Fataal interstitieel longbeeld bij erlotinib-gebruik

Background

Erlotinib is used to treat patients with non-small cell lung cancer (NSCLC). The use of this tyrosine kinase inhibitor can result in interstitial lung disease, but the aetiology of this phenomenon is not clear.

Case description

A 68-year-old man with NSCLC, who had been undergoing treatment with erlotinib (150 mg daily) for the previous two weeks, presented with dyspnoea. A chest x-ray revealed infiltrates for which we started broad-spectrum antibiotics, high dose glucocorticoids and oxygen supplementation; erlotinib was discontinued. Despite these measures, the patient died of respiratory failure. Autopsy showed diffuse alveolar damage; the blood cultures taken while the patient was still alive and the post-mortem lung cultures were negative. The alveolar damage was possibly a consequence of the use of erlotinib.

Conclusion

Clinicians should be alert to worsening pulmonary symptoms without signs of infection in patients using erlotinib. Discontinuation of erlotinib and glucocorticoid treatment should be considered until alveolar damage caused by the use of erlotinib can be excluded.

Conflict of interest and financial support: a disclosure form provided by the author is available along with the full text of this article at www.ntvg.nl, search for A5519; click on ‘Belangenverstrengeling’ (‘Conflict of interest’).