Pulmonary toxicities of biologics: a review

Abstract

With the advancement of research in cancer treatment more and more drugs are being introduced for the treatment of cancer. In this review study, we have tried to look at some of the relatively newly introduced drugs, commonly referred to as biologics. The aim of this study was to review the very rare but fatal pulmonary toxicities (mostly interstitial lung disease) caused by these drugs. The drugs that were reviewed are rituximab, cetuximab, bevacizumab, alemtuzumab, and trastuzumab. This review basically aims at presenting a basic introduction (mechanism of action and indications of use) of these drugs followed by a summary of the incidence, various clinical presentations, diagnosis, treatment options, and outcome of patients around the world who presented with pulmonary toxicities caused by these drugs.

Vasculitic emergencies in the intensive care unit: a special focus on cryoglobulinemic vasculitis

“…Our case contrasts with other reported cases, because diffuse alveolar hemorrhage is usually associated with a poor outcome [30]. It is worth noting that the lung manifestations occurred shortly after the administration of rituximab, a drug whose reported adverse events include interstitial pneumonitis [35-37]. Interestingly, in patients with HCV-related CV, rituximab may form a complex with IgM kappa mixed cryoglobulin, thereby inducing an acute systemic flare of CV [38].…”

Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: the Mayo Clinic experience

“…The following infusion was delayed by 1 week without any further myelosuppressive or infectious sequelae. Finally, subject #2 was diagnosed with probable bronchiolitis obliterans organising pneumonia, which has been rarely associated with RTX 16. Bronchoscopy was negative for infectious organisms, and his pulmonary infiltrates improved with steroid therapy.…”

Fatal interstitial pneumonitis in a patient with relapsed diffuse large B cell lymphoma following yttrium-90 ibritumomab tiuxetan

“…Moreover, both ibritumomab tiuxetan and rituximab, which are routinely included in radioimmunotherapy using Y-90, have rare, but a potential risk for interstitial pneumonitis, according to previous literature and case reports [5][6][7][8][9] Cytokine release such as TNF-α is postulated to be the mechanism especially related with delayed lung injury following anti-CD 20 monoclonal antibody infusions [14].…”