Interstitial Pneumonitis after Treatment with Pemetrexed in a Patient with Non-small Cell Lung Cancer: A Case Report

一位非小細胞肺癌病患使用愛寧達治療出現間質性肺炎：一病例報告

王薏婷(I-Ting Wang) ； 劉景隆(Ching-Lung Liu) ； 林榮祿(Rong-Luh Lin)

《胸腔醫學》 31卷4期 (2016/08) Pp. 243-249

摘要

愛寧達是一種抗葉酸化療藥物。它被廣泛和安全地用於治療各種腫瘤，包括惡性間皮瘤和局部晚期或轉移性非小細胞肺癌。在此，我們要報告一位57歲男性經確診為第四期肺腺癌。在他接受順鉑和愛寧達五個療程後，接著進行愛寧達維持治療，治療產生了顯著的效果。但是，他在進行十六個週期的愛寧達維持治療之後出現了呼吸困難。他的胸部電腦斷層掃描顯示，在兩側肺野出現毛玻璃樣陰影伴隨蜂窩狀表徵。在胸腔鏡內視鏡手術切片取樣顯示普通型間質性肺炎，且沒有任何殘餘的癌細胞。因此，給予口服類固醇治療，之後，在臨床與影像學上觀察到顯著的反應。愛寧達引起的間質性肺炎是比較少見的。立即停止所給予的藥物並加上類固醇治療可以改善愛寧達所帶來的副作用。

關鍵字

間質性肺炎 ； 非小細胞肺癌 ； 愛寧達

並列摘要

Pemetrexed is a multi-targeted anti-folate chemotherapy agent. It is widely and safely used to treat various types of tumors, including malignant mesothelioma and locally advanced or metastatic non-small-cell lung cancer. We report the case of a 57-year-old man diagnosed with stage IV lung adenocarcinoma. He was administered 5 courses of cisplatin and pemetrexed followed by pemetrexed maintenance therapy, resulting in a marked response. However, progressive dyspnea developed after 16 cycles of maintenance pemetrexed. A computed tomography scan of the chest showed ground glass opacities with a honeycomb appearance in both lung fields. The video-assisted thoracoscopic surgery lung biopsy specimens showed a usual interstitial pneumonia pattern, and were free from any residual cancer cells. A diagnosis of drug-induced interstitial pneumonitis caused by pemetrexed was made. Therefore, oral prednisolone treatment was administered, and a clinical and radiological response was observed. Pemetrexed-induced interstitial pneumonitis is relatively rare. This adverse effect may respond to withdrawal of the offending agent and the use of corticosteroid therapy.

並列關鍵字

interstitial pneumonitis ； non-small cell lung cancer ； pemetrexed