aldona
Uploaded by
24 SLIDES
359 VUES
240LIKES

Managing Interferon-Induced Lung Disease in Melanoma Treatment

DESCRIPTION

Interferon alfa therapy, commonly used as an adjuvant treatment for melanoma, can induce significant complications, including interstitial lung disease (ILD). This case study presents an 80-year-old male patient who developed symptoms of dyspnea and fever post-therapy, raising suspicion for IFN-induced ILD. Despite negative infectious and autoimmune work-ups, clinical deterioration persisted until discontinuation of interferon therapy led to improvement. It highlights the importance of recognizing ILD as a serious, albeit rare, complication of interferon therapy in melanoma management.

1 / 24

Télécharger la présentation

Managing Interferon-Induced Lung Disease in Melanoma Treatment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. When the treatment becomes the problem Sonia M. CastilloMD Mark Hamblin MD, FCCP Department of Internal Medicine University of Kansas Medical Center, Kansas City

  2. Background • Melanoma: 5th most prevalent cancer1 • First line treatment: local excision • Interferon (IFN)alfa therapy: indicated as adjuvant treatment2 • Kim KB, Davies MA, Rapini RP, Hwu P, Bedikian AY. Chapter 39. Malignant Melanoma. In: Kantarjian HM, Wolff RA, Koller CA, eds. The MD Anderson Manual of Medical Oncology. 2nd ed. New York: McGraw-Hill; 2011. • Ascierto PA, Gogas HJ, Grob JJ et al. Adjuvant interferon alfa in malignant melanoma: an interdisciplinary and multinational expert review. Critial Reviews in Oncology/Hematology. 2013;85:149-161

  3. Case presentation 80 year old male with malignant melanoma • 09/2011  Shave biopsy of scalp lesion • 11/2011  Excision and nodal dissection • 01/2012  Peginterferonalpha 2b • 12/2012  Shortness of breath for 6 weeks

  4. Past Medical History • Malignant Melanoma • Hypertension Social History • Nonsmoker • No pets • No sick contacts Medications • Peginteron alfa-2b • Amlodipine

  5. Physical exam Temp=38.2C HR=102 BP=122/58 RR=24 SO2=88% on room air • General: Well-developed male in mild respiratory distress • Cardiovascular: Tachycardic • Respiratory: Bibasilar fine crackles • Extremities: no clubbing

  6. Chest X-ray

  7. Initial laboratory testing • White blood cell count: 6.2 • Neutrophils: 54% • Lymphocytes: 34% • Monocytes: 12% • Arterial blood gas: 7.49/30/55/23 • B-type natriuretic peptide: 39

  8. Chest CT Angiography Apices Mid-lung fields Lung bases

  9. Infectious work-up • Bacterial and AFB smear and culture • Legionella urine antigen • Mycoplasma IgG and IgM • Aspergillus galactomannan • Fungitell • Histoplasma and coccidioides urine antigens • Cryptococcal serum antigen • Respiratory viral panel Negative

  10. Autoimmune work-up • ANA • C-ANCA, P-ANCA • Anti GBM Antibody Negative

  11. Bronchoalveolar lavage • Cell count: • Red blood cells: 1450/uL • White blood cells: 360/uL • Monocytes: 55% (Normal>85%1) • Lymphocytes: 29% (Normal=10-15%1) • Neutrophils: 16% (Normal<3%1) • Other studies: • Bacterial, mycobacterial and fungal stain and culture • Respiratory viral panel • PJP PCR • Cytology  NEGATIVE 1. Meyer K, Raghu G, Baughman R et al. An Official American Thoracic Society Clinical Practice Guideline: The Clinical Utility of BronchoalveolarLavage Cellular Analysis in Interstitial Lung Disease. Am J Respir Crit Care Med Vol 185, Iss. 9, pp 1004–1014, May 1, 2012

  12. Hospital course • Antibiotics and trial of diuresis • Non-invasive positive pressure ventilation • Unrevealing infectious work-up • Methylprednisolone 125mg IV q6hrs • No response •  Discontinuation of antibiotics  Clinical improvement

  13. Follow-up CT chest 2 months later

  14. Discussion Why did we suspect IFN-induced interstitial lung disease (ILD) on this patient? • Negative work-upfor infectious, autoimmune and malignant processes • Findings on Chest CT • Lymphocytosis on BAL cell count • Clinical deterioration despite empiric antibiotics

  15. IFN-inducedILD • Uncommon complication (0.01-0.3%)1 • Presenting symptoms:dyspnea, dry cough,fever, fatigue, anorexia, myalgias2 • Average time of presentation: 12 weeks • Solsky J, Liu J, Peng M, Schaerer M, Tietz A. Rate of interstitial pneumonitis among hepatitis virus C infected patients treated with pegylated infeterferon. J Hepatol. 2009; 50 Suppl 1: S238. • Ji FP, Li ZX, Deng H et al. Diagnosis and management of interstitial pneumonitis associated with interferon therapy for chronic hepatitis C. World Journal of Gastroenterology. 2010;16(35):4394.

  16. Case reports

  17. Diagnosis of IFN-induced ILD1 • Exclusion of other etiologies • Compatible chest CT • Lymphocytosis on BAL cell count • Resolution of symptoms and infiltrates after cessation of therapy 1. Ji F-P. Diagnosis and management of interstitial pneumonitis associated with interferon therapy for chronic hepatitis C. World Journal of Gastroenterology. 2010;16(35):4394.

  18. Treatment of IFN-induced ILD • Discontinuation of IFN • Corticosteroids1 • Puente Vazquez J, Moreno Anton F, Grande Pulido E, Lopez Tarruella-Cobo S, Perez Segura P, Diaz-Rubio E. Interstitial pneumonitis and lung fibrosis during adjuvant treatment of melanoma with interferon alpha according to the Kirkwood schedule. Dermatology. 2005;210(3):247-249.

  19. Key points IFN-induced Interstitial Lung Disease: • Uncommon complication of IFN-alfa 2b therapy, but potentially life threatening • Should be a diagnosis of exclusion

  20. Acknowledgements • Mark Hamblin MD, FCCP Division of Pulmonary and Critical Care Department of Internal Medicine University of Kansas Medical Center, Kansas City, Kansas • Gary DoolittleMD Division of Hematology and Oncology Department of Internal Medicine University of Kansas Medical Center, Kansas City, Kansas

  21. Questions? Thank you!

  22. Case reports

  23. IFN-related pulmonary toxicity • Interstitial pneumonitis • BOOP • ARDS • Pleural effusion • Asthma exacerbation

  24. Cases with other malignancies • Melanoma. Puente Vasquez et al. Dermatology 2005 • Hemangioendotelioma. Wolf et al. Clinical Toxicology 1997 • CML. Yufu et al. American Journal of Hematology 1994

More Related