Therapy-induced Toxicity of the Lungs: An Overview

Pulmonary toxicity induced by novel antineoplastic agents has not been well characterized because of the simultaneous or sequential use of drugs and a multimodality therapeutic approach. To further investigate this topic, relevant studies were identified through Medline. The generic names of novel antineoplastic agents and the key words pulmonary toxicity, dyspnea and pneumonitis were used for the search. References from the articles identified were also reviewed for additional sources. Most novel antineoplastic drugs may induce pulmonary toxicity. The most recognized patterns of lung toxicity consist of unspecified dyspnea and interstitial lung disease (ILD). Exclusion diagnosis of possible underlying diseases is necessary. Genetic predisposition, autoimmune conditions or superimposed disease may also be involved in the development of lung toxicity. Conclusion: Clinicians should be aware of potential pulmonary toxicity as a complication in the treatment of cancer and focus on its early detection or prediction. Pulmonary toxicity occurs as a complication in the treatment of lung cancer. With the current trends in lung cancer therapy, pulmonary toxicity is unavoidable. It is estimated that the frequency of this complication is anywhere between 10-30% depending on the type of treatment. Anticancer agents for lung cancer have been implicated in lung injury and interstitial lung disease (ILD). ILD comprises histopathological patterns of acute lung injury (ALI), nonspecific interstitial pneumonitis (NSIP), diffuse alveolar damage (DAD), bronchiolitis obliterans with organizing pneumonia, eosinophilic pneumonia, and pulmonary hemorrhage (1). The clinical manifestations of disease range from cough and low-grade fever to serious severe dyspnea and respiratory failure. Understanding of the mechanisms involved is limited although it is considered to be a multistep process. Simultaneous or sequential use of drugs and a multimodality therapeutic approach make assessment of toxicity to a specific agent difficult. This review focuses on cell injuring mechanisms, potential pulmonary toxicity of the novel antitumor agents for lung cancer (cytotoxic and targeted therapies) and future developments in the early detection or prediction of the candidates for ILD from the therapy. To further investigate this topic, relevant studies were identified through Medline. The generic names of novel antineoplastic agents (docetaxel, gemcitabine, paclitaxel, irinotecan, gefinitib, erlotinib and bevacizumab) were used in the search. The key phrases pulmonary toxicity, dyspnea, pneumonitis, apoptosis and radiotherapy were used for better results. The references from the articles identified were also reviewed for additional sources.