Chemotherapy-induced noncardiogenic pulmonary edema related to gemcitabineplus docetaxel combination with granulocyte colony-stimulating factor support

Several cancer therapeutic agents have been associated with pulmonary toxic ity. Herein, we describe the case of a 73-year-old woman with breast cancer metastatic to the liver, who developed noncardiogenic pulmonary edema (NPE ) while on treatment with gemcitabine plus docetaxel combination with granu locyte colony-stimulating factor (G-CSF) support. Gemcitabine, a deoxycytid ine analogue, is reported to produce mild self-limiting and only occasional ly severe pulmonary toxicity. The microtubule stabilizer docetaxel has been associated with water retention complications. The combination of these tw o agents has shown promising activity in several solid tumors and is in a p hase of clinical development with prophylactic G-CSF in most of the trials due to the high rate of dose-limiting neutropenia observed with this combin ation. In our case pulmonary toxicity resolved rapidly following the admini stration of corticosteroids. A possible deleterious synergy of the compound s involved in this case is discussed and the medical literature on NPE rela ted to cancer therapy is shortly reviewed. We conclude that NPE should alwa ys be considered in patients with respiratory function deterioration while on therapy with the gemcitabine-docetaxel combination and G-CSF. Corticoste roids can provide maximum benefit if started early upon diagnosis coupled w ith withdrawal of the causative drugs. Copyright (C) 2000 S. Karger AG, Bas el.