Drug-induced interstitial lung disease caused by olaparib: three case reports and review of the Japanese Adverse Drug Event Report database and literature

• Published in: BMC pulmonary medicine Vol. 23; no. 1; p. 289
• Main Authors: Ishimoto, Hiroshi, Sakamoto, Noriho, Kido, Takashi, Ozasa, Mutsumi, Tsutsui, Shin, Mori, Mayako, Setoguchi, Daichi, Takemoto, Shinnosuke, Obase, Yasushi, Ishimatsu, Yuji, Tomonaga, Chiharu, Matsumoto, Kanako, Morisaki, Sachiko, Miura, Kiyonori, Mukae, Hiroshi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.08.2023; BioMed Central; BMC
• Subjects: Aged; Alveolitis; Alveolitis, Extrinsic Allergic; Analysis; Antigens; Blood tests; BRCA mutations; BRCA1 protein; BRCA1 Protein - adverse effects; BRCA1 Protein - genetics; BRCA2 Protein - genetics; Bronchoscopy; Cancer therapies; Care and treatment; Case Report; Case reports; Chemotherapy; Chest; Computed tomography; Cough; COVID-19; CT imaging; Diagnosis; Drug-induced interstitial lung disease; Drug-Related Side Effects and Adverse Reactions; Dyspnea; East Asian People; Female; Fever; Health aspects; Humans; Hypersensitivity; Hypersensitivity pneumonitis like pattern; Hypoxia; Lung diseases; Lung diseases, Interstitial; Lung Diseases, Interstitial - chemically induced; Lungs; Middle Aged; Olaparib; Ovarian cancer; Ovarian Neoplasms; Oxygen saturation; PARP inhibitor; Pneumonia; Pneumonitis; Prednisolone; Pulmonology; Respiration; Risk factors; Steroids; Streptococcus infections; Tumors; Japan; Case report; Olaparib; Drug-induced interstitial lung disease; Hypersensitivity pneumonitis like pattern; PARP inhibitor; Ovarian cancer
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-023-02569-3

Olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, has demonstrated effectiveness in treating ovarian, breast, and other cancers, particularly those with specific molecular subtypes including, but not limited to, BRCA1/2 mutations. Consequently, its utilization is expected to increase in the future. For this reason, it is important to acknowledge the potential for adverse events associated with olaparib, including the relatively rare but significant risk of drug-induced interstitial lung disease (DIILD). Since DIILD can lead to fatal outcomes, its early detection is crucial. The dissemination of knowledge regarding DIILD can be facilitated through case reports; however, specific reports of DIILD caused by olaparib have only been published in Japanese. To the best of our knowledge, this is the first report in English of our experience with three cases of DIILD caused by olaparib. Cases 1, 2, and 3 involved Japanese women with ovarian cancer who had been receiving olaparib at a dose of 600 mg/day. Case 1, a 72-year-old woman who had been on olaparib for 4 months, and case 2, a 51-year-old woman who had been on olaparib for 8 months, reported fever and general malaise. Chest computed tomography (CT) revealed pale ground glass opacity (GGO) similar to hypersensitivity pneumonitis. The severity grade was 2 in both cases. Case 3, a 78-year-old woman who had been on olaparib for 3 weeks, presented with cough and reported dyspnea on exertion. Chest CT revealed non-specific interstitial pneumonia and organizing pneumonia-like shadows. The severity grade was 4. Olaparib was discontinued in all cases. Case 1 received 0.6 mg/kg of prednisolone due to mild hypoxia, while prednisolone was not administered in case 2 due to the absence of hypoxia. Case 3 received steroid pulse therapy due to severe hypoxia. Olaparib administration was not resumed in any patient. DIILD caused by olaparib in Japan, including the present three cases, commonly presents with GGO, similar to hypersensitivity pneumonitis on chest CT. The prognosis for the majority of patients is favorable; however, there have been instances of severe cases. Early recognition of drug-induced lung injury and further accumulation of cases is important.