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) and docetaxel (Taxotere), are anti-microtubulin drugs that have a broad range of antitumor activity. Both drugs have the potential to induce pulmonary injury through a variety of mechanisms.
Acute infusion reactions (both mast cell/basophil and cytokine-mediated) are common manifestations of chemotherapy and are seen with both paclitaxel and docetaxel. The most common pulmonary toxicity, interstitial pneumonitis, can develop within days to weeks of receiving either drug, or later in the course of therapy. A syndrome of capillary leakage resulting in peripheral edema, noncardiogenic pulmonary edema, and pleural effusions has been reported with docetaxel.
The range of pulmonary toxicity seen with use of the taxanes will be reviewed here. An overview of chemotherapy-induced infusion reactions 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".)
ACUTE INFUSION REACTIONS
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 associated with these reactions overlap, although the mechanisms are different. The important reason to differentiate these reactions is that 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 and the clinical manifestations of anaphylaxis (from all causes) are presented in detail elsewhere. (See "Infusion reactions to systemic chemotherapy" and "Anaphylaxis: Emergency treatment".)
Acute infusion reactions to paclitaxel and docetaxel usually develop within the first 10 to 15 minutes of drug infusion, and nearly 95 percent occur during the first or second drug infusion. Symptoms may include dyspnea (with or without bronchospasm), urticaria, back pain, hypotension (or sometimes hypertension), and an erythematous rash, which may not begin until after the patient has returned home following drug infusion.
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- ACUTE INFUSION REACTIONS
- INTERSTITIAL PNEUMONITIS
- Incidence and impact of dose and schedule
- Concomitant drugs
- Concomitant radiotherapy
- Radiographic appearance
- Findings at BAL and biopsy
- CAPILLARY LEAKAGE AND DOCETAXEL
- RADIATION RECALL
- Infusion reactions
- - Treatment
- Diffuse interstitial pneumonitis
- - Treatment
- Docetaxel-related capillary leakage