PACLITAXEL-INDUCED ACUTE BILATERAL PNEUMONITIS

OBJECTIVE: TO report three cases of paclitaxel-induced acute bilateral pneumonitis, as well as to ascertain its incidence and outcome. CASE SUMMARIES: A total of 239 patients with a variety of underlying malign ancies received 528 courses of paclitaxel-containing chemotherapy. Pac litaxel 200 mg/m(2) was infused over 3 hours with standard premedicati on. Three patients developed bilateral interstitial infiltrates either during or within 6 hours of the administration of paclitaxel. Symptom s included a nonproductive cough, dyspnea, and sudden arterial oxygen desaturation. Response to parenteral corticosteroids was dramatic and reversed the process in all 3 patients. DISCUSSION: Paclitaxel-induced acute bilateral pneumonitis appears to be a rare adverse reaction. It may either be a direct toxic effect of the chemotherapeutic agent or an adverse effect of its Cremophor EL diluent. Although the exact path ophysiology is unclear, a variety of immune and nonimmune mechanisms h ave been postulated, including hypersensitivity reactions, release of cytokines from macrophages, and the possible role of prior thoracic ir radiation. CONCLUSIONS: Acute bilateral pneumonitis occurs in less tha n 1% of individuals receiving 3-hour infusions of paclitaxel, and resp onds dramatically to parenteral corticosteroid therapy.