Z Gastroenterol 2019; 57(05): e147-e148
DOI: 10.1055/s-0039-1691898
POSTER
Gastroenterologie
Georg Thieme Verlag KG Stuttgart · New York

Gemcitabine related pneumonitis (GRP) in patients with pancreatic ductal adenocarcinoma (PDAC) – A case series

A Schmiderer
1   Department of Internal Medicine I, Division of Gastroenterology, Hepatology and Endocrinology, Medical University Innsbruck, Innsbruck, Austria
,
M Niederreiter
1   Department of Internal Medicine I, Division of Gastroenterology, Hepatology and Endocrinology, Medical University Innsbruck, Innsbruck, Austria
,
L Niederreiter
1   Department of Internal Medicine I, Division of Gastroenterology, Hepatology and Endocrinology, Medical University Innsbruck, Innsbruck, Austria
,
A Djanani
1   Department of Internal Medicine I, Division of Gastroenterology, Hepatology and Endocrinology, Medical University Innsbruck, Innsbruck, Austria
,
H Tilg
1   Department of Internal Medicine I, Division of Gastroenterology, Hepatology and Endocrinology, Medical University Innsbruck, Innsbruck, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
16 May 2019 (online)

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Introduction:

Gemcitabine, first approved for medical use in 1995, is a nucleoside analogue that shows activity against a variety of solid tumors. In pancreatic ductal adenocarcinoma (PDAC) gemcitabine is used both in adjuvant and in palliative therapy. Myelosuppression, mild dyspnea and fatigue are common side effects during treatment, but severe pulmonary toxicities like gemcitabine related pneumonitis (GRP) are reported to be uncommon with a incidence of approximately 0.3 – 2% of treated patients.

Methods:

We report a case series of three patients that developed GRP during treatment of PDAC at our department in the years 2016 – 2017. We report on clinical presentation, diagnostic approach and treatment outcome.

Results:

Two of the patients reported underwent adjuvant monotherapy with gemcitabine for PDAC after surgical resection and one patient received a palliative chemotherapy with gemcitabine and nab-paclitaxel. After 3 – 5 cycles of chemotherapy patients presented with increasing dyspnea – one patient had to be admitted, the other two patients were managed in our outpatient clinic. HR-CT scans were performed and showed radiological signs associated with GRP in all three patients. After clinical work up to rule out other common causes of dyspnea, the diagnosis of GRP was established in consultation with our pulmonary specialists. Upon diagnosis gemcitabine was discontinued and treatment with systemic steroids was initiated. Symptoms of all three patients improved significantly over the following weeks and follow-up HR-CT scans showed also marked improvements.

Conclusion:

GRP is an uncommon but potentially life-threatening complication during gemcitabine treatment. Distinguishing GRP from infectious causes is not trivial but once diagnosis is established most patients respond well to systemic steroids. In conclusion, clinicians treating patients with gemcitabine should be alert to GRP, especially when patients develop pulmonary symptoms.