A case of death caused by severe interstitial lung disease after taking the gefitinib

Gefitinib (IRESSA) is an orally active, selective epidermal growth factor receptor tyrosinekinase inhibitor which has shown tumor regression in patients with advanced non-small cell lung cancer (NSCLC) and has been approved only in Japan. This is a molecular target drug and its adverse events had been reported as “generally mild”, however, severe interstitial lung disease (ILD) has been diagnosed in some patients. In the present case, cough and exertional dyspnea appeared on the 51st day after starting gefitinib. Although this patient was treated with steroid pulse therapy under respiratory control, he died from ILD on the 50th day after initial symptom appeared. The chest X-ray and CT showed bilateral distribution of diffuse ground glass opacities and we diagnosed “interstitial pneumonia”. In the lung autopsy, we detected usual interstitial pneumonia (UIP) with organized diffuse alveolar damage (DAD). A final diagnosis of ILD induced by gefinitib was made on March 26, 2003. Frequent evaluation of the respiratory system is strongly recommended during the first 2 months after starting gefitinib. Investigation into the mechanism of ILD is urgently needed, and the selection of responders/non-responders as well as efficient individual medical treatment is desired.