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A6628 - A Case of Pulmonary Fibrosis Secondary to Oxaliplatin: From Rarity to Reality
Author Block: A. Alves Moreira, R. Gomes, J. Soares, J. Roldão Vieira; Pulmonology, Hospital Garcia de Orta, Almada, Lisboa, Portugal.
Oxaliplatin currently integrates the standard therapeutic regimen of colorectal carcinoma at different stages. The most commonly observed adverse effects are peripheral neuropathy, haematological toxicity and allergic reactions. Acute pulmonary toxicity has only been described in very few reports.The true incidence is unknown but has been associated with respiratory failure and pulmonary infiltrates with subsequent evolution to fibrosis. The authors present a case of pulmonary fibrosis of a rapidly progressive evolution following initiation of oxaliplatin and capecitabine (Xelox) therapy. A 71-year-old male patient with a previous history of smoking (40 pack/ year), arterial hypertension, dyslipidemia and femoro-popliteal venous thrombosis in 2009. Since January 2014 under treatment with auto- adjusting Continuous Positive Airway Pressure (APAP), for Severe Sleep Obstructive Apnea Syndrome. In March 2016, after the diagnosis of colorectal adenocarcinoma (stage T1N1M0), he underwent sigmoidectomy and ileostomy and adjuvant chemotherapy with Oxaliplatin and Capecitabine, which began in April, and completed 8 cycles, until October. Concomitant with the last cycle of chemotherapy, he started a rapidly progressive dyspnea associated with productive cough and quantified weight loss of 18 kg in 8 months. When observed at a Pulmonology consultation in November 2016, he had complaints of dyspnea grade 4 (Modified Medical Research Council), with evidence of partial respiratory insufficiency (arterial pressure O2 53mmHg). Pulmonary Ventilation/ Perfusion scintigraphy was performed, with no evidence of pulmonary thromboembolism. In the respiratory functional study, evidence of a mild restrictive pattern and diffusion to carbon monoxide (DLCOc 35.4%) severely decreased. Thoracic computed tomography was performed in February 2017, with evidence of pulmonary fibrosis predominant at the periphery, more pronounced at the lung bases and more on the right lung, with interstitial reticular pattern and bronchiectasis, compatible with usual interstitial pneumonia (UIP). After discussion at a Multidisciplinary Meeting on Interstitial Pathology, regarding the temporal association between clinical and imaging findings and the initiation of chemotherapy, the most likely hypothesis was that of pulmonary fibrosis secondary to oxylaplatin. This case demonstrates a rare complication of Oxilaplatin therapy compared to pulmonary infectious complications, and the clinical suspicion of pulmonary toxicity is essential given the associated morbidity and mortality.