Nanoparticle albumin-bound paclitaxel -induced severe interstitial lung disease in a gastric cancer patient: a case report

Background: Nanoparticle albumin-bound paclitaxel (nab-PTX) is a novel formulation that combines paclitaxel with human serum albumin via nanotechnology. Without the need for solubilizers, it allows for higher safe doses, shorter infusion time, and no premedication for hypersensitivity prevention. nab-PTX has been widely used in the treatment of various solid tumors. Its common adverse reactions include fatigue, alopecia, myelosuppression, etc., while pulmonary toxicity is extremely rare. To date, there are no reports of severe drug-induced interstitial lung disease (DILD) caused by nab-PTX in gastric cancer patients. Case presentation: We report a case of a 77-year-old male patient with gastric adenocarcinoma. On the 15th day after receiving second-line nab-PTX monotherapy, the patient developed chest tightness, dyspnea, high fever, and severe respiratory distress. High-resolution computed tomography (HRCT) of the chest showed diffuse exudative changes in both lungs, involving more than 90% of the lung fields. After excluding other causes such as pulmonary infection and tumor progression, the patient was diagnosed with severe nab-PTX-related DILD. nab-PTX was discontinued immediately, and the patient was treated with intravenous methylprednisolone sodium succinate. Subsequently, the pulmonary inflammation was gradually absorbed, and the clinical symptoms were significantly improved. Conclusion: nab-PTX-induced severe interstitial pneumonia in gastric cancer patients is a rare and life-threatening adverse event. Clinicians should closely monitor respiratory symptoms and signs of patients receiving nab-PTX, achieve early identification and timely intervention, so as to reduce the risk of adverse outcomes and improve patient prognosis.