However, the presence of antecedent parenchymal lung disease may abrogate the utility of cetuximab in select patients. Pulmonary embolism, also considered a severe reaction, occurred in small numbers of patients in the groups analyzed herein. An association between the presence

of malignancy in the lung, regardless of primary origin, and pulmonary adverse events could not be determined from this FK506 nmr investigation. Of the 43 non-lung cancer studies included in our series only 9 reported the location of metastatic disease. When combined with studies of lung cancer, 17% of this cohort reported direct pulmonary involvement of cancer. In those defining the sites of metastatic foci, the lungs were involved in 46.0 ± 10% of patients. Primary or metastatic involvement of the lung with any cancer could account for patients experiencing pulmonary adverse events when treated with Cetuximab.

Unfortunately, a more clear PCI-32765 cost relationship is limited by the presentation of the data in the original studies. Our investigation suffers from several limitations which should be pointed out. First, it is a compilation of clinical trials, most of which are early phase, with limited numbers including control populations available for comparison of pulmonary adverse events. Most of the studies examined only cited positive adverse events, omitting negative responses to pulmonary symptom changes. This may lead to an over-estimation of the absolute incidence of pulmonary-specific complications. Conversely, transfusion reactions and sepsis which often include symptoms such as dyspnea or respiratory insufficiency were not included in the present analysis due to lack of a clear definition. There were significant differences in the duration of Cetuximab therapy before pulmonary

Epothilone B (EPO906, Patupilone) complications were reported in the clinical trials, ranging from 1 week into therapy to more than several months. This also limits the generalizability of the summation data. Finally, although there appears to be an increase in the incidence of pulmonary adverse events with cetuximab therapy, there is no clearly defined causal relationship that can be proven as mechanistic understandings are lacking. Despite these limitations, we believe that this investigation adds to the sparse literature describing the pulmonary adverse events related to cetuximab therapy. Conclusion Cetuximab (Erbitux® ImClone, Branchburg, NJ) therapy, in combination or as monotherapy, is efficacious in the treatment of colorectal, head/neck, lung and possibly other cancers. Although there is an overall increase in the incidence of pulmonary adverse events with this treatment, there seems to be sparse evidence suggesting treatment limitations related to these complications. Particular attention should be given to cetuximab recipients with underlying parenchymal lung disease and those with NSCLC, in particular in conjunction with radiation therapy, as these groups may have more severe pulmonary reactions.