Chest CT Diagnosis and Clinical Management of Drug-Related Pneumonitis in Patients Receiving Molecular Targeting Agents and Immune Checkpoint Inhibitors: A Position Paper From the Fleischner Society.

Abstract

Use of molecular targeting agents and immune checkpoint inhibitors (ICIs) has increased the frequency and broadened the spectrum of lung toxicity, particularly in patients with cancer. The diagnosis of drug-related pneumonitis (DRP) is usually achieved by excluding other potential known causes. Awareness of the incidence and risk factors for DRP is becoming increasingly important. The severity of symptoms associated with DRP may range from mild or none to life-threatening with rapid progression to death. Imaging features of DRP should be assessed in consideration of the distribution of lung parenchymal abnormalities (radiologic pattern approach). The CT patterns reflect acute (diffuse alveolar damage) interstitial pneumonia and transient (simple pulmonary eosinophilia) lung abnormality, subacute interstitial disease (organizing pneumonia and hypersensitivity pneumonitis), and chronic interstitial disease (nonspecific interstitial pneumonia). A single drug can be associated with multiple radiologic patterns. Treatment of a patient suspected of having DRP generally consists of drug discontinuation, immunosuppressive therapy, or both, along with supportive measures eventually including supplemental oxygen and intensive care. In this position paper, the authors provide diagnostic criteria and management recommendations for DRP that should be of interest to radiologists, clinicians, clinical trialists, and trial sponsors, among others.

• Authors: Takeshi Johkoh, Kyung Soo Lee, Mizuki Nishino, William D Travis, Jay H Ryu, Ho Yun Lee, Christopher J Ryerson, Tomás Franquet, Alexander A Bankier, Kevin K Brown, Jin Mo Goo, Hans-Ulrich Kauczor, David A Lynch, Andrew G Nicholson, Luca Richeldi, Cornelia M Schaefer-Prokop, Johny Verschakelen, Suhail Raoof, Geoffrey D Rubin, Charles Powell, Yoshikazu Inoue, Hiroto Hatabu
• Journal: Chest (Chest) Vol. 159 Issue 3 Pg. 1107-1125 (03 2021) ISSN: 1931-3543 [Electronic] United States
• PMID: 33450293 (Publication Type: Journal Article, Practice Guideline)
• Copyright: Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Immune Checkpoint Inhibitors

Topics

• Alveolitis, Extrinsic Allergic (chemically induced, diagnosis, therapy)
• Drug-Related Side Effects and Adverse Reactions (diagnosis, etiology, therapy)
• Humans
• Immune Checkpoint Inhibitors (administration & dosage, adverse effects)
• Lung (diagnostic imaging)
• Molecular Targeted Therapy (adverse effects, methods)
• Neoplasms (drug therapy, immunology)
• Patient Care Management (methods)
• Risk Adjustment (methods)