Being aware of potentially fatal interstitial lung disease in patients with head and neck cancer treated with concurrent cetuximab and radiotherapy

Abstract

Cetuximab-induced interstitial lung disease (ILD), especially for tumors in the head and neck area, has rarely been reported. The present case may serve as an important reference to alert clinicians who use this chemotherapeutic agent. We report a case of acute ILD in a 66-year-old male with double cancers (oral floor cancer T4aN0M0 and supraglottic cancer T2N0M0), who received concurrent cetuximab and radiation therapy. He had severe dyspnea on day 51 along with worsened bilateral, progressive infiltration in chest X-ray, elevated C-reactive protein, Krebs von den Lungen 6 (KL-6), Surfactant Protein D (SP-D) and Surfactant Protein A (SP-A), and was diagnosed with ILD. He was treated with High-dose methylprednisone (1 mg/kg) soon after the diagnosis was made. He recovered remarkably and was discharged at day 100. For early detection of ILD, we suggest weekly chest X-rays for cetuximab-treated patients. In suspicious cases, High-resolution computed tomography scan and measurements of KL-6, SP-A, and SP-D levels should be considered.

Keywords:

• cetuximab
• interstitial lung disease
• diagnosis
• chest X-ray
• KL-6

Public Interest statement

The treatment with cis-diamminedichloroplatinum has been the first choice for the patients with head and neck squamous cell carcinoma (HNSCC). Although, the complication such as severe radiation induced dermatitis, mucositis or renal damage has lead us to seek for alternative anti-cancer agent. Cetuximab has been introduced as “safer” alternative to cis-diamminedichloroplatinum, although we have experienced several severe complications including interstitial lung disease. Interstitial lung disease is not a very common disease that otolaryngologist confront with in daily practice, but it could be lethal without a quick diagnose and prompt treatment, thus we believe it’s very important to acknowledge this complication and to try to detect the early signs during the treatment. We present a case we were successful in diagnosing and treating the patient with interstitial lung disease in the course of HNSCC treatment with cetuximab.

Competing Interests

The content is solely the responsibility of the authors and does not necessarily represent the official views of Jichi Medical University.

Additional information

Funding

Funding. The authors received no direct funding for this research.

Notes on contributors

Mari Shimada

We treat various patients with head and neck squamous cell carcinoma. In the last few years, concurrent cetuximab and radiation therapy has become one of the major choices of treatment for advanced head and neck cancer patients. Together with the oncologists, we have been actively gaining the cetuximab treated cases. Among those cases, we experienced some severe complications including interstitial lung disease. Cetuximab has started to be used as an alternative for cis-diamminedichloroplatinum for its expectation for less complication and safety, although our experience might give an important alert to the use of cetuximab.