Tarceva-Induced Respiratory Disease ?

[Bill]

I have read where some of you have experienced adverse respiratory effects with Tarceva. Not sure if this applies to Iressa or not. For those of you that have experienced Tarceva ( or Iressa ? )-induced adverse respiratory effects I'd appreciate hearing a detailed description of what kind of respiratory condition developed along with such things as symptoms, time of onset, maybe x-ray or scan results, etc.

Thanks much.

[Ry]

One of the side effects of Iressa was pneumonia (Don's Lucie had it I believe). Since Tarceva is similar it makes sense that it may be a complication of that drug also.

[Don Wood]

I agree with Ry's observation. My wife got bilateral pneumonia from Iressa, a cousin of Tarceva. Don

[Andrea]

Bill,

This does not directly answer you, but my mom has radiaton fibrosis. Her oncologist said in 5-10% of peope, Tarceva also causes radiation fibrosis. And since she appears to be "predisposed" since radiation gave her more fibrosis than normal, it was not a good idea for her to be on it b/c she was likely to develop the respiratory problems.

[Bill]

I'm inquiring about this adverse effect for the following reason. My wife should be in recovery mode right now after having a respiratory crisis followed by thoracentesis and prophylactic Levaquin, Lasix, prednisone, etc. SHE ALSO STARTED TARCEVA 150MG. ON 3/3. I now have her chest x-ray and radiology report from last night's ER visit. The radiology report is largely unchanged vs. her 3/14 chest x-ray & report except that he mentions an overall increase in congestion ( pulmonary edema ) with new congestion found in a portion of her right lung. My impression is that her lung fields should be clearing up at this time, not becoming increasingly congested. The radiologist goes on to state that it's unclear whether this is congestion or infection.

To Andrea : you mention radiation fibrosis. Please explain where the radiation would be directed in order to cause Tarceva-induced radiation fibrosis ? And, is it radiation fibrosis of the lungs or where ? Please explain the connection as you understand it.

Thanks.

[Andrea]

Bill--here is how I undersatnd it:

My mom had chemo, surgery, and radiation to the lung. Radiation to the lung causes some fibrosis/damage in most people. However, some people suffer more severe radiation fibrosis (they also referred to it as radiation pneumitis with my mom). My mom suffered a lot of radiation fibrosis in the lung from the radiation to the lung. This causes her lung capacity to be at 60%, whereas after surgery the dr expected her to be at about 80% of a normal person.

Tarceva itself (nothing to do with radiation) from what the oncologist explained can cause fibrosis in 5-10% of the people and comes on as shortness of breath and typical respiratory symptoms.

Since my mom suffered fibrosis from radiation, she is more likely to be have the respiratory side effect of Tarceva.

[Fay A.]

Bill,

The epidermal growth factor receptor inhibitors are known to cause something called Interstitial Fibrosis in some of those who take it. I don't think the researchers know why it happens to some and not others. I will say that at one point while I was taking Iressa I developed pneumonia, was treated with antibiotics, got better, but the pneumonia itself was not totally cleared and I had a relapse. The pneumonia appeared as "fluffy areas with ground glass opaciities, non solid and semi solid lesions." These cleared after a new antibiotic was prescribed. Months later, when Iressa was obviously no longer working, the recurrent disease showed up as "fluffy areas with ground glass opacities, semi-solid and non solid lesions." This group did not clear up with antibiotic use. And subsequent removal of my right lung showed most of the lesions to be malignant.

For those of us who have radiation treatments there is something called Radiation Recall....when we are exposed to radiation (chest xrays, scans, treatment with radiation elsewhere) we may experience an exaserbation of the symptoms from full radiation treatments. I don't recall it occurring as a result of receiving chemotherapy, but that doesn't mean it doesn't happen.

I sincerely hope that your wife is not having the kind of negative reaction that happened to Don Woods wife, Lucie. I hope that this is an infection that is treatable with a different antibiotic. And something to remember is that those of us who have been through what your wife has endured are prone to fungal infections and not just bacterial. One of the worst respiratory infections I've had was the result of a fungal infection in my sinuses, throat and lung. It was so bad...and my docs kept treating me with antibiotics which made the fungal infection worse. No one thought to treat as a fungal infection until I asked if it could possibly be that.

PS Bill, do you have pets in the house that she might have developed an allergy to, or that might be the source of an infection? (when my kids were little we had a dog that was the source of a recurrent Strep infection in the kids..until we had the dog treated at the same times the kids were!). Is there any kind of mold growing in your home, heater/air conditioner ductwork that needs to be cleaned out? These are all things that can be problematic for those of us with respiratory limitations. These are all things I've encountered personally.

[Bill]

When you review your chest x-rays you may have noticed that the light intensity can vary from one chest x-ray to the next. I can spot it by the overall brightness of the various anatomical bony structures, etc, in the x-ray. In my wife's case I can also tell by the instrumentation in her back. The darker films reveals more of the notches and markings in the hardware whereas the brighter films show little or no detail in the hardware just the whited out shape of the metal. The 3/14 chest x-ray was of the darker variety and the lung fields looked good. The 3/17 chest x-ray was overall brighter and more white showed up in the lung fields. IMO it made the lungs look worse but the radiologist still noted more congestion vs. the 3/14 chest x-ray. How do radiologists factor in this variable when they view chest x-rays for infiltrate and tumor activity ?

[tnmynatt]

Bill,

I don't personally think chest X rays are very reliable. My husband had several chest X rays that did not show cancer when it was definitely there. The last X ray was taken 3 weeks before he was hospitalized with stage IV nsclc. I think CT scans are much better. But, I found that the reading has to left to the experts. I thought Charlie's CT scan in Jan. looked better than the Nov. scan. But, the radiologist reported that it was worse. Take care. Praying for you and your wife.

[jcawork]

Please post this in ask the experts. Great question. Thanks