Chemotherapy-Induced Lung Disease

Abstract

In Brief Chemotherapy-induced lung disease (CILD) can be caused by multiple agents. The diagnosis should be considered in any patient who develops pulmonary symptoms during or after treatment with chemotherapy. It is a diagnosis made by exclusion of other etiologies, especially recurrent tumor or infection. The most common clinical presentations are interstitial pneumonitis/fibrosis, hypersensitivity pneumonitis, and capillary leak syndrome. The clinical characteristics of bleomycin, mitomycin, carmustine, and methotrexate have been well characterized, while newer syndromes caused by gemcitabine, paclitaxel, docetaxel, and fludarabine are being recognized. The clinical approach to patients with suspected CILD must be tailored to the individual patient according to their underlying disease and treatment history, with special attention to the nature of their immunocompromise. Diagnostic procedures are performed to the extent needed to exclude other likely diagnoses. For patients with limited pulmonary reserve, empiric therapy may be a reasonable option. Chemotherapy-induced lung disease can be caused by dozens of agents. Diagnosis is established by exclusion of other etiologies, especially recurrent tumor or infection. This article reviews agents such as bleomycin and carmustine that have extensive literature and well-documented molecular mechanisms, as well as agents more recently described to cause lung disease such as gemcitabine, fludarabine, and the taxanes.