Gemcitabine-Induced Pulmonary Toxicity: A Case Report of Pulmonary Veno-Occlusive Disease

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Although chemotherapy with gemcitabine for pancreatic cancer is very well tolerated, pulmonary veno-occlusive disease (PVOD) might be considered when characterizing any serious gemcitabine-related pulmonary toxicity, according to a case report published in the journal Clinical Medicine Insights: Oncology.

Gemcitabine is a nucleoside metabolic inhibitor indicated for the treatment of various solid tumors in combination with other chemotherapeutic agents and as monotherapy for pancreatic cancer.

The most common adverse event associated with single-agent gemcitabine is myelosuppression, but it may also cause pulmonary toxicity and respiratory failure in some patients.

In this case report, clinicians at University Hospital of Besançon in France, describe an 83-year-old man with metastatic pancreatic cancer who received first-line gemcitabine for 8 cycles.

After 6 months, the patient achieved complete response, but developed severe dyspnea on exertion and hemoptysis. He was ultimately diagnosed with PVOD, which was suspected to be gemcitabine-induced.

Gemcitabine was discontinued and the patient was treated with high doses of diuretics and curative doses of heparin. Two years after diagnosis, the patient remained in completed remission and 18 months after discontinuing chemotherapy, the patient’s dyspnea improved.

This is the second known case of PVOD likely associated with gemcitabine administration, with the first case occurring in a patient with lung cancer.

Although myelosuppression is the most adverse event of this therapy, gemcitabine might induce severe pulmonary toxicities.

Abstract

Introduction: Gemcitabine is a chemotherapeutic agent frequently used by for the treatment of several malignancies both in the adjuvant and metastatic setting. Although myelosuppression is the most adverse event of this therapy, gemcitabine might induce severe pulmonary toxicities.

We describe a case of pulmonary veno-occlusive disease (PVOD) related to gemcitabine.

Case presentation: The patient was an 83-year-old man with a metastatic pancreatic cancer who was treated by gemcitabine as first-line therapy. He was in good health and received no other chemotherapy.

A dose of 1000 mg/m² of gemcitabine was administered over a 30-minute intravenous infu-sion on days 1, 8, and 15 of a 28-day cycle. After a period of 6 months, a complete response was observed.

Nevertheless, the patient developed a severe dyspnea, with arterial hypoxemia and very low lung diffusion for carbon monoxide. A CT scan showed diffuse ground glass opacities with septal lines, bilateral pleural effusion, and lymph node enlargement.

On echocardiography, there was a suspicion of pulmonary hypertension with elevated systolic pulmonary artery pressure and normal left ventricular pressures. Right heart catheterization confirmed pulmonary hypertension and normal pulmonary artery occlusion pressure.

Diagnosis of PVOD was made, and a gemcitabine-induced toxicity was suspected. A symptomatic treatment was started.

At last follow-up, patient was in functional class I with near-normal of CT scan, arterial blood gases, and echocardiography. A gemcitabine-induced PVOD is the more likely diagnosis.

Keywords: gemcitabine, pancreatic cancer, pulmonary toxicities, veno occlusive disease

Citation: Turco et al. Gemcitabine-Induced Pulmonary Toxicity: A Case Report of Pulmonary Veno-Occlusive Disease. Clinical Medicine Insights: Oncology 2015:9 75–79 doi: 10.4137/CMO.S26537.

Received: March 24, 2015. Resubmitted: May 04, 2015. Publication Date: May 05, 2015.

Academic Editor: William C S Cho, Editor in Chief

Type: Case Report

Funding: Authors disclose no funding sources.

Competing Interests: Authors disclose no potential conflicts of interest.

Correspondence: [email protected]

Copyright: © the authors, publisher and licensee Libertas Academica Limited. This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 License.

Paper subject to independent expert blind peer review by minimum of two reviewers. All editorial decisions made by independent academic editor. Upon submission manuscript was subject to anti-plagiarism scanning. Prior to publication all authors have given signed confirmation of agreement to article publication and compliance with all applicable ethical and legal requirements, including the accuracy of author and contributor information, disclosure of competing interests and funding sources, compliance with ethical requirements relating to human and animal study participants, and compliance with any copyright requirements of third parties. This journal is a member of the Committee on Publication Ethics (COPE).

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Gemcitabine-Induced Pulmonary Toxicity: A Case Report of Pulmonary Veno-Occlusive Disease

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