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
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 the drug or immunologic responses to treatment.
Radiologically, DILD can resemble different patterns which can be classified using the American Thoracic Society/European Respiratory Society (ATS/ERS) classification of idiopathic interstitial pneumonias. Non-specific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia (COP), acute interstitial pneumonia (AIP) and hypersensitivity pneumonitis (HP) are among the most common patterns in pneumonitis. (1-3)
Clinically, DILD usually manifests as dyspnoea, dry cough and occasionally fever. The degree of severity is classified using the Grading of Drug-Related Pneumonitis in National Cancer Institute Common Terminology Criteria for Adverse Events (9) and ranges from the lack of symptoms to death (grade 1 to grade 4). The imaging patterns have been correlated with histological patterns, but a clear correlation to clinical symptoms has not been demonstrated.
Due to its potential reversibility, early diagnosis is crucial, therefore patients enrolled in clinical trials should be carefully monitored to ensure timely detection of drug induced pneumonitis and a successful management of the patient.