A Rare Case of Gemcitabine-Induced Pulmonary Hypertension.
Gemcitabine is a pyrimidine analog that is used to treat several malignancies including biliary tract
cancers, pancreatic cancer, nonsmall cell lung cancer, and breast cancer. Although it is relatively well tolerated despite its tendency to be myelosuppressive, gemcitabine-induced pulmonary toxicity is a rare yet critical
entity whose incidence remains unknown.
Various types of lung injuries have been reported with gemcitabine use including interstitial pneumonitis, diffuse alveolar damage, pulmonary fibrosis, and acute respiratory distress syndrome. While the exact mechanism is unknown, several hypotheses have been proposed to explain the pathogenesis of GIPT.
For example, the induction of pro-inflammatory cytokines and an enhanced expression of growth factors are linked to idiopathic pulmonary fibrosis related to gemcitabine use. Furthermore, causative mechanisms including damage to alveoli, pulmonary vasculature, and/or the interstitium may also explain the development of pulmonary hypertension in these patients.
Gemcitabine-induced pulmonary hypertension and other lung toxicities remain a diagnosis of exclusion. However, physicians should remain vigilant of detecting and treating symptoms when they arise.
Untreated pulmonary hypertension can cause significant morbidity and mortality, and therefore, early recognition of this condition is essential. Further development of new treatment modalities, based on the suspected mechanisms, is needed to ensure good patient outcomes.
Pulm Res Respir Med Open J. 2019; 5(1): 1-3. doi: 10.17140/PRRMOJ-5-139