Oxaliplatin-induced Pulmonary Toxicity: A Rare but Serious Complication

Krishna H Suthar,Rohit Venkatesan,Salwan Al Mutar

doi:10.7759/cureus.7483

Abstract

The FOLFOX regimen (oxaliplatin, leucovorin, and 5-fluorouracil) is FDA approved for use in patients with colorectal cancer and other gastrointestinal malignancies. The initial phase III randomized controlled trials that led to FDA approval of oxaliplatin with leucovorin and 5-fluorouracil showed a less than 1% incidence of pulmonary fibrosis and grade IV pulmonary toxicities. Here we describe two cases of pulmonary toxicity in patients with metastatic colorectal cancer treated with FOLFOX and briefly review the literature regarding oxaliplatin-induced pulmonary toxicity.

Highlights

Oxaliplatin is a third-generation platinum derivative that exerts cytotoxic effects by interrupting DNA synthesis [1]
Various case reports have been published describing oxaliplatin-associated acute interstitial lung disease and pulmonary fibrosis [512]. We describe two such cases of pulmonary toxicity in patients with metastatic colorectal cancer treated with FOLFOX
Oxaliplatin is the only known agent in the FOLFOX regimen to have pulmonary side effects as 5-fluorouracil and leucovorin have not been implicated in the development of pulmonary toxicities alone [8,16,17]

Summary

Introduction

Oxaliplatin is a third-generation platinum derivative that exerts cytotoxic effects by interrupting DNA synthesis [1]. Repeat imaging demonstrated new ground-glass pulmonary opacities, but the patient was asymptomatic so chemotherapy was continued without dosage adjustments. After her 15th dose, she presented to the hospital with progressive dyspnea, a dry cough, and hypoxia. (a) High-resolution computed tomography of the chest for patient 1 prior to the initiation of mFOLFOX-6, (b) High-resolution computed tomography of the chest for patient 1 after 15 cycles of mFOLFOX-6 demonstrates extensive mixed solid and ground-glass opacities with mild bronchiectasis. (a) High-resolution computed tomography of the chest for patient 2 prior to initiation of chemotherapy, (b) High-resolution computed tomography of the chest for patient 2 after three cycles of mFOLFOX + bevacizumab showing extensive bilateral ground-glass opacities

Discussion

Findings

Conclusions

Disclosures