Drug-induced interstitial lung disease during cancer therapies: expert opinion on diagnosis and treatment

ESMO Open

article

P. Conte¹  P.A. Ascierto²  G. Patelli³  R. Danesi⁵  A. Vanzulli³  F. Sandomenico⁷  P. Tarsia⁸  A. Cattelan⁹  A. Comes^1,10  M. De Laurentiis^1,11  A. Falcone^1,12  D. Regge^1,13  L. Richeldi^1,10  S. Siena³ 

[1] DiSCOG, University of Padova and Medical Oncology 2, IOV—Istituto Oncologico Veneto IRCCS;Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale;Department of Oncology and Hemato-Oncology, Università degli Studi di Milano;Department of Hematology, Oncology and Molecular Medicine, Grande Ospedale Metropolitano Niguarda;Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University of Pisa;Radiology Department, Grande Ospedale Metropolitano Niguarda;Radiology Unit, Buon Consiglio Fatebenefratelli Hospital;Pneumology Unit, Grande Ospedale Metropolitano Niguarda;Tropical and Infectious Diseases Unit, Padua University Hospital;Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore;Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale;Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana;Department of Radiology, Candiolo Cancer Institute;Department of Surgical Sciences, University of Turin

关键词: antineoplastic agents;    diagnostic–therapeutic algorithm;    differential diagnosis;    interstitial lung disease;    pneumonia;   

DOI  :  10.1016/j.esmoop.2022.100404

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background Drug-induced interstitial lung disease (DIILD) is a form of interstitial lung disease resulting from exposure to drugs causing inflammation and possibly interstitial fibrosis. Antineoplastic drugs are the primary cause of DIILD, accounting for 23%-51% of cases, with bleomycin, everolimus, erlotinib, trastuzumab-deruxtecan and immune checkpoint inhibitors being the most common causative agents. DIILD can be difficult to identify and manage, and there are currently no specific guidelines on the diagnosis and treatment of DIILD caused by anticancer drugs.Objective To develop recommendations for the diagnosis and management of DIILD in cancer patients.Methods Based on the published literature and their clinical expertise, a multidisciplinary group of experts in Italy developed recommendations stratified by DIILD severity, based on the Common Terminology Criteria for Adverse Events.Results The recommendations highlight the importance of multidisciplinary interaction in the diagnosis and management of DIILD. Important components of the diagnostic process are physical examination and careful patient history-taking, measurement of vital signs (particularly respiratory rate and arterial oxygen saturation), relevant laboratory tests, respiratory function testing with spirometry and diffusing capacity of the lung for carbon monoxide and computed tomography/imaging. Because the clinical and radiological signs of DIILD are often similar to those of pneumonias or interstitial lung diseases, differential diagnosis is important, including microbial and serological testing to exclude or confirm infectious causes. In most cases, management of DIILD requires the discontinuation of the antineoplastic agent and the administration of short-term steroids. Steroid tapering must be undertaken slowly to prevent reactivation of DIILD. Patients with severe and very severe (grade 3 and 4) DIILD will require hospitalisation and often need oxygen and non-invasive ventilation. Decisions about invasive ventilation should take into account the patient's cancer prognosis.Conclusions These recommendations provide a structured step-by-step diagnostic and therapeutic approach for each grade of suspected cancer-related DIILD.

【 授权许可】

CC BY|CC BY-NC-ND