Life-threatening hypersensitivity pneumonitis induced by docetaxel (taxotere)

4 patients with advanced non-small-cell lung cancer (NSCLC) treated with do cetaxel developed life-threatening pneumonitis requiring mechanical ventila tion. Docetaxel (30-60 mg m(-2), according to a different protocol) was inf used within one hour with standard premedications. One patient's pneumoniti s occurred 5 days,after the first dose of docetaxel, and that of the other 3 between the 2nd and 6th cycles. Based on the clinical course, radiologica l findings of an interstitial pneumonitis, and exclusion of other possible resultant causes, including metastatic cancer, radiation pulmonary injury, infection, or connective tissue disease, hypersensitivity pneumonitis was d iagnosed. The patients were treated with hydrocortisone at 1200 mg per day or methylprednisolone at 240 mg per day. Although 3 of the 4 had a partial improvement in lung oxygenation, all patients' conditions of hypersensitivi ty pneumonitis persisted and were complicated by other events, such as hosp ital-acquired infection and tension pneumothorax. The presence of this unus ual hypersensitivity pneumonitis, which was so severe as to be life-threate ning and refractory to high-dose corticosteroid therapy, should be taken in to account during docetaxel treatment. (C) 2001 Cancer Research Campaign.