John D Mayfield1, Catherine E Mercado1, Frederic J Kaye2, William M Mendenhall1. 1. Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida. 2. Division of Medical Oncology, University of Florida College of Medicine, Gainesville, Florida.
Abstract
BACKGROUND: Cetuximab is a common EGFR monoclonal antibody used with radiotherapy to treat head-and-neck cancer. Severe pulmonary toxicity, including interstitial lung disease (ILD), caused by cetuximab is rare. METHODS: We describe a patient who developed ILD and acute respiratory failure after concurrent chemoradiation with cetuximab for oropharyngeal squamous cell carcinoma, and review the literature. RESULTS: A patient developed acute respiratory failure 2 months after starting concurrent chemoradiation with cetuximab and was hospitalized in intensive care after a procedure for progressive respiratory distress. Cultures and serology were negative for infection and radiologic findings were consistent with drug associated pneumonitits. Steroids were administered until the patient was stabilized. The patient fully recovered 1 month after the onset of respiratory distress, although he died of recurrent disease 10 months after completing treatment. CONCLUSION: Although severe pulmonary toxicity caused by EGFR inhibitors has been well described in the literature, ILD caused by cetuximab, an EGFR monoclonal antibody, is rare and not well-documented. Given its life-threatening effects, awareness of this potential side effect and early diagnosis is critical.
BACKGROUND:Cetuximab is a common EGFR monoclonal antibody used with radiotherapy to treat head-and-neck cancer. Severe pulmonary toxicity, including interstitial lung disease (ILD), caused by cetuximab is rare. METHODS: We describe a patient who developed ILD and acute respiratory failure after concurrent chemoradiation with cetuximab for oropharyngeal squamous cell carcinoma, and review the literature. RESULTS: A patient developed acute respiratory failure 2 months after starting concurrent chemoradiation with cetuximab and was hospitalized in intensive care after a procedure for progressive respiratory distress. Cultures and serology were negative for infection and radiologic findings were consistent with drug associated pneumonitits. Steroids were administered until the patient was stabilized. The patient fully recovered 1 month after the onset of respiratory distress, although he died of recurrent disease 10 months after completing treatment. CONCLUSION: Although severe pulmonary toxicity caused by EGFR inhibitors has been well described in the literature, ILD caused by cetuximab, an EGFR monoclonal antibody, is rare and not well-documented. Given its life-threatening effects, awareness of this potential side effect and early diagnosis is critical.
Authors: Valerio Nardone; Maria Grazia Calvanese; Ida D'Onofrio; Mario Di Stasio; Claudio Vitale; Antonia Silvestri; Bruno Daniele; Pierpaolo Correale; Paolo Fierro; Giuseppe Tortoriello; Alfonso Reginelli; Salvatore Cappabianca; Cesare Guida Journal: Rep Pract Oncol Radiother Date: 2020-04-12