392 Lung Toxicity Induced by Novel Antineoplastic Therapies in Cancer Patients

BACKGROUND: Pulmonary toxicity and respiratory failure are major adverse events complicating the use of novel antineoplastic agents in the treatment of lung cancer. We aim to investigate the risk and characteristics of cytostatic-induced pulmonary toxicity caused by agents currently used to treat lung cancer. METHODS: A literature search was performed in PubMed to identify relative studies published until June 2011. RESULTS: Almost all categories of antineoplastic agents have been associated with some kind of pulmonary complications. Taxanes have been linked to acute pneumonitis, pleural effusion and reactions during infusion. Nucleoside analogs can cause diffuse alveolar damage, bronchospasm and acute respiratory distress syndrome (ARDS). Monoclonal antibodies are associated with pulmonary hemorrhage and hemoptysis. Acute pneumonitis and hypersensitivity reactions have been reported with podophyllotoxins, while diffuse interstitial pneumonia has been attributed to pemetrexed. Tyrosine kinase inhibitors of the epidermal growth factor receptor have been associated with acute pneumonitis, diffuse alveolar damage and pulmonary fibrosis. The exact incidence of lung toxicity caused by these agents remains unclear, although it seems relatively low. Clinical manifestation includes cough, fever, dyspnea and hypoxemia. Chest imaging reveals diffuse or patchy, unilateral or bilateral, ground-glass opacities or consolidations. It is important that other possible causes of respiratory failure be excluded when treating a lung cancer patient receiving chemotherapy. CONCLUSIONS: Physicians should be aware of the potential of lung toxicities from antineoplastic agents, especially when they are combined with other cytotoxic drugs or radiation.