Pepleomycin-induced pneumonitis resulting in death

Summary Two cases of fatal pneumonitis induced by pepleomycin, a new antitumour antibiotic analogous to bleomycin, are described. In the first case, the patient received radiation in combination with intra-arterial administration of pepleomycin to a total dose of 100 mg. for the treatment of an epidermoid carcinoma of the maxilla. The pulmonary changes were noted two weeks after cessation of the chemotherapy and the patient died of pulmonary insufficiency despite intensive therapy with antibiotics and a steroid. The other case with an epidermoid carcinoma of the cheek and oropharynx was treated by radiation and pepleomycin given to a total dose of 205 mg. Pepleomycin was replaced by predonin soon after bilateral shadows were noticed on a chest radiograph, but the patient died of pneumonitis 10 months later. Various factors which may affect the development of pulmonary toxicity by pepleomycin are discussed.