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Abstract
Gefitinib is a novel drug used to treat advanced non-small cell lung cancer. However, drug-related interstitial pneumonia is a major life-threatening side effect, which has a worldwide prevalence of 0.3-0.4%. In Japan, the prevalence is high as 3-4% but the actual frequency in Korea has not been officially assessed. We report two cases of gefitinib-induced interstitial lung disease during the treatment of non-small cell lung cancer. High-resolution computerized tomography (HRCT) of one case showed nonspecific ground glass opacity and the chest x-ray of another case showed diffuse bilateral ground glass opacity. The former patient showed a rapid good response to corticosteroid treatment whereas the latter died despite receiving aggressive treatment with high dose corticosteroid and empirical antibiotics.
Figures and Tables
Figure 1
(A) Chest X-ray on day 25 of gefitinib therapy. Poorly defined ground glass opacities in right upper lung field has developed. (B) HRCT on day 25 of gefitinib therapy. Besides previously existed large amount of left pleural effusion and nodular thickenings, new ground glass opacity of both upper lung zone has developed.
Figure 2
Chest X-ray 1 week after the discontinuation of gefitinib and steroid treatment. Ground glass opacity of right lung has improved.
Figure 3
Chest X-ray on day 67 of gefitinib therapy. Diffuse poorly defined air-space opacities of both lung has developed.
Figure 4
Chest X-ray one week after high dose steroid and antibiotics therapy. Diffuse poorly defined air-space opacities and volume reduction of both lung have markedly aggravated.
Figure 5
(A) Acute interstitial pneumonia-like observations. (B) Chronic organizing pneumonia-like observations. (C) Acute eosinophilic pneumonia-like observations. (D) Light ground-glass shadows in bilateral lung fields lacking shrinkage of lung field and traction bronchiectasis (With permission, AstraZeneca and Iressa Expert Committee, 2003).
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