Title:Novel Drug-Induced Pulmonary Complications in Cancer Patients You Can Save Life!
Volume: 12
Issue: 2
Author(s): Wael El-Melouk and Abdul Rahman Jazieh
Affiliation:
Keywords:
Novel drugs, lung, cancer patients.
Abstract: The novel Antineoplastic agent can induce respiratory complications up
to respiratory failure. As the incidence seems to be low, we tried to collect most of
the information available aiming to highlight the problems such as wasting
unnecessary resources and increasing medical professional’s awareness and its
impact on patient care. Mechanisms of drug-associated lung injury are limited.
There are no specific markers known to differentiate drug-associated interstitial
lung disease from other pathologies. Therefore, we tried to collect possible
mechanism pathways, histopathological patterns and factors discussed in
literatures, directly or indirectly affecting lung tissue like, oxidant injury, vascular
damage, and CNS depression. Risk factors are both dependent and independent,
and interestingly Smoking is not a dependent risk factor and might decrease the
likelihood of bleomycin pulmonary toxicity, It may even be protective. FREQUENCY In USA, more
than 2 million cases of adverse drug reactions occur annually resulting in approximately 100,000
fatalities. Several studies reported that drug-induced pulmonary toxicity is under-diagnosed
worldwide. We summarized the Novel agent causing pulmonary toxicity such as monoclonal
antibodies, rapamycin analog, Tyrosine Kinase inhibitor, and the new immunotherapy (check points
inhibitors) with toxicity type seen and percentage of patients reported.
Clinical Manifestations and Diagnosis: The diagnosis of chemotherapy-induced pneumonitis
should be considered when pneumonitis develops shortly after the initiation of treatment, there is no
specific time of presentation, lack of an alternative explanation for respiratory failure, and the
resolution of pneumonitis after corticosteroid treatment and withdrawal of the presumed agent. It is
presented with various clinical syndromes/presentations may be confusing due to the different
criteria used in the literature such as no specific laboratory or radiological test to diagnosis such
complication Concurrent treatment with corticosteroids and antihistamines may not prevent the
development of drug-induced pneumonitis. One unique presentation of antineoplastic agent-induced
pneumonitis is so-called radiation recall pneumonitis as the chest imaging shows pulmonary
infiltrates in exactly the same field of previously irradiated area. The differential diagnosis of
antineoplastic agent-induced pneumonitis is extensive and in most of the cases is by exclusion of
infectious, malignant, and cardiac diseases. Trans-bronchial or open-lung biopsy can be helpful in
diagnosis.
Imaging: The pattern and topographic distribution of opacities are highly variable. Occasionally,
imaging features are suggestive.
Treatment: Cessation of the apparent causative agent and initiating systemic corticosteroids.
Different doses of methylprednisolone had been used according to severity ranged from 1g/day in
severe cases to 60 mg every six hourly in mild to moderate cases. Laryngotracheal intubation,
tracheostomy, esophagoscopy with fragmentation and lavage, Supportive care, and lung
transplantation might be needed in some cases along with corticosteroid treatment. Re-exposure
contraindicated and considered only if continuing treatment is essential to control a life-threatening
underlying condition.
