Tuberc Respir Dis TRD Tuberculosis and Respiratory Diseases 1738-3536 2005-6184 The Korean Academy of Tuberculosis and Respiratory Diseases 10.4046/trd.2007.62.2.144 Case Report Acute Respiratory Failure Developed in Non-small Cell Lung Cancer Patients Treated With Gefitinib Ryu Jeong-Seon M.D. 1 Kim Lucia M.D. 2 Kim Chul-Hyun M.D. 1 Kim Hyun-Jung M.D. 1 http://orcid.org/0000-0002-3432-3997 Cho Jae-Hwa M.D. 1 Kwak Seung-Min M.D. 1 Lee Hong-Lyeol M.D. 1 Department of Internal Medicine, College of Medicine, Inha University, Incheon, South Korea. Department of Pathology, College of Medicine, Inha University, Incheon, South Korea. Corresponding author: Jeong Seon Ryu, M.D., Ph.D. Associate Professor, Pulmonary Division, Dept. of Internal Medicine, Inha University Hospital 7-206, 3Ga, Shinheung Dong, Jung Gu, Incheon, 400-103, Korea. jsryu@inha.ac.kr 02 2007 28 02 2007 62 2 144 148 15 01 2007 02 02 2007 Copyright © 2007 The Korean Academy of Tuberculosis and Respiratory Diseases 2007

Gefitinib is an oral selective inhibitor that targets the tyrosine kinase of the epidermal growth factor receptor. The prevalence of interstitial lung disease is 2% in Japan and 0.3% in the USA with a mortality rate of up to one third. We describe two non-small cell lung cancer patients who developed acute respiratory failure after gefitinib, and suggest that clinicians take extreme caution when deciding to treat patients with gefitinib.

 Adverse effect Gefitinib Lung cancer

This study was supported by INHA University Research Grant (INHA)

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Chest radiography shows newly developed pulmonary infiltrates on left lower lung field in case 1 and 2. Bilateral ground glass opacities are noted on chest CT scan of case 2.

It demonstrates hyaline membranes lining the alveolar wall with edema and interstitial mononuclear cell infiltrate in case 1. Fibrinoid proteinaceous exudate in the alveolar space and sometimes along the alveolar walls and intra-alveolar and interstitial infiltration of neutrophils and lymphocytes are shown in case 2.

Summary of Death Cases from Respiratory Failure Induced by Gefitinib*

*AD=adenocarcinoma, CTx=chemotherapy, DAD=diffuse alveolar damage, IPF=idiopathic pulmonary fibrosis, L=large cell carcinoma, NE=not evaluated, PY=pack-years, RTx=radiation therapy, SQ=squamous cell carcinoma, SD=stable disease, Clinical diagnosis=diagnosis made by clinical and radiologic findings; †, response to gefitinib; , Period of administration of gefitinib before the development of acute respiratory failure; ‡, post-radiation pulmonary fibrosis