Fatal interstitial lung disease associated with oral erlotinib therapy for lung cancer

<p>Abstract</p> <p>Background</p> <p>Erlotinib is a Human Epidermal Growth Factor Receptor Type 1/tyrosine kinase (EGFR) inhibitor which is used for non-small-cell lung cancer treatment. Despite that erlotinib is considered to have a favorable safety profile, adverse events such as interstitial lung disease (ILD) were reported in pivotal studies. The authors report the first histologically confirmed case of fatal ILD associated with erlotinib therapy.</p> <p>Case Presentation</p> <p>The medical record of a patient who developed fatal ILD after receiving erlotinib treatment was reviewed to identify the cause of death and other factors potentially contributive to this adverse outcome. A 55-year-old smoker with no evidence of pre-existing interstitial disease developed bilateral ILD and respiratory failure which could be explained only as a toxicity of erlotinib. He had a history of stage IV left upper lobe squamous-cell carcinoma for which he had received three successive regimens of chemotherapy (ifosfamide plus gemcitabine, docetaxel, mitomycin plus navelbine), followed five months later by erlotinib. At initiation of erlotinib treatment there were no radiological signs suggestive of ILD disease or apparent clinical signs of respiratory distress. While the patient completed two months with erlotinib therapy he developed bilateral interstitial infiltrates; despite discontinuation of erlotinib he was admitted with respiratory failure two weeks later. Diagnostic work up for other causes of pneumonitis including infectious diseases, congestive cardiac failure and pulmonary infraction was negative. Empiric treatment with oxygene, corticosteroids and later with cyclophosphamide was ineffective and the patient progressively deteriorated and died. The clinical and post-mortem examination findings are presented and the possible association relationship between erlotinib induced ILD and previous chemotherapy is discussed.</p> <p>Conclusion</p> <p>Physicians should be alert to the fact that erlotinib related ILD, although infrequent, is potential fatal. The association between selective EGFR-inhibitors and ILD should be further investigated.</p

Endobronchial Electrocautery and Argon Plasma Coagulation: A Practical Approach

The present review covers the technical and practical aspects of endobronchial electrocautery, including argon plasma coagulation, which have great potential for widespread use by pulmonologists around the world. The various electrocautery modes, power settings and electrode probes are described in detail, and the authors' clinical and technical approach is demonstrated with a narrative description and brief case presentations. Malignant airway obstruction, hemoptysis, web-like stenosis, stent related granulation tissue and early lung carcinomas are the most common indications for treatment. Advantages of electrocautery, such as low cost, rapid effect, safety and ease of use, are contrasted to other endobronchial therapeutic modalities. Published experience with electrocautery is reviewed.Peer Reviewe

Endobronchial Electrocautery and Argon Plasma Coagulation: A Practical Approach

The present review covers the technical and practical aspects of endobronchial electrocautery, including argon plasma coagulation, which have great potential for widespread use by pulmonologists around the world. The various electrocautery modes, power settings and electrode probes are described in detail, and the authors' clinical and technical approach is demonstrated with a narrative description and brief case presentations. Malignant airway obstruction, hemoptysis, web-like stenosis, stent related granulation tissue and early lung carcinomas are the most common indications for treatment. Advantages of electrocautery, such as low cost, rapid effect, safety and ease of use, are contrasted to other endobronchial therapeutic modalities. Published experience with electrocautery is reviewed

Le pigtail catheter (une approche thérapeutique origininale des pleurésies purulentes)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Etude pilote de faisabilité de prise en charge des premiers épisodes de pneumothorax spontanés idiopathiques du sujet jeune par mini-cathéter connecté à une valve de Hemlich

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Lung Volume Reduction Coils for Severe Emphysema—Reply

International audienc

Circulating Tumor Cell Detection in Lung Cancer: But to What End?

The understanding of the natural history and biology of lung cancer has been enhanced by studies into circulating tumor cells (CTCs). Fundamental and translational research, as well as clinical trials in the characterization and behavior of these cells, have constantly contributed to improving understanding within the domain of thoracic oncology. However, the use of these CTCs as prognostic and predictive biomarkers has not been adopted to the same extent as circulating free DNA (cf-DNA) in plasma, in the daily practice of thoracic oncologists. However, recent technological advances have firmly put the detection and characterization of CTCs in thoracic oncology back on the agenda, and have opened up perspectives for their routine clinical use. This review discusses the major advances of using CTCs in the domain of thoracic oncology, as well as the envisaged short- and long-term prospects

Experimental ventilator-associated pneumonia : distribution of lung infection and consequences for lung aeration

Ventilator-associated pneumonia (VAP) has been described in humans and in experimental animals. The most severe lesions are located in dependent lung segments along a sterno-vertebral axis, however the cephalocaudal distribution of lung infection remains unknown. We used an experimental model to evaluate the distribution of lung infection, considering its anteroposterior and cephalocaudal gradient, and its impact on lung aeration. Ten healthy domestic piglets were anesthetized, paralyzed and mechanically ventilated for 59 hours in the prone position. At the end of the experiment they were sacrificed and their lungs were fixed. Six segments were analyzed: a non-dependant (ND) and a dependant (D) segment of the upper (UL), middle (ML) and lower (LL) lobes. The presence of healthy lung or of histological infectious lesions was analyzed with a semiquantitative method. The regional distribution of lung infection was compared between upper, middle and lower lobes, as well as between dependant and non-dependant regions. The presence of infectious lesions was correlated with measurements of lung aeration. Nine of the ten piglets developed VAP. Infectious lesions were distributed along a sterno-vertebral and a cephalocaudal gradient; the lower and middle lobes were more frequently infected than the upper lobes. There was an inverse correlation (R= - 0.902) between the development of lung lesions and lung aeration. In conclusion, VAP was a frequent complication in healthy mechanically ventilated piglets, showing an anteroposterior as well as a cephalocaudal gradient. As expected, development of lung infection was accompanied by a corresponding loss of aeration