Severe Interstitial Lung Disease Associated with Amrubicin Treatment

Abstract

Amrubicin is a novel anthracycline agent that is well known to exert significant activity against small cell lung cancer (SCLC), but the adverse pulmonary effects of amrubicin are less well known. We investigated the incidence of acute interstitial lung disease (ILD) in SCLC patients who had been treated with amrubicin. Medical records were used to retrospectively investigate a total of 100 cases of SCLC patients treated with single-agent amrubicin therapy at the National Cancer Center Hospital East between June 2003 and March 2008. The patients' radiographic records and clinical data were reviewed to identify patients who had developed acute ILD after being treated with amrubicin. After receiving amrubicin, seven of the 100 SCLC patients subsequently developed pulmonary infiltrates, and they were identified as cases of acute ILD associated with amrubicin. Of the seven patients who developed ILD, six were treated with corticosteroids, and the ILD improved in three of them, but the other three patients died of respiratory failure. The incidence of ILD was 33% (4/12) among the patients with pre-existing pulmonary fibrosis (PF) and 3% (3/88) among the patients without PF, and the difference between the two groups was statistically significant (P = 0.0036). The results of this study indicated that amrubicin may cause severe ILD and that pre-existing PF was associated with a higher rate of ILD among SCLC patients treated with amrubicin. We recommend not administering amrubicin in the treatment of SCLC patients with pre-existing PF.