Exacerbation of pre-existing interstitial lung disease after oxaliplatin therapy: A report of three cases

Background: To describe the possible role of oxaliplatin in worsening pre-existing interstitial lung disease. Methods: After we encountered a patient with an interstitial lung disease who experienced a fatal progression of his pulmonary disease associated with oxaliplatin therapy, a computer-aided search was conducted to identify other similar patients. Twenty-six patients with various lung diseases who had received oxaliplatin therapy at Mayo Clinic in Rochester, MN from January 2000 to December 2006 were identified. Three of these patients had radiologic evidence of interstitial lung disease before undergoing oxaliplatin therapy. We examined the medical records and imaging studies of these three patients to further define their clinical presentation, radiological and functional characteristics, and clinical outcome. Results: All three patients experienced symptomatic and radiologic worsening of their interstitial lung disease following oxaliplatin administration. One of these patients died from refractory respiratory failure; the remaining two patients stabilized after the discontinuation of oxaliplatin therapy and have since shown modest improvement in pulmonary symptoms and lung function. There were no other potential causes identified for the unexpected progression of their lung disease other than the temporal relationship to oxaliplatin therapy. Conclusions: Treatment with oxaliplatin, in the setting of a pre-existing interstitial lung disease, may be associated with respiratory deterioration. It is unknown whether this is mediated by acceleration of the underlying parenchymal disease or by a superimposed acute lung injury caused by oxaliplatin.