severe diffuse GGO on both lung fields.

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  Figure 2 Mild interstitial lymphocytic infiltration with fibrosis and intraalveolar fibrous plugging in lung tissue at high magnification.

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