Chemotherapy-associated pulmonary toxic reactions during treatment for breast cancer

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Abstract
Chemotherapy-related [methotrexate, 5-fluorouracil, vincristine, prednisone, cyclophosphamide, chlorambucil] pneumonitis developed in 8 patients during treatment for breast cancer. Six were receiving adjuvant therapy; 2 were being treated for metastatic disease. Fever, chills, dyspnea and dry cough were the initial symptoms. Observations from chest roentgenograms varied from normal to bilateral interstitial-alveolar infiltrates. Results of pulmonary function tests were markedly abnormal, with a decreased diffusing capacity being the most characteristic abnormality. The pneumonitis developed in 6 patients while receiving .ltoreq. 20 mg/day of prednisone and appeared temporarily related to tapering of steroid therapy in 4 patients. All patients recovered clinically, although prednisone therapy of 60 mg/day or its equivalent was required in 3 cases. Mild pulmonary function abnormalities persisted. Drug-induced pneumonitis should be considered in the differential diagnoses of patients with breast cancer in whom unexplained fever, dyspnea or infiltrates develop during multi-drug chemotherapy.