Pulmonary toxicity resulting from treatment with gemcitabine

Background: Description of cases of acute and chronic life-threatening pulmonary toxicity resulting from treatment with gemcitabine in order to alert to this problem and to avoid fatal incidents by timely administration of corticosteroids and diuretics. Materials and Methods: Description of 4 patients pre senting with gemcitabine-induced toxicity: one with chronic-onset, life-threatening acute RDS and bronchoscopically gained histological diagnosis, requiring intensive-care treatment in our hospital; the 2nd patient similar, without developing acute RDS; the 3rd with subacute-onset, life-threatening shock and intensive-care hospitalization in a peripheral clinic, and the 4th with :allergic reaction including shivering, fever and skin rushes, requiring as well premature re-hospitalization. Results: All 4 patients survived, although requiring intensive-care treatment. Extensive diagnostic efforts in the 1st case allowed the histological diagnosis of interstitial pneumonia with bronchiolitis obliterans. The patient recovered completely by steroid and diuretic therapy, and a re-exposure to gemcitabine was possible under steroid cover. Conclusion: The pulmonary toxicity of gemcitabine seems to be an underestimated side effect since more similar case reports have been published and also personally communicated to us. In some cases early signs of a potentially fatal pulmonary toxicity may be missed due to lack of knowledge, but could well be picked up and be treated if considered with more caution. This could even lead to a continuation of the gemcitabine treatment under steroid cover, just as we did in the Ist patient, vr;ho had a gemcitabine-induced complete remission of his pancreas carcinoma, and as well in the 2nd patient.