Drug-Related Pneumonitis in Cancer Treatment during the COVID-19 Era

Abstract

Interstitial lung disease is recognized as a group of diseases with a different etiopathogenesis characterized by chronic lung inflammation with the accumulation of inflammatory cells, lymphocytes and macrophages, and the consequent release of proinflammatory cytokines. Various degrees of pulmonary fibrosis can be associated with this inflammatory condition. Interstitial lung disease related to oncological drugs is a relevant problem in clinical practice. The etiopathogenetic mechanisms underlying this adverse event are not completely known but can be partly explained by the mechanism of action of the drug involved. Therefore, knowledge of the relevance of this potentially fatal adverse event supported by the reported safety data of pivotal studies becomes fundamental in the management of patients. The prompt diagnosis of drug-related pneumonia and the consequent differential diagnosis with other forms of pneumonia allow a rapid suspension of treatment and the establishment of an immunosuppressive treatment if necessary. In the context of the health emergency related to SARS CoV2 infection and COVID-19-related interstitial lung disease, such knowledge holds decisive relevance in the conscious choice of cancer treatments. Our intent was to describe the oncological drugs most correlated with this adverse event by reporting, where possible, the percentages of insurgency in pivotal studies to provide an overview and therefore promote greater awareness of this important toxicity related to oncological treatment.

Multidisciplinary clinical guidance on trastuzumab deruxtecan (T-DXd)–related interstitial lung disease/pneumonitis—Focus on proactive monitoring, diagnosis, and management

“…Additional evaluations suggested in the current guidelines include pulmonologist consultation; sputum/blood culture and complete blood count; pulmonary function tests; pulse oximetry; arterial blood gases; pharmacokinetic analysis using a blood sample (if feasible); and a standard infectious disease evaluation to rule out infectious causes, [5] including viral pneumonias such as COVID-19 and influenza [81]. In our experience, COVID-19 and T-DXd-related ILD/pneumonitis can have overlapping CT features.…”

Alpelisib induced interstitial lung disease in a patient with advanced breast cancer

“…Bleomycin, platins, methotrexate, taxanes, gemcitabine are the most common chemotherapeutic agents causing drug-induced ILD in cancer patients. 2,6 Here we report a case of alpelisib-induced ILD in a patient with PIK3CA-mutated, HR-positive, and HER2-negative advanced breast cancer. Alpelisib is the only targeted agent approved for patients with PIK3CA-mutated, HR-positive, and HER2-negative advanced breast cancer patients who had been treated with endocrine therapy ± CDK inhibitors.…”

Strategies for mitigating adverse events related to selective RET inhibitors in patients with RET-altered cancers

“…It is mandatory to exclude COVID-19 infection and other lung pathologies. 46 Clinical examination and patient monitoring are mandatory. Laboratory tests can be unspecific, but excluding rheumatological diseases, myositis, is important.…”