Gefitinib-induced interstitial lung disease-addition of intravenous cyclophosphamide to corticosteroids is a valuable treatment option: A case report

A 77-year-old woman was diagnosed as having advanced non-small cell lung cancer, and was started on treatment with gefitinib. Fifty days after the start of treatment, the patient was admitted to the hospital with complaints of dry cough, fever, and shortness of breath. A diagnosis of gefitinib-induced interstitial lung disease was made, and administration of high-dose prednisolone (1 g/day of intravenous methylprednisolone for three consecutive days, followed by oral prednisolone at 50 mg/day) was started. Although progression to respiratory failure could be stopped by the corticosteroid treatment, there was still no improvement in either the lung opacities seen on radiologic imaging, or in the symptoms; moreover, the patient developed corticosteroid-induced myopathy. Therefore, in order to allow reduction of the daily steroid dose, the patient was started on intravenous cyclophosphamide (500 mg/day). This additional treatment allowed the daily dose of oral prednisolone to be reduced to 15 mg/day. Thus, it is considered that intravenous cyclophosphamide may be a valid treatment option for gefitinib-induced lung injury.