Pulmonary toxicity associated with systemic antineoplastic therapy: Clinical presentation, diagnosis, and treatment
- Fabien Maldonado, MD
Fabien Maldonado, MD
- Assistant Professor of Medicine
- Vanderbilt University School of Medicine
- Andrew H Limper, MD
Andrew H Limper, MD
- Professor of Pulmonary Medicine
- Mayo Clinic College of Medicine
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Section Editor
- Kevin R Flaherty, MD, MS
Kevin R Flaherty, MD, MS
- Section Editor — Interstitial Lung Disease
- Associate Professor of Medicine
- University of Michigan Health System
- Deputy Editors
- Helen Hollingsworth, MD
Helen Hollingsworth, MD
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor of Medicine
- Boston University School of Medicine
- Diane MF Savarese, MD
Diane MF Savarese, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Oncology and Palliative Care
- Clinical Instructor of Medicine
- Harvard Medical School
Adverse drug reactions (ADRs) due to antineoplastic agents are a common form of iatrogenic injury, and the lungs are a frequent target [1-4]. While some antineoplastic agent-induced ADRs are potentially preventable (particularly those that are related to cumulative dosing), many are idiosyncratic and unpredictable.
This topic review will provide an overview of the clinical presentation, pathogenesis, diagnosis, and treatment of pulmonary toxicity associated with antineoplastic agents. Specific patterns of lung injury seen with individual agents (table 1) are reviewed separately. (See "Pulmonary toxicity associated with antineoplastic therapy: Cytotoxic agents" and "Pulmonary toxicity associated with antineoplastic therapy: Molecularly targeted agents" and "Bleomycin-induced lung injury" and "Busulfan-induced pulmonary injury" and "Chlorambucil-induced pulmonary injury" and "Cyclophosphamide pulmonary toxicity" and "Methotrexate-induced lung injury" and "Mitomycin-C pulmonary toxicity" and "Nitrosourea-induced pulmonary injury" and "Taxane-induced pulmonary toxicity".)
Some estimate that 10 to 20 percent of all patients treated with an antineoplastic agent have some form of lung toxicity [2,3]. The high prevalence may be a result of the lungs receiving the entire blood supply, leading to greater exposure to potentially harmful antineoplastic agents compared to other organs.
The pathogenesis of antineoplastic agent-induced lung injury is poorly understood. Most toxic effects are thought to result from direct cytotoxicity. The following pathophysiologic mechanisms have been proposed [5,6]:
●Direct injury to pneumocytes or the alveolar capillary endothelium with the subsequent release of cytokines and recruitment of inflammatory cells.
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- CLINICAL MANIFESTATIONS
- Symptoms and signs
- Pulmonary function tests
- Bronchoscopy and bronchoalveolar lavage
- Routine testing
- DIFFERENTIAL DIAGNOSIS
- Drug discontinuation
- Supportive care
- SUMMARY AND RECOMMENDATIONS
- Clinical manifestations and diagnosis