Interstitial Lung Disease During Chemotherapy Combined with Oxaliplatin and/or Bevacizumab in Advanced Colorectal Cancer Patients

Objective: Interstitial lung disease in patients with colorectal cancer during chemotherapy combined with bevacizumab is rare. Methods: We reviewed 104 colorectal cancer patients treated with standard chemotherapy with bevacizumab and examined the incidence of interstitial lung disease and its clinical features. Results: We identified interstitial lung disease in four patients (3.85%). All patients were male. The median age was 64.5 years. Three of four patients had a history of smoking; median smoking index was 40 pack-years. Except one patient who had asymptomatic pulmonary fibrosis, chest computed tomography before chemotherapy showed no fibrotic changes. Pulmonary function test before chemotherapy showed normal values. All patients had received median 10 cycles (range 10-15 cycles) of FOLFOX before the onset of interstitial lung disease. Interstitial lung disease developed during FOLFOX + bevacizumab in two patients and during FOLFIRI + bevacizumab in two patients. The initial symptom of interstitial lung disease was fever in all patients. The median duration from the last chemotherapy to the onset of interstitial lung disease was 3.5 days (range 2-8 days). Three of four patients showed Grade 3 or more severity of interstitial lung disease according to Common Terminology Criteria for Adverse Events v3.0. High-dose steroid therapy was effective in all patients. Conclusions: Interstitial lung disease induced by standard chemotherapy with bevacizumab is rare, but rapidly progressed and were severe in our experience.