A pictorial review of drug induced pneumonitis in early clinical trials

Congress:

ECR 2020

Poster Number:

C-09310

Type:

Educational Exhibit

Keywords:

Performed at one institution, Diagnostic or prognostic study, Not applicable, Toxicity, Drugs / Reactions, Treatment effects, CT-High Resolution, Oncology, Lung, Oncologic Imaging

Authors:

A. D. Curcean¹, A. Terbuch², I. M. Candilejo³, D.-M. Koh⁴, A. Minchom⁴, J. S. Lopez⁴, N. Tunariu⁴; ¹Sutton, London/UK, ²Graz/AT, ³Madrid/ES, ⁴London/UK

DOI:

10.26044/ecr2020/C-09310

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-09310

Fig. 1: Hypersensitivity pneumonitis - centrilobular nodules - mosaic air...

Fig. 2: Non-specific interstitial pneumonia - ground-glass opacities - usually...

Fig. 3: Cryptogenic organising pneumonia - band-like consolidations and air...

Fig. 4: Acute interstitial pneumonia - extensive ground-glass opacities +/- lung...

Learning objectives

To describe radiological HRCT patterns of drug induced interstitial lung disease (DILD) To highlight the correlation between clinical symptoms and the radiological patterns of DILD

Background

Cancer therapy is rapidly evolving, new treatments being developed at a much faster pace than before. As information about potential toxicities of investigational medical products (IMP) in early phase clinical trials is scarce, early diagnosis of side effects is crucial for patient safety. The most common form of pulmonary toxicity is drug induced interstitial lung disease (DILD), a serious adverse effect that can be life-threatening leading to respiratory impairment or even death.The exact pathogenetic mechanisms remain unknown, but they include direct alveolar injury caused by...

Findings and procedure details

The HRCT (High resolution CT) scans of 60 advanced cancer patients enrolled on phase I clinical trials with reported radiological features of drug induced interstitial lung disease were reviewed by an experienced radiologist. Radiological patterns of DILD were categorized according to the ATS/ERS classifications and clinical symptoms recorded and graded according tothe Common Terminology Criteria for Adverse Events (CTCAE). The following patterns were identified on HRCT scans: Hypersensitivity pneumonitis (33.3%) – Fig. 1 centrilobular nodules mosaic air trapping upper lobe distribution Non-specific interstitial pneumonia (30%)...

Conclusion

Considering the unpredictable side effects of IMPs, early diagnosis and knowledge of DILD radiological patterns are crucial for patient safety in early phase clinical trials. New pulmonary changes should not be ignored, even if the patient is asymptomatic, as the continuation of the treatment may lead to irreversible lung changes.

Personal information and conflict of interest

A. D. Curcean; Sutton, London/UK - nothing to disclose A. Terbuch; Graz/AT - nothing to disclose I. M. Candilejo; Madrid/ES - nothing to disclose J. S. Lopez; London/UK - nothing to disclose N. Tunariu; Sutton, London/UK - nothing to disclose D.-M. Koh; London/UK - nothing to disclose A. Minchom; London/UK - nothing to disclose

References

1.Travis WD, Costabel U, Hansell DM et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2013; 188: 733-748. 2.Nishino M, Sholl LM, Hodi FS et al. Anti-PD-1-Related Pneumonitis during Cancer Immunotherapy. N Engl J Med 2015; 373: 288-290. 3.Nishino M, Chambers ES, Chong CR et al. Anti-PD-1 Inhibitor-Related Pneumonitis in Non-Small Cell Lung Cancer. Cancer Immunol Res 2016; 4: 289-293.