Pemetrexed induced pneumonitis

Our plain-English summary of Pemetrexed induced pneumonitis, by B. Dhakal, V. Singh, A. Shrestha, et al (Clinics and Practice, 2011).

The study

• Authors: B. Dhakal, V. Singh, A. Shrestha, A. Rao, N. Choong
• Journal: Clinics and Practice
• Published: 2011;1(4):e106
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pemetrexed is an antifolate chemotherapy agent that is active in malignant mesothelioma and non-small cell lung cancer (NSCLC). Pneumonitis is a rare side effect of Pemetrexed. We report the case of 72-year-old female with metastatic poorly differentiated lung adenocarcinoma. She was placed on maintenance pemetrexed and developed gradual progressive dyspnea after first cycle of maintenance of pemextrexed. The computed tomography (CT) of the chest showed ground glass opacity in both lung fields. Transbronchial lung biopsy showed uniform interstitial widening by a cellular chronic infiltrate with areas of type II pneumocyte and exudation of pale eosinophilic edema fluid; features consistent with acute lung injury. Patient improved both clinically and radiological after stopping pemetrexed and starting prednisone. Although pemetrexed induced lung injury is relatively rare, with the increasing use of peme-trexed in first-line treatment and in maintenance therapy of non-small cell lung cancer, awareness of this potential adverse effects is important.

In plain English

This was a case report with a brief review of published case reports. It described a 72-year-old woman with metastatic poorly differentiated lung adenocarcinoma. The authors note pemetrexed is active in malignant mesothelioma and non-small cell lung cancer. After 6 cycles of carboplatin and pemetrexed, she started maintenance pemetrexed. About a month after her first maintenance cycle, she developed worsening breathlessness and was hospitalized on oxygen. A chest CT showed new ground glass infiltrates in both lungs. A lung biopsy showed features consistent with acute lung injury; lavage cultures were negative for PCP, viral and bacterial infections. Pemetrexed was stopped and prednisone 40 mg daily was started. Her symptoms improved within a few days, and a CT at 4 weeks showed improvement. The authors' literature review found 4 earlier case reports. Two of those patients died, both after a single dose. In this case and the other 2, injury followed 4-7 exposures and was non-fatal and reversible. The authors concluded that awareness of this rare side effect is important as pemetrexed use increases. The article does not concern asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report with a brief literature review of published case reports
• Who was studied: one 72-year-old female patient with metastatic poorly differentiated lung adenocarcinoma; no place or dates of treatment are stated beyond the authors' affiliation (Medical College of Wisconsin, Milwaukee, USA)
• Exposure: the chemotherapy drug pemetrexed: 6 cycles of carboplatin plus pemetrexed, followed by maintenance pemetrexed; no asbestos or fiber exposure is discussed
• Main results:
  • About one month after her first cycle of maintenance pemetrexed, the patient developed gradually worsening shortness of breath (dyspnea)
  • She was hospitalized and needed oxygen by nasal cannula
  • Chest CT showed new scattered ground glass infiltrates in both lungs
  • Transbronchial biopsy showed uniform interstitial widening by a cellular chronic infiltrate, with features consistent with acute lung injury
  • Bronchoalveolar lavage cultures were negative for PCP, viral and bacterial infections
  • After pemetrexed was stopped and oral prednisone 40 mg daily was started, her symptoms improved within a few days
  • A repeat chest CT scan at 4 weeks showed radiographic improvement
  • The authors' literature review identified 4 earlier case reports of pemetrexed-induced pneumonitis
  • In the published reports reviewed, 2 cases were fatal, and both occurred after only 1 dose of pemetrexed
  • In this case and 2 other reported cases, lung injury occurred after 4-7 exposures to pemetrexed and was non-fatal and reversible
• The authors' conclusion: The authors concluded that, although pemetrexed-induced lung injury is relatively rare, awareness of it is important given the increasing use of pemetrexed in first-line and maintenance treatment of non-small cell lung cancer

Topics

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Pneumonitis, Antifolate, Chemotherapy, Mesothelioma, Non-Small Cell Lung Cancer, Lung Adenocarcinoma, Dyspnea.

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