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━━ Background. Pazopanib is a multitargeted tyrosine kinase inhibitor. Frequent adverse events caused by pazopanib include hypertension, fatigue, nausea, diarrhea, weight loss and liver toxicity. Pneumothorax was reported in a clinical trial of treatment with pazopanib for soft tissue sarcoma; however, this complication has not been reported in detail and its relevance for treatment is unclear. Case. A 73-year-old male with pulmonary metastasis of myxofibrosarcoma originating in the left chest wall underwent systemic chemotherapy with doxorubicin. The pulmonary metastatic lesions were progressive; therefore, treatment with pazopanib (800 mg daily) was initiated. Ten days later, the patient experienced right chest pain and dyspnea. A chest roentgenogram revealed right tension pneumothorax, and chest drainage was performed. Chest computed tomography (CT) showed multiple nodules in the bilateral lungs that were slightly smaller than those observed before the administration of pazopanib. Moreover, the lesion in the right upper lobe was found to be a cavity with a thin wall compared with that observed in the previous CT findings. Massive air leakage was observed, a surgery was performed. The location of the air leak was identified to be the lesion of pulmonary metastasis that had been found to be a cavity in the right upper lobe. Thoracoscopic partial pulmonary resection including the lesion was performed. Pathologically, the specimen was confirmed to be pulmonary metastasis of high-grade myxofibrosarcoma. Microscopically, invasion of tumor cells to the visceral pleura, exposure of tumor cells to the pleural cavity and collapse of the visceral pleura were detected. We speculated that the pneumothorax observed in our patient was likely an adverse event of the treatment with pazopanib. Conclusions. It is necessary to pay attention to the development of pneumothorax when prescribing pazopanib in patients with pulmonary metastasis. (JJLC. 2013;53:888-892) KEY WORDS━━ Pazopanib, Pneumothorax, Sarcoma Reprints : Makoto Motoishi, Department of Thoracic Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan (e-mail: mmotoish@kyotolan.hosp.go.jp). Received October 31, 2013; accepted December 6, 2013. 要旨━━背景.パゾパニブはマルチターゲットチロシ ンキナーゼ阻害薬であり,頻度の高い有害事象として高 血圧,疲労,嘔気,下痢,体重減少,肝障害がある.軟 部肉腫に対するパゾパニブの臨床試験で気胸が報告され ているが詳細な報告はみられず,治療との関係は不明で ある.症例.症例は 73 歳男性.左胸壁原発粘液線維肉腫 肺転移に対しドキソルビシンの投与を行ったが奏功せ ず,パゾパニブ(800 mg 日)を開始した.治療開始 10 日後に右胸痛と呼吸苦を自覚,胸部X線上右緊張性気胸 を認め胸腔ドレナージを行った.胸部CTで両肺多発結 独立行政法人国立病院機構京都医療センター 1呼吸器外科,2腫瘍 内科. 別刷請求先:元石 充,独立行政法人国立病院機構京都医療セ ンター呼吸器外科,〒612-8555 京都市伏見区深草向畑町 1-1(email: mmotoish@kyotolan.hosp.go.jp). 受付日:2013 年 10 月 31 日,採択日:2013 年 12 月 6 日. (肺癌.2013;53:888-892) 2013 The Japan Lung Cancer Society Secondary Pneumothorax During the Administration of Pazopanib―Motoishi et al Japanese Journal of Lung Cancer―Vol 53, No 7, Dec 20, 2013―www.haigan.gr.jp 889 Figure 1. A chest X-ray revealed right tension pneumothorax. 節影を認めたがパゾパニブ開始前よりやや縮小してお り,右上葉の転移巣は薄壁空洞化していた.高度なエアー リークがみられるため手術を施行,術中に右肺上葉の空 洞化した転移巣からエアーリークを確認し,病巣を含め た肺部分切除術を行った.組織学的には高悪性度粘液線 維肉腫と診断され,腫瘍の臓側胸膜への浸潤,胸腔への 露出,及び臓側胸膜の破綻を認めた.以上より,パゾパ ニブの有害事象として発症した続発性気胸と診断した. 結論.肺転移を有する症例にパゾパニブを投与する際 は,気胸の発症に留意する必要があると考えられる. 索引用語━━パゾパニブ,気胸,肉腫

Secondary Pneumothorax in a Patient with Pulmonary Metastasis of Myxofibrosarcoma During the Administration of Pazopanib