Hiromichi Yamane, Masahide Kinugawa, Shigeki Umemura, Yasuhiro Shiote, Kenichiro Kudo, Toshimitsu Suwaki, Haruhito Kamei, Division of Clinical Oncology, Sumitomo-Besshi Hospital Cancer Center, 3-1 Ohji-cho, Niihama, Ehime 792-8543, Japan
Hiromichi Yamane, Nagio Takigawa, 4th Department of General Medicine, Kawasaki Medical School, 2-1-80 Nakasange, Okayama 700-8505, Japan
Nagio Takigawa, Katsuyuki Kiura, Department of Respiratory Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, Okayama 700-8558, Japan
Author contributions: Yamane H and Kinugawa M analyzed the bibliographical data; Yamane H, Kinugawa M, Umemura S, Shiote Y, Kudo K, Suwaki T and Kamei H were involved in the case of the patient; Yamane H, Takigawa N and Kiura K wrote the paper.
Correspondence to: Hiromichi Yamane, MD, PhD, Director, Division of Clinical Oncology, Sumitomo-Besshi Hospital Cancer Center, 3-1Ohji-cho, Niihama, Ehime 792-8543, Japan. hiromichi_yamane@ni.sbh.gr.jp
Telephone: +81-897-377111 Fax: +81-897-377121
Received: March 22, 2011 Revised: May 19, 2011 Accepted: May 26, 2011 Published online: July 10, 2011
Abstract
A 66-year-old Japanese man with pancreatic cancer received eleven courses of gemcitabine monotherapy. The tumor responded to gemcitabine until metastatic liver tumors progressed. Subsequently, he was treated with S-1, an oral fluoropyrimidine anticancer agent, as salvage chemotherapy. Forty-two days after initiating S-1, he presented with dyspnea and fever. Chest computed tomography showed diffuse interstitial lesions with thickening of the alveolar septa and ground glass opacity. Serum KL-6 level was elevated to 1,230 U/mL and he did not use any other drugs except insulin. Thus, the development of interstitial lung disease (ILD) was considered to be due to S-1. Arterial blood oxygen pressure was 49.6 Torr in spite of oxygen administration (5 L/min). Steroid therapy improved his symptoms and the interstitial shadows on chest radiograph. Although S-1-induced ILD has mostly been reported to be mild, clinicians should be aware that S-1 has the potential to cause fatal ILD.
