Successful Gefitinib Treatment of a Case of Bronchioloalveolar Carcinoma with Respiratory Failure

Bronchioloalveolar carcinoma (BAC) is a form of pulmonary adenocarcinoma that presents endobronchial spread and bronchorrhea in advanced stages. The prognosis for BAC patients in advanced stages is poor because of poor response to conventional chemotherapy. Gefitinib ("Iressa") is an orally active, selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (EGFR-TKI) that blocks signal transduction pathways implicated in the proliferation and survival of cancer cells. In this paper, we report on our experience treating with Gefitinib and other life saving measures an 84-yearold man with BAC of RLL and impending respiratory failure. Our selected treatment dramatically reduced the production of serous sputum and the patient was successfully liberated from mechanical ventilation within one week of the onset of treatment. We postulate that ex-smoker who have already quit for an extended period of time (> 20 years) and display a complex papillary structure of bronchioloalveolar carcinoma in the lungs might be suitable candidates for treatment with Gefitinib. Furthermore, this treatment may even be particularly suited for difficult patient subgroups such as the elderly and those with existing serious medical conditions. ( J Intern Med Taiwan 2005; 17: 22-27 )