Reactions 1680, p258 - 2 Dec 2017 disease] developed and progressed rapidly in all 3 patients within 10 days of commencing nivolumab therapy, and 2 patients died." Severe acute interstitial lung disease and Nakahama K, et al. Severe acute interstitial lung disease after nivolumab in three respiratory failure: 3 case reports non-small cell lung cancer patients with imaging findings of airway obstruction adjacent to lung tumors. Journal of Infection and Chemotherapy 23: 826-829, No. In a study, three women aged 67–75 years were described, 12, Dec 2017. Available from: URL: http://doi.org/10.1016/j.jiac.2017.07.006 - who developed severe acute interstitial lung disease (ILD) Japan 803284600 during treatment with nivolumab [routes not stated]. Additionally, two women developed respiratory failure due to which they died. Case 1: A 74-year-old woman, who was diagnosed with stage IV lung adenocarcinoma with brain metastases, started receiving third-line chemotherapy with nivolumab 3 mg/kg, once every two weeks. Prior to nivolumab administration, a chest CT scan revealed a mass in the lower lobe of the right lung and consolidation, which suggested airway obstruction, with no signs of interstitial pneumonia. She was initiated on antibiotic therapy prior to nivolumab administration. On day 1 of nivolumab administration, her plasma C-reactive protein (CRP) level was significantly elevated. By day 3 of nivolumab administration, she complained of dyspnoea. Her oxygenation status and symptoms rapidly deteriorated. A chest radiography demonstrated extensive bilateral infiltrations indicative of diffuse alveolar damage. However, laboratory data and sputum cultures showed no evidence of infection or other specific aetiologies. All these tests indicated severe acute ILD. She was started on a treatment with prednisolone and methylprednisolone. On day 7, sivelestat [sivelestat sodium hydrate] was administered for two days. Additionally, she was treated with cyclophosphamide. Despite treatment, her oxygenation and lung infiltrations worsened gradually. Her laboratory data revealed increased white blood cell count following nivolumab administration. The CRP levels were found to be at 20.77 mg/dL on day 3, 5.90 mg/dL on day 5 and 14.15 mg/dL on day 8. Six days prior to nivolumab administration, KL-6 levels were 918 U/mL, which increased to 1216 U/mL on day 6. On day 10, she died due to respiratory failure. Case 2: A 67-year-old woman was diagnosed with stage IV lung adenocarcinoma with multiple pulmonary metastases and a bone metastasis at the right fifth rib. She started receiving fifth-line chemotherapy with nivolumab 3 mg/kg, once every two weeks. A chest CT scan showed airway obstruction in the lower lobe of the right lung because of tumour-mediated compression. No evidence of interstitial pneumonia was found. Prior to the nivolumab administration, her plasma CRP level was 5.01 mg/dL. On day 7 following nivolumab initiation, she complained of dyspnoea. A chest radiography demonstrated new lung infiltrations in the left lung. Chest CT scan showed an extensive ground-glass opacities, distributed predominantly through the left lung. All these tests indicated severe acute ILD. On day 8, she was started on a treatment with betamethasone and methylprednisolone. On day 11, she was given 90% FiO nasal high-flow therapy. Subsequently, her oxygenation levels and chest shadow showed an immediate improvement. Her CRP levels were found to be at 5.71 mg/dL on day 8 and 3.49 mg/dL on day 15 [outcome not stated]. Case 3: A 75-year-old woman, who was diagnosed with stage IV squamous cell carcinoma, started receiving second- line chemotherapy with nivolumab 3 mg/kg, once every two weeks. A chest CT scan showed no evidence of interstitial pneumonia. On the day 1 of nivolumab administration, her plasma CRP level was 3.73 mg/dL. On day 5, she developed dyspnoea and desaturation. A chest CT scan demonstrated bilateral ground-glass opacities. All these tests indicated severe acute ILD. She was treated with methylprednisolone and cyclophosphamide. However, her oxygenation and lung infiltrations showed no improvement. On day 18, she died due to respiratory failure. Her CRP levels were found to be 17.83 mg/dL on day 6, 8.07 mg/dL on day 8 and 2.76 mg/dL on day 10. Her KL-6 levels were 376 U/mL on day 1, 808 U/mL on day 13 and 1150 U/mL on day 17. Author comment: "In the present study, [interstitial lung 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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