-
Current Oncology Reports Oct 2021Since the past year, the fast spread of coronavirus disease 2019 (COVID-19) has represented a global health threat, especially for cancer patients, that has required an... (Review)
Review
PURPOSE OF REVIEW
Since the past year, the fast spread of coronavirus disease 2019 (COVID-19) has represented a global health threat, especially for cancer patients, that has required an urgent reorganization of clinical activities. Here, we will critically revise the profound impact that the pandemic has generated in lung cancer patients, as well the most significant challenges that oncologists have to face to maintain the highest possible standards in the management of lung cancer patients in the pandemic era.
RECENT FINDINGS
Evidences suggested a higher susceptibility and mortality of lung cancer patients due to COVID-19. The hard management of this patient population has been also due to the potential cross interference of anti-tumor drugs on SARS-Cov-2 infection and to the differential diagnosis between COVID-19 pneumonitis and drug-related pneumonitis. COVID-19 pandemic has generated a profound reshaping of oncological activities and the development of recommendations by the oncology scientific community to prioritize anti-tumor treatments for lung cancer patients.
Topics: Antineoplastic Agents; COVID-19; COVID-19 Vaccines; Comorbidity; Diagnosis, Differential; Humans; Lung Neoplasms; Medical Oncology; Pandemics; Pneumonia; Risk Factors; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 34677721
DOI: 10.1007/s11912-021-01125-8 -
Journal of Neurology Mar 2022
Topics: Humans; Immunologic Factors; Multiple Sclerosis; Multiple Sclerosis, Relapsing-Remitting; Natalizumab; Pneumonia
PubMed: 34550470
DOI: 10.1007/s00415-021-10811-3 -
Chest Aug 2001The cytotoxic agent bleomycin is feared for its induction of sometimes fatal pulmonary toxicity, also known as bleomycin-induced pneumonitis (BIP). The central event in... (Review)
Review
The cytotoxic agent bleomycin is feared for its induction of sometimes fatal pulmonary toxicity, also known as bleomycin-induced pneumonitis (BIP). The central event in the development of BIP is endothelial damage of the lung vasculature due to bleomycin-induced cytokines and free radicals. Ultimately, BIP can progress in lung fibrosis. The diagnosis is established by a combination of clinical symptoms, radiographic alterations, and pulmonary function test results, while other disorders resembling BIP have to be excluded. Pulmonary function assessments most suitable for detecting BIP are those reflecting lung volumes. The widely used transfer capacity of the lungs for carbon monoxide appeared recently not to be specific when bleomycin is used in a polychemotherapeutic regimen. There are no proven effective treatments for BIP in humans, although corticosteroids are widely applied. When patients survive BIP, they almost always recover completely with normalization of radiographic and pulmonary function abnormalities. This review focuses on BIP, especially on the pathogenesis, risk factors, and its detection.
Topics: Animals; Antibiotics, Antineoplastic; Bleomycin; Humans; Pneumonia; Risk Factors
PubMed: 11502668
DOI: 10.1378/chest.120.2.617 -
Chest Aug 2021Immune checkpoint inhibitors (ICIs) are standard treatments for advanced non-small cell lung cancer and have expanded use in small cell lung cancer. Although generally...
Immune Checkpoint Inhibitor-Related Pneumonitis in Lung Cancer: Real-World Incidence, Risk Factors, and Management Practices Across Six Health Care Centers in North Carolina.
BACKGROUND
Immune checkpoint inhibitors (ICIs) are standard treatments for advanced non-small cell lung cancer and have expanded use in small cell lung cancer. Although generally better tolerated than traditional chemotherapy, immune-related adverse events, such as immune checkpoint inhibitor-related pneumonitis (ICI-P), remain poorly understood toxicities that limit ICI treatment and can result in considerable morbidity. In this retrospective case-control study, we assessed a lung cancer cohort to identify ICI-P risk factors.
RESEARCH QUESTION
What are the risk factors, clinical presentations, radiographic findings, and outcomes for ICI-P in a real-world lung cancer cohort? Do chronic pulmonary diseases confer increased risk for ICI-P?
STUDY DESIGN AND METHODS
Medical records from lung cancer patients receiving nivolumab, pembrolizumab, or combination ipilimumab and nivolumab at six centers in North Carolina were reviewed (January 2004-July 2017). Patients with ICI-P and control participants were characterized, and logistic regression was used to assess for ICI-P risk factors.
RESULTS
Three hundred fifteen lung cancer patients who predominantly received nivolumab (76.5%) or pembrolizumab (22%) were included. The incidence of ICI-P was 9.5%, with a median time to diagnosis of 52.5 days. Most patients with ICI-P had cases of high severity, and eight patients (27%) died with ongoing ICI-P treatment. Development of ICI-P was independently associated with the presence of baseline fibrosis on chest CT scan (adjusted OR [aOR], 6.61; 95% CI, 2.48-17.7), a composite measure of obstructive lung disease (aOR, 2.79; 95% CI, 1.07-7.29), and treatment with pembrolizumab (aOR, 2.57; 95% CI, 1.08-6.11).
INTERPRETATION
In this cohort, ICI-P was more common and severe than previously reported and carried an unexpectedly high mortality rate. Risk for ICI-P was shown to be independently associated with several chronic pulmonary diseases, which may account for the higher incidence of ICI-P in patients with lung cancer.
Topics: Aged; Case-Control Studies; Female; Humans; Immune Checkpoint Inhibitors; Incidence; Lung Neoplasms; Male; Middle Aged; North Carolina; Pneumonia; Retrospective Studies; Risk Factors; Spirometry
PubMed: 33621599
DOI: 10.1016/j.chest.2021.02.032 -
Journal of the Formosan Medical... May 2007Amiodarone-related pneumonitis is a potentially limiting factor for amiodarone usage. However, it is believed that amiodarone-related pneumonitis is unlikely to occur...
Amiodarone-related pneumonitis is a potentially limiting factor for amiodarone usage. However, it is believed that amiodarone-related pneumonitis is unlikely to occur during low-dose and short courses of therapy. We report three patients who received low-dose amiodarone, 200 mg/day, for an average of 6.6 months and who developed amiodarone-related pneumonitis. All patients were male with age of 75, 93 and 85, respectively, and had the habit of cigarette smoking. The initial presentation was dyspnea without symptoms and signs of heart failure. Their chest radiographs showed diffuse interstitial pneumonitis pattern and chest computed tomography scan also confirmed interstitial pneumonitis. Treatment included cessation of amiodarone and corticosteroid usage. All patients improved symptomatically by early detection and early treatment. This case report implies that old age and possible pre-existing pulmonary abnormalities caused by smoking could be associated with amiodarone-related pulmonary toxicity. Clinicians must remain alert to detect amiodarone-related pneumonitis even under low dosage and short duration of amiodarone usage. Immediate withdrawal of amiodarone and prompt steroid therapy will ensure full recovery.
Topics: Age Factors; Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Glucocorticoids; Humans; Male; Pneumonia; Prednisolone; Smoking
PubMed: 17561478
DOI: 10.1016/S0929-6646(09)60328-4 -
Current Opinion in Pulmonary Medicine Sep 2022Immune checkpoint inhibitors (ICIs) have rapidly become a mainstay of cancer treatment. However, immune modulation resulting from checkpoint inhibition can cause... (Review)
Review
PURPOSE OF REVIEW
Immune checkpoint inhibitors (ICIs) have rapidly become a mainstay of cancer treatment. However, immune modulation resulting from checkpoint inhibition can cause inflammation in any organ system, with pneumonitis being one of the most severe immune-related adverse events (irAEs). Here, we review the most recent literature on pulmonary adverse events following ICIs.
RECENT FINDINGS
Several systematic reviews and meta-analyses of data from trials of antiprogrammed death-1 (PD-1; nivolumab, pembrolizumab), anti-PD-ligand-1 (PD-L1; atezolizumab, avelumab, durvalumab) and anticytotoxic T lymphocyte antigen-4 (CTLA-4; ipilimumab or tremelimumab) in patients with advanced cancer have explored the relative risk and incidence of lung toxicity among different tumor types and therapeutic regimens. They have showed that the incidence of all-grade (1-4) and high-grade (3-4) pneumonitis is significantly higher in nonsmall cell lung cancer (NSCLC) compared with other tumor types. In addition, they have demonstrated that immunotherapy, especially monoimmunotherapy, has a significantly lower risk of irAEs compared to immune-chemotherapy. Treatment for lung cancer, preexisting interstitial lung disease, smoking history and male sex appear to increase the risk for ICI-related pneumonitis.
SUMMARY
Lung toxicity is an uncommon but potentially severe and even fatal complication of ICIs. Timely recognition is critically important but challenging, particularly in patients with lung cancer wherein drug toxicity can mimic disease progression or recurrence.
Topics: Antineoplastic Agents, Immunological; Carcinoma, Non-Small-Cell Lung; Drug-Related Side Effects and Adverse Reactions; Humans; Immune Checkpoint Inhibitors; Lung; Lung Neoplasms; Male; Pneumonia
PubMed: 35838354
DOI: 10.1097/MCP.0000000000000895 -
Human Genetics Jun 2020Influenza viruses infect millions of people around the globe annually, usually causing self-limited upper respiratory tract infections. However, a small but... (Review)
Review
Influenza viruses infect millions of people around the globe annually, usually causing self-limited upper respiratory tract infections. However, a small but non-negligible proportion of patients suffer from life-threatening pulmonary disease. Those affected include otherwise healthy individuals, and children with primary infections in particular. Much effort has been devoted to virological studies of influenza and vaccine development. By contrast, the enormous interindividual variability in susceptibility to influenza has received very little attention. One interesting hypothesis is that interindividual variability is driven largely by the genetic makeup of the infected patients. Unbiased genomic approaches have been used to search for genetic lesions in children with life-threatening pulmonary influenza. Four monogenic causes of severe influenza pneumonitis-deficiencies of GATA2, IRF7, IRF9, and TLR3-have provided evidence that severe influenza pneumonitis can be genetic and often in patients with no other severe infections. These deficiencies highlight the importance of human type I and III IFN-mediated immunity for host defense against influenza. Clinical penetrance is incomplete, and the underlying mechanisms are not yet understood. However, human genetic studies have clearly revealed that seemingly sporadic and isolated life-threatening influenza pneumonitis in otherwise healthy individuals can be genetic.
Topics: Disease Susceptibility; Human Genetics; Humans; Influenza, Human; Orthomyxoviridae; Pneumonia
PubMed: 32025908
DOI: 10.1007/s00439-019-02108-3 -
BMJ Case Reports Oct 2020We present a case of azacitidine-induced pneumonitis which is a rare adverse drug reaction and reported in less than 0.1% of cases. Common side effects of azacitidine... (Review)
Review
We present a case of azacitidine-induced pneumonitis which is a rare adverse drug reaction and reported in less than 0.1% of cases. Common side effects of azacitidine are weakness, nausea, vomiting, constipation, injection site reactions, insomnia, among others. Our patient received azacitidine to treat her acute myeloid leukaemia and began to develop shortness of breath which progressed to dyspnoea at rest after completing a 7-day course of azacitidine and venetoclax. Initial chest X-ray revealed severe airspace disease for which the patient began receiving broad spectrum antibiotics, antifungals and antivirals therapy. Although infectious workup revealed invasive aspergillosis she did not clinically and radiologically improve despite being on isavuconazole until high-dose glucocorticoids were initiated. This case illustrates the importance of recognising and understanding the potential side effects of azacitidine and other chemotherapy agents as some adverse drug reactions can be life-threatening.
Topics: Aged; Azacitidine; Enzyme Inhibitors; Female; Humans; Invasive Fungal Infections; Lung; Pneumonia; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 33122228
DOI: 10.1136/bcr-2020-236349 -
Ugeskrift For Laeger Dec 2016A 28-year-old woman diagnosed with schizophrenia was admitted to hospital due to progressing dyspnoea for months. At admission, she was oxygen-dependent, and a...
A 28-year-old woman diagnosed with schizophrenia was admitted to hospital due to progressing dyspnoea for months. At admission, she was oxygen-dependent, and a high-resolution computed tomography revealed ground glass opacities. She had no obvious exposures besides having been treated with lamotrigine for several years. A psychiatrist doubted the diagnosis, and the lamotrigine treatment was tapered. After some months, she became clinically stable without further need of oxygen. Lamotrigine can cause pneumonitis, and this side effect should be suspected in patients who are being treated with lamotrigine and presenting with progressive dyspnoea. Crucial treatment is to remove the exposure.
Topics: Adult; Anticonvulsants; Female; Forced Expiratory Volume; Humans; Lamotrigine; Pneumonia; Schizophrenia; Tomography, X-Ray Computed; Triazines
PubMed: 27966426
DOI: No ID Found -
Revue Des Maladies Respiratoires May 2014Hydroxyurea is an antimetabolite drug used in the treatment of myeloproliferative disorders. Common adverse effects include haematological, gastrointestinal cutaneous...
INTRODUCTION
Hydroxyurea is an antimetabolite drug used in the treatment of myeloproliferative disorders. Common adverse effects include haematological, gastrointestinal cutaneous manifestations, and fever. Hydroxyurea-induced pneumonitis is unusual.
CASE REPORT
A female patient was treated with hydroxyurea for polycythemia vera. She was admitted 20 days after commencing treatment with a high fever, productive cough, clear sputum and nausea. A chest CT-scan showed diffuse ground-glass opacities. Microbiological investigations were negative. The symptoms disappeared a few days after discontinuation of the drug and rechallenge led to a relapse of symptoms.
CONCLUSION
Our case and 15 earlier cases of hydroxyurea-induced pneumonitis are reviewed. Two patterns of this disease may exist: an acute febrile form occurring within 1 month of introduction of hydroxyurea and a subacute form without fever. Even if uncommon, one should be aware of this complication of hydroxyurea.
Topics: Aged; Antineoplastic Agents; Female; Humans; Hydroxyurea; Lymphoproliferative Disorders; Pneumonia; Stroke
PubMed: 24878159
DOI: 10.1016/j.rmr.2013.09.001