required, in addition to the withdrawal of gefitinib treatment and the administration of high-dose glucocorticoids, as well as oxygen inhalation and anti-infective therapies, in order to relieve the symptoms. In conclusion, following the onset of gefitinib‐induced interstitial pneumonia, the discont

The aim of this study was to explore the clinical characteristics of and treatment strategies for interstitial pneumonia induced by gefitinib in patients with advanced non-small cell lung cancer (NSCLC). The detailed clinical data of one patient with NSCLC and gefitinib‐induced interstitial pneumonia were compiled and a review of relevant previous studies was performed. Based on this case report and the review, the clinical characteristics, mechanisms and treatment strategies of this rare disease were analyzed. The analyses showed that older, male patients with a long smoking history, high smoking index and adenocarcinoma (particularly bronchoalveolar carcinoma) were more likely to suffer from interstitial pneumonia while taking gefitinib. The onset time of interstitial pneumonia was 1-2 months subsequent to gefitinib administration. The clinical manifestations included chest tightness, shortness of breath, progressive dyspnea, severe hypoxemia and respiratory failure. Diffuse infiltration and alveolar interstitial shadows were observed on the chest tomography scan. In such circumstances, a timely judgment is required, in addition to the withdrawal of gefitinib treatment and the administration of high-dose glucocorticoids, as well as oxygen inhalation and anti-infective therapies, in order to relieve the symptoms. In conclusion, following the onset of gefitinib‐induced interstitial pneumonia, the discontinuation of gefitinib is likely to alleviate the suffering of the majority of patients. Early interstitial pneumonia is not an absolute index for the permanent discontinuation of gefitinib treatment. It is necessary to comprehensively consider the benefits and hazards of gefitinib for the patients. Introduction Gefitinib, an epidermal growth factor receptor (EGFR) type 1 tyrosine kinase inhibitor, blocks the signal transduction pathway implicated in the proliferation and survival of cancer cells (1). The use of gefitinib to treat patients with advanced non-small-cell-lung cancer (NSCLC) has raised significant concern among physicians. Gefitinib is better-tolerated and less toxic than conventional cytotoxic drugs; however, gefitinib-induced interstitial lung disease (ILD) has been demonstrated to be a serious adverse effect (2). Phase II studies showed that the objective response rates achieved after gefitinib treatment were between 10 and 20%, with minimal toxicities; mainly an acne-like rash and mild diarrhea, in patients with recurrent non-small cell lung cancer (the IDEAL trials) (3). In subsequent phase III trials, the addition of gefitinib to standard platinum-based chemotherapy failed to demonstrate a survival advantage in patients with untreated non-small cell lung cancer (the INTACT trials) (4,5). The worldwide incidence of ILD was approximately 1% (2% in the Japanese post-marketing experience and approximately 0.3% in a United States expanded access program). The median time to onset of ILD was 24 days in the Japan group and 42 days in the United States group. Approximately one‐third of all ILD cases caused by gefitinib have been fatal (6). In this study, a case of gefitinib‐induced interstitial pneumonia is described and previous case reports between 2003 and 2011 are reviewed, with the aims of summarizing the clinical features, mechanisms and treatment strategies of gefitinib‐induced interstitial pneumonia and providing a reference for medication safety in the clinical treatment of NSCLC.