MBCL-33. RARE PULMONARY TOXICITY IN THREE MEDULLOBLASTOMA PATIENTS UNDERGOING ANTIANGIOGENIC METRONOMIC COMBINATION THERAPY
MBCL-33. RARE PULMONARY TOXICITY IN THREE MEDULLOBLASTOMA PATIENTS UNDERGOING ANTIANGIOGENIC METRONOMIC COMBINATION THERAPY
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DOI：
10.1093/neuonc/noaa222.509
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发表时间：
2020-12-04
期刊：
影响因子：
15.9
通讯作者：
Pillay-Smiley N
中科院分区：
文献类型：
--
作者：
Lenzen A;Gryzlo D;McKenzie I;Goldman S;Pillay-Smiley N
节拍和靶向抗血管生成治疗 (MEMMAT) 已成为治疗复发性/进行性髓母细胞瘤的一种有前途的治疗方法。这种治疗包括贝伐单抗、口服药物（沙利度胺、塞来昔布、非诺贝特、依托泊苷和环磷酰胺）和鞘内化疗（依托泊苷和阿糖胞苷）。常见的毒性包括骨髓抑制、恶心和感染。可能会发生轻微的呼吸道毒性。我们报告了三例具有显着呼吸道毒性的病例。 IRB 批准的图表审查对三名患有复发性髓母细胞瘤的儿童进行了 MEMMAT 治疗和有意义的肺毒性。文献回顾没有发现类似发现的报道。患者年龄从3岁到11岁不等。患者平均完成治疗 6.33 个月。开始 MEMMAT 之前没有慢性呼吸道疾病史。 1 号患者出现慢性咳嗽，需要多次呼吸道和抗感染治疗； CT 扫描显示与慢性炎症变化有关的气腔混浊。每一次新的病毒感染都会导致严重的呼吸困难。他最终死于呼吸衰竭，CT 上显示有大的囊性病变。 2 号患者出现慢性咳嗽，对抗生素或呼吸治疗没有反应。图像报告了空域疾病、支气管扩张和慢性炎症状态。 3 号患者出现慢性咳嗽，尽管使用了抗生素和吸入性呼吸治疗，但没有任何改善；图像提示小气道疾病。所有三名患者都需要多次住院治疗和额外治疗。尽管很少有呼吸道症状的报道，但 MEMMAT 预计会出现许多副作用。我们的案例强调了接受 MEMMAT 治疗时肺毒性可能存在的重要相关性，及其对患者整体健康和生活质量的影响。
Metronomic and targeted anti-angiogenesis therapy (MEMMAT) has emerged as a promising treatment for recurrent/progressive medulloblastoma. This treatment includes bevacizumab, oral agents (thalidomide, celecoxib, fenofibrate, etoposide & cyclophosphamide) and intrathecal chemotherapy (etoposide & cytarabine). Common toxicities include myelosuppression, nausea, and infection. Mild respiratory toxicities can occur. We report three cases with significant respiratory toxicity. An IRB approved chart review was performed of three children with recurrent medulloblastoma on MEMMAT treatment and meaningful pulmonary toxicity. Literature review found no reports of similar findings. Patient ages ranged from 3 to 11 years old. Patients completed a mean of 6.33 months on treatment. There was no history of chronic respiratory disease prior to starting MEMMAT. Patient #1 developed chronic cough requiring multiple respiratory and anti-infective treatments; CT scan demonstrated airspace opacities concerning for chronic inflammatory change. Each new viral infection led to significant respiratory distress. He eventually died from respiratory failure with large cystic lesions noted on CT. Patient #2 developed a chronic cough not responsive to antibiotics or respiratory treatments. Images reported airspace disease, bronchiectasis, and chronic inflammatory state. Patient #3 developed chronic cough without improvement despite antibiotics and inhaled respiratory treatments; images were suggestive of small airway disease. All three patients required numerous hospitalizations and additional treatment. With MEMMAT, many side effects are expected though respiratory symptoms have rarely been reported. Our cases highlight the possible important correlation of pulmonary toxicity while being treated on MEMMAT, and its impact on patients’ overall health and quality of life.