Unusal lung damage associated with pemetrexed in malignant pleural mesothelioma: A case report

Giovenzio Genestreti, Noemi Giovannini, Dino Amadori, Gian Luca Casoni, Venerino Poletti

Research output: Contribution to journalArticle

Abstract

A 64-year-old male was diagnosed with malignant pleural mesothelioma (MPM) in June 2006 after complaining of dyspnoea and a persistent cough. In July 2006 the patient underwent talc pleurodesis and started first-line chemotherapy with cisplatin associated with pemetrexed (Alimta ®). At the end of the third chemotherapy cycle the disease was stable and no significant drug toxicity was recorded. The patient progressed through another three cycles under the same treatment schedule. Restaging at the end of the sixth cycle confirmed a stable disease and the patient started follow-up. In January 2007, further restaging showed disease progression and the patient was enrolled in a phase I clinical trial involving a continuous infusion of pemetrexed until at a dose of 100 mg m -2 at day one. After 8 days the patient was referred to the Accident and Emergency Department for acute dyspnoea and a fever of 38.5 °C. A high resolution CT-scan of the thorax showed diffuse, bilateral areas of ground glass attenuation with a patchy distribution. A 13-day broad-spectrum antibiotic therapy did not achieve any clinical and/or radiological improvement of respiratory abnormalities, and for this reason a bronchoscopy, with a fluoroscopic-guided transbronchial lung biopsy (TBB), and a bronchoalveolar lavage (BAL), were performed. BAL cultures for common bacteria, acid fast bacilli and fungi, as well as vial cultures and/or immunofluorescent tests for viruses (cytomegalovirus, adenovirus, herpes simplex virus, syncytial respiratory virus, influenzae and parainfluenzae viruses) and Legionellae, proved negative. Examination of BAL cytospin preparations, stained by both Diff-Quick and Papanicolaou methods, showed cuboidal hyperplastic/dysplastic cells (diffuse alveolar damage cells) whilst no malignant cells, viral inclusions, fungi, or Pneumocystis jiroveci cysts were identified. The TBB showed remnants of jaline membranes in the alveolar spaces along with granulation tissue partly obliterating the alveolar spaces, and slight thickening of the interalveolar septa. Plump elongated reactive type II pneumocytes covering the alveolar septa were also numerous. A regimen of 200 mg methylprednisolone once a day was started and a partial remission of clinical and radiological abnormalities was achieved. Based on our clinical and radiological findings we therefore conclude a possible diagnosis of drug-induced toxicity by pemetrexed chemotherapy in continuous infusion.

Original languageEnglish
Pages (from-to)267-269
Number of pages3
JournalRespiratory Medicine CME
Volume1
Issue number4
DOIs
Publication statusPublished - 2008

Fingerprint

Pemetrexed
Bronchoalveolar Lavage
Lung
Alveolar Epithelial Cells
Drug-Related Side Effects and Adverse Reactions
Drug Therapy
Dyspnea
Fungi
Pleurodesis
Talc
Biopsy
Paramyxoviridae Infections
Pneumocystis carinii
Legionella
Clinical Trials, Phase I
Respiratory Syncytial Viruses
Granulation Tissue
Methylprednisolone
Bronchoscopy
Simplexvirus

Keywords

  • Lung damage
  • Malignant pleural mesothelioma
  • Pemetrexed

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Unusal lung damage associated with pemetrexed in malignant pleural mesothelioma : A case report. / Genestreti, Giovenzio; Giovannini, Noemi; Amadori, Dino; Casoni, Gian Luca; Poletti, Venerino.

In: Respiratory Medicine CME, Vol. 1, No. 4, 2008, p. 267-269.

Research output: Contribution to journalArticle

Genestreti, Giovenzio ; Giovannini, Noemi ; Amadori, Dino ; Casoni, Gian Luca ; Poletti, Venerino. / Unusal lung damage associated with pemetrexed in malignant pleural mesothelioma : A case report. In: Respiratory Medicine CME. 2008 ; Vol. 1, No. 4. pp. 267-269.
@article{87c6c5c1526e41a4b5a931f1f480cf24,
title = "Unusal lung damage associated with pemetrexed in malignant pleural mesothelioma: A case report",
abstract = "A 64-year-old male was diagnosed with malignant pleural mesothelioma (MPM) in June 2006 after complaining of dyspnoea and a persistent cough. In July 2006 the patient underwent talc pleurodesis and started first-line chemotherapy with cisplatin associated with pemetrexed (Alimta {\circledR}). At the end of the third chemotherapy cycle the disease was stable and no significant drug toxicity was recorded. The patient progressed through another three cycles under the same treatment schedule. Restaging at the end of the sixth cycle confirmed a stable disease and the patient started follow-up. In January 2007, further restaging showed disease progression and the patient was enrolled in a phase I clinical trial involving a continuous infusion of pemetrexed until at a dose of 100 mg m -2 at day one. After 8 days the patient was referred to the Accident and Emergency Department for acute dyspnoea and a fever of 38.5 °C. A high resolution CT-scan of the thorax showed diffuse, bilateral areas of ground glass attenuation with a patchy distribution. A 13-day broad-spectrum antibiotic therapy did not achieve any clinical and/or radiological improvement of respiratory abnormalities, and for this reason a bronchoscopy, with a fluoroscopic-guided transbronchial lung biopsy (TBB), and a bronchoalveolar lavage (BAL), were performed. BAL cultures for common bacteria, acid fast bacilli and fungi, as well as vial cultures and/or immunofluorescent tests for viruses (cytomegalovirus, adenovirus, herpes simplex virus, syncytial respiratory virus, influenzae and parainfluenzae viruses) and Legionellae, proved negative. Examination of BAL cytospin preparations, stained by both Diff-Quick and Papanicolaou methods, showed cuboidal hyperplastic/dysplastic cells (diffuse alveolar damage cells) whilst no malignant cells, viral inclusions, fungi, or Pneumocystis jiroveci cysts were identified. The TBB showed remnants of jaline membranes in the alveolar spaces along with granulation tissue partly obliterating the alveolar spaces, and slight thickening of the interalveolar septa. Plump elongated reactive type II pneumocytes covering the alveolar septa were also numerous. A regimen of 200 mg methylprednisolone once a day was started and a partial remission of clinical and radiological abnormalities was achieved. Based on our clinical and radiological findings we therefore conclude a possible diagnosis of drug-induced toxicity by pemetrexed chemotherapy in continuous infusion.",
keywords = "Lung damage, Malignant pleural mesothelioma, Pemetrexed",
author = "Giovenzio Genestreti and Noemi Giovannini and Dino Amadori and Casoni, {Gian Luca} and Venerino Poletti",
year = "2008",
doi = "10.1016/j.rmedc.2008.07.007",
language = "English",
volume = "1",
pages = "267--269",
journal = "Respiratory Medicine CME",
issn = "1755-0017",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Unusal lung damage associated with pemetrexed in malignant pleural mesothelioma

T2 - A case report

AU - Genestreti, Giovenzio

AU - Giovannini, Noemi

AU - Amadori, Dino

AU - Casoni, Gian Luca

AU - Poletti, Venerino

PY - 2008

Y1 - 2008

N2 - A 64-year-old male was diagnosed with malignant pleural mesothelioma (MPM) in June 2006 after complaining of dyspnoea and a persistent cough. In July 2006 the patient underwent talc pleurodesis and started first-line chemotherapy with cisplatin associated with pemetrexed (Alimta ®). At the end of the third chemotherapy cycle the disease was stable and no significant drug toxicity was recorded. The patient progressed through another three cycles under the same treatment schedule. Restaging at the end of the sixth cycle confirmed a stable disease and the patient started follow-up. In January 2007, further restaging showed disease progression and the patient was enrolled in a phase I clinical trial involving a continuous infusion of pemetrexed until at a dose of 100 mg m -2 at day one. After 8 days the patient was referred to the Accident and Emergency Department for acute dyspnoea and a fever of 38.5 °C. A high resolution CT-scan of the thorax showed diffuse, bilateral areas of ground glass attenuation with a patchy distribution. A 13-day broad-spectrum antibiotic therapy did not achieve any clinical and/or radiological improvement of respiratory abnormalities, and for this reason a bronchoscopy, with a fluoroscopic-guided transbronchial lung biopsy (TBB), and a bronchoalveolar lavage (BAL), were performed. BAL cultures for common bacteria, acid fast bacilli and fungi, as well as vial cultures and/or immunofluorescent tests for viruses (cytomegalovirus, adenovirus, herpes simplex virus, syncytial respiratory virus, influenzae and parainfluenzae viruses) and Legionellae, proved negative. Examination of BAL cytospin preparations, stained by both Diff-Quick and Papanicolaou methods, showed cuboidal hyperplastic/dysplastic cells (diffuse alveolar damage cells) whilst no malignant cells, viral inclusions, fungi, or Pneumocystis jiroveci cysts were identified. The TBB showed remnants of jaline membranes in the alveolar spaces along with granulation tissue partly obliterating the alveolar spaces, and slight thickening of the interalveolar septa. Plump elongated reactive type II pneumocytes covering the alveolar septa were also numerous. A regimen of 200 mg methylprednisolone once a day was started and a partial remission of clinical and radiological abnormalities was achieved. Based on our clinical and radiological findings we therefore conclude a possible diagnosis of drug-induced toxicity by pemetrexed chemotherapy in continuous infusion.

AB - A 64-year-old male was diagnosed with malignant pleural mesothelioma (MPM) in June 2006 after complaining of dyspnoea and a persistent cough. In July 2006 the patient underwent talc pleurodesis and started first-line chemotherapy with cisplatin associated with pemetrexed (Alimta ®). At the end of the third chemotherapy cycle the disease was stable and no significant drug toxicity was recorded. The patient progressed through another three cycles under the same treatment schedule. Restaging at the end of the sixth cycle confirmed a stable disease and the patient started follow-up. In January 2007, further restaging showed disease progression and the patient was enrolled in a phase I clinical trial involving a continuous infusion of pemetrexed until at a dose of 100 mg m -2 at day one. After 8 days the patient was referred to the Accident and Emergency Department for acute dyspnoea and a fever of 38.5 °C. A high resolution CT-scan of the thorax showed diffuse, bilateral areas of ground glass attenuation with a patchy distribution. A 13-day broad-spectrum antibiotic therapy did not achieve any clinical and/or radiological improvement of respiratory abnormalities, and for this reason a bronchoscopy, with a fluoroscopic-guided transbronchial lung biopsy (TBB), and a bronchoalveolar lavage (BAL), were performed. BAL cultures for common bacteria, acid fast bacilli and fungi, as well as vial cultures and/or immunofluorescent tests for viruses (cytomegalovirus, adenovirus, herpes simplex virus, syncytial respiratory virus, influenzae and parainfluenzae viruses) and Legionellae, proved negative. Examination of BAL cytospin preparations, stained by both Diff-Quick and Papanicolaou methods, showed cuboidal hyperplastic/dysplastic cells (diffuse alveolar damage cells) whilst no malignant cells, viral inclusions, fungi, or Pneumocystis jiroveci cysts were identified. The TBB showed remnants of jaline membranes in the alveolar spaces along with granulation tissue partly obliterating the alveolar spaces, and slight thickening of the interalveolar septa. Plump elongated reactive type II pneumocytes covering the alveolar septa were also numerous. A regimen of 200 mg methylprednisolone once a day was started and a partial remission of clinical and radiological abnormalities was achieved. Based on our clinical and radiological findings we therefore conclude a possible diagnosis of drug-induced toxicity by pemetrexed chemotherapy in continuous infusion.

KW - Lung damage

KW - Malignant pleural mesothelioma

KW - Pemetrexed

UR - http://www.scopus.com/inward/record.url?scp=54149098164&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=54149098164&partnerID=8YFLogxK

U2 - 10.1016/j.rmedc.2008.07.007

DO - 10.1016/j.rmedc.2008.07.007

M3 - Article

AN - SCOPUS:54149098164

VL - 1

SP - 267

EP - 269

JO - Respiratory Medicine CME

JF - Respiratory Medicine CME

SN - 1755-0017

IS - 4

ER -