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Interstitial Lung Disease in Lung Cancer

Separating Disease Progression from Treatment Effects

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Abstract

Lung cancer often develops in individuals with pre-existing pulmonary and cardiac pathology. Many of these individuals with pre-existing pathology are also at risk of occupational lung disease. New and worsening symptoms can be secondary to pre-existing pathology, progressive cancer or treatment. Pulmonary toxicity, including interstitial lung disease, following radiotherapy and conventional cytotoxic chemotherapy (e.g. cyclophosphamide, bleomycin), has been recognised for many years. Pulmonary toxicity also occurs with the newer classes of cytotoxic agents, including the deoxycytidine analogue gemcitabine. A small percentage (0.88%) of patients treated with the epidermal growth factor receptor tyrosine kinase inhibitor gefitinib have developed interstitial lung disease. This complication has been reported at a higher frequency in Japanese patients than in US patients (1.9% vs 0.34%, respectively) and in those with pre-existing pulmonary fibrosis. This review discusses the difficulties in both recognition and treatment of gefitinib-associated interstitial lung disease. Symptoms are vague, such as dyspnoea, cough and fever and can be difficult to differentiate from progressive disease, co-existing morbidity and new pulmonary pathology. Diagnosis is, therefore, by rigorous investigation to exclude all other differential diagnoses. Treatment, at present, is supportive and includes discontinuation of gefitinib, oxygen supplementation, high-dose corticosteroids and antibacterials.

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The authors have no conflicts of interest that are directly relevant to the content of this study. No sources of funding were used to assist in the preparation of this study.

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  1. Department of Medical Oncology, Christie Hospital NHS Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK

    Sarah Danson, Fiona Blackhall & Malcolm Ranson

  2. Department of Radiology, Christie Hospital NHS Trust, Withington, Manchester, UK

    Paul Hulse

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  1. Sarah Danson
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Correspondence to Sarah Danson.

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Danson, S., Blackhall, F., Hulse, P. et al. Interstitial Lung Disease in Lung Cancer. Drug-Safety 28, 103–113 (2005). https://doi.org/10.2165/00002018-200528020-00002

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