Abstract
We report a case of drug-induced interstitial lung disease (ILD) caused by epirubicin and cyclophosphamide (EC) therapy in a patient with breast cancer. The patient suffered from a dry cough, fever, and exertional dyspnea after two courses of EC therapy. Antibiotic treatment did not improve her symptoms. Chest CT images revealed diffuse, ground-glass opacities and mild interlobular septal thickening in both lungs, a pattern suggesting a hypersensitivity pneumonitis. Bronchoalveolar lavage fluid analysis revealed lymphocytosis with no evidence of infection nor malignancy. Corticosteroid therapy was initiated, which led to a rapid resolution of ILD. To date, there has been only one case report regarding drug-induced ILD caused by EC therapy. This case report could increase awareness of chemotherapy-induced pneumonitis.
Highlights
Breast cancer is the most common cancer in women [1], and systemic therapy is an essential part of the treatment for breast cancer, including endocrine therapy, targeted therapy, and chemotherapy, based on the three major breast cancer subtypes: hormone receptor positive/estrogen or progesterone receptors and human epidermal growth factor 2 (ERBB2) negative (HR+/ERBB2−), ERBB2 positive (ERBB2+), and triple negative [2]
We report a case of drug-induced interstitial lung disease (ILD) caused by epirubicin and cyclophosphamide (EC) therapy before breast cancer surgery
Based on the clinical course, chest image findings, and Bronchoalveolar lavage fluid (BALF) results, the patient was diagnosed with druginduced pneumonitis, possibly caused by EC therapy
Summary
Breast cancer is the most common cancer in women [1], and systemic therapy is an essential part of the treatment for breast cancer, including endocrine therapy, targeted therapy, and chemotherapy, based on the three major breast cancer subtypes: hormone receptor positive/estrogen or progesterone receptors and human epidermal growth factor 2 (ERBB2) negative (HR+/ERBB2−), ERBB2 positive (ERBB2+), and triple negative [2]. Anthracycline-based regimens are the recommended therapies [2] These systemic therapies can reduce the relapse rate and improve the prognosis of breast cancer. They are toxic, and drug-induced interstitial lung disease (ILD) is one of the adverse events. How to cite this article Egashira A, Yanagihara T, Ogo N, et al (December 25, 2021) A Case of Drug-Induced Interstitial Lung Disease Caused by Epirubicin and Cyclophosphamide Therapy Before Breast Cancer Surgery. Based on the clinical course, chest image findings, and BALF results, the patient was diagnosed with druginduced pneumonitis, possibly caused by EC therapy. Symptoms, including respiratory distress and dry cough, serum levels of CRP, and chest X-ray findings, improved rapidly (Figure 1B).
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