Trifluridine and Tipiracil Hydrochloride Combination-Induced Interstitial Pneumonia: A Case Report

Abstract

We report a case of a 62-year-old male who was diagnosed with advanced rectal cancer. The attending gastro-enterologist initiated chemotherapy using capecitabine plus oxaliplatin and bevacizumab; however, this treatment regimen was discontinued, as the patient developed a skin rash. Once the skin rash improved, chemotherapy was re-initiated using a combination of trifluridine and tipiracil hydrochloride (TAS-102). The patient developed high fever and dyspnea 2 months after initiation of TAS-102. Chest high-resolution computed tomography showed bilateral diffuse ground glass opacities in all lung lobes with traction bronchiectasis. At this time, the gastro-enterologist consulted our department. The patient was put on non-invasive positive pressure ventilation due to worsening respiratory symptoms. The patient was suspected to develop TAS-102-induced interstitial pneumonia based on positive TAS-102 drug-induced lymphocyte stimulation test. The patient’s respiratory symptoms and radiological findings improved after corticosteroid treatment. The corticosteroid dose was gradually decreased by 5 mg. Thereafter, chemotherapy was re-initiated using different anti-cancer agents.

Keywords:

• TAS-102
• colorectal cancer
• DAD
• corticosteroid

Abbreviations

TAS-102, trifluridine and tipiracil hydrochloride; HRCT, High-resolution computed tomography; JRS, Japanese Respiratory Society; DAD, diffuse alveolar damage; GGO, ground-glass opacity.

Consent

We received informed consent from the patient to have the case details and any accompanying images published. Ethical approval was also obtained from the Juntendo University Graduate School of Medicine Institutional Review Board (IRB approval number: JHS22-028).

Acknowledgments

We thank Editage for English language editing.

Disclosure

The authors report no conflicts of interest in this work.