Taxane-induced pulmonary toxicity
- Talmadge E King, Jr, MD
Talmadge E King, Jr, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Interstitial Lung Disease
- Dean, School of Medicine
- Vice Chancellor, Medical Affairs
- University of California San Francisco
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Section Editors
- Kevin R Flaherty, MD, MS
Kevin R Flaherty, MD, MS
- Section Editor — Interstitial Lung Disease
- Associate Professor of Medicine
- University of Michigan Health System
- Reed E Drews, MD
Reed E Drews, MD
- Section Editor — Complications of Cancer
- Associate Professor of Medicine
- Harvard Medical School
- Deputy Editors
- Diane MF Savarese, MD
Diane MF Savarese, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Oncology and Palliative Care
- Clinical Instructor of Medicine
- Harvard Medical School
- Helen Hollingsworth, MD
Helen Hollingsworth, MD
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor of Medicine
- Boston University School of Medicine
The taxanes, paclitaxel (Taxol), nanoparticle albumin-bound paclitaxel (nabpaclitaxel [Abraxane]), docetaxel (Taxotere), and cabazitaxel (Jevtana), are anti-microtubulin drugs that have a broad range of antitumor activity. These agents have the potential to induce pulmonary injury through a variety of mechanisms:
●The most common pulmonary toxicity, interstitial pneumonitis, can develop within days to weeks of receiving paclitaxel or docetaxel, or it may arise later in the course of therapy . In contrast, interstitial pneumonitis seems to be less common with nabpaclitaxel and with cabazitaxel, a semisynthetic taxane derivative used for treatment of advanced prostate cancer.
●A syndrome of capillary leakage, resulting in peripheral edema, noncardiogenic pulmonary edema, and pleural effusions, has also been reported with docetaxel but not with the other taxanes.
●Reactions that occur during or shortly after infusion of an antineoplastic agent can be categorized as hypersensitivity/allergic reactions (associated with mast cell/basophil activation) and standard infusion reactions (cytokine mediated) (table 1). The clinical signs and symptoms often include the lungs, and they overlap, although the mechanisms are different. Patients with symptoms and signs to suggest mast cell/basophil mediation (eg, urticaria, angioedema, wheezing, stridor) are at risk for life-threatening anaphylaxis should rechallenge be undertaken (table 2). The evaluation of reactions during or shortly after infusion of taxanes is presented in detail elsewhere. (See "Infusion reactions to systemic chemotherapy".)
Taxane-induced interstitial pneumonitis and capillary leakage syndrome will be reviewed here. An overview of chemotherapy-induced infusion reactions (which may present with respiratory symptoms) and general issues related to interstitial pneumonitis in adults are presented separately. (See "Infusion reactions to systemic chemotherapy" and "Approach to the adult with interstitial lung disease: Clinical evaluation" and "Approach to the adult with interstitial lung disease: Diagnostic testing" and "Acute interstitial pneumonia (Hamman-Rich syndrome)" and "Idiopathic interstitial pneumonias: Clinical manifestations and pathology".)
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- INTERSTITIAL PNEUMONITIS
- Paclitaxel, docetaxel, and nabpaclitaxel
- - Incidence and impact of dose and schedule
- - Concomitant drugs
- - Concomitant radiotherapy
- - Patterns of disease
- - Clinical manifestations
- - Diagnostic evaluation
- - Treatment
- CAPILLARY LEAKAGE AND DOCETAXEL
- RADIATION RECALL
- SUMMARY AND RECOMMENDATIONS
- Interstitial pneumonitis
- Docetaxel-related capillary leakage