Gemcitabine-Related Pneumonitis in Pancreas Adenocarcinoma-An Infrequent Event: Elucidation of Risk Factors and Management Implications

A total of 2440 pancreatic cancer patients who received gemcitabine treatment were screened for gemcitabine-related pneumonitis (GRP). The observed rate of GRP was 1.1%. History of smoking, alcohol use, and history of underlying lung disease were identified as possible risk factors of GRP. Early pulmonary consult and cessation of gemcitabine is recommended once clinical suspicion arises. Background: Gemcitabine-related pneumonitis (GRP) has been reported relatively frequently for pancreas cancer in the literature; however, underlying risk factors and optimal management remain to be defined. We studied a cohort of patients with GRP and investigated potential predisposing factors in pancreatic cancer patients. Patients and Methods: A total 2440 patients at Memorial Sloan Kettering Cancer Center were identified between January 1, 2000, and December 31, 2012, and were screened for grade 2 or higher GRP in an institutional tumor registry and using an ICD billing code database. Demographic and clinical information was extracted by electronic chart review. Results: A total of 28 patients (1.1%) with GRP were identified. Incidence of grade 2, 3, and 4 reactions were 7 (25%), 18 (64%), and 3 (11 %), respectively. No GRP-related mortality was observed. Twenty-one patients (75%) reported a history of cigarette smoking. Seventeen patients (61 %) were alcohol users. Six patients (21%) were either regular or heavy drinkers. Most patients (93%) had either locally advanced or metastatic disease. Three patients (11%) underwent a diagnostic bronchoscopy, and in 1 patient a diagnosis of organizing pneumonia was established. Morbidity was significant; 3 patients (11 %) required treatment in the intensive care unit. All hospitalized patients received steroid treatment. Conclusion: GRP is relatively uncommon but incurs significant morbidity. Potential risk factors include advanced-stage disease, along with smoking and alcohol consumption and possibly underlying lung disease. We recommend a high level of clinical alertness regarding the diagnosis, early pulmonary referral, and cessation of gemcitabine on suspicion of GRP.