Diffuse alveolar damage after a single dose of topotecan in a patient with pulmonary fibrosis and small cell lung cancer

Lung Cancer. 2006 Nov;54(2):243-5. doi: 10.1016/j.lungcan.2006.07.017. Epub 2006 Sep 1.


Drug-induced pulmonary toxicities of anticancer agents have been well described, but the pathophysiology of agents typically used in advanced disease has not been well studied. Symptoms of pulmonary drug toxicity in advanced lung cancer patients may frequently be attributed to disease progression, pulmonary embolism, or infection. In patients with pre-existing interstitial pulmonary fibrosis even less is known. This report describes an unfortunate patient with pre-existing pulmonary fibrosis and progressive extensive stage small cell lung cancer. After receiving a single intravenous dose of topotecan, the patient developed sub-acute respiratory failure, and died 15 days later with pathology findings of organizing, reparative phase, diffuse alveolar damage. To our knowledge this is the first pathology confirmation of diffuse alveolar damage in a patient developing dyspnea following topotecan therapy. The frequency with which camptothecin-related dyspnea is associated with diffuse alveolar damage might be underestimated and is of special concern in patients with limited pulmonary reserve.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Small Cell / complications
  • Carcinoma, Small Cell / drug therapy*
  • Dyspnea / chemically induced
  • Fatal Outcome
  • Humans
  • Lung / pathology
  • Lung Neoplasms / complications
  • Lung Neoplasms / drug therapy*
  • Male
  • Middle Aged
  • Pulmonary Alveoli / pathology*
  • Pulmonary Fibrosis / complications*
  • Respiratory Insufficiency / chemically induced*
  • Topotecan / administration & dosage
  • Topotecan / adverse effects*
  • Topotecan / therapeutic use


  • Antineoplastic Agents
  • Topotecan