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Interstitial lung disease during targeted therapy in metastatic renal cell carcinoma: a case series from three
Philipp Ivanyi1, Thomas Fuehner, Meike Adam
1Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School Hannover, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
Abstract:
Interstitial lung disease (ILD) is an adverse event which occurs also during targeted treatment of patients with metastatic renal cell carcinoma (mRCC). Experiences on ILD-management in mRCC remain limited. mRCC patients treated with everolimus, temsirolimus, or sunitinib at three centres from January 2006 until December 2009 were analysed, retrospectively. Medical records and imaging studies, as well as clinical course, the incidence, diagnostic measures, treatment, and outcome of ILD were assessed. Twenty-six ILD patients (11 %) were identified out of 237 mRCC patients. Median treatment until ILD-diagnosis was 3.8 (range: 1-21.5) months. The ILD-frequency was 2.7 % (n = 6/226) during sunitinib therapy and 19.8 % (n = 20/101) during m-TOR-inhibitor treatment. Cough was the prevailing symptom (69.2 %, n = 18). Bronchoalveolar lavage reviled often lymphocytic (42.9 %, n = 6/14) or eosinophilic cellularity (28.6 %, n = 4/14). Dose reduction (42.3 %, n = 11), treatment interruption (46.2 %, n = 12) or termination (23.1 %, n = 6), and steroid application (34.6 %, n = 9) were common measures in ILD. Interestingly, eosinophilic ILD required pulsed steroids. Improvement occurred in 73.7 % of symptomatic patients. Continuation of targeted therapies was warranted in 65.4 % of ILD patients. No patient died from ILD. ILD during targeted mRCC treatment is common, and supportive measures should be adapted to the clinical course, and potentially in dependence of BAL findings. Re-exposure to targeted therapies appears feasible.
Insights
Interstitial lung disease (ILD) is a common adverse event in metastatic renal cell carcinoma (mRCC) patients undergoing targeted therapy. Management strategies, including dose adjustments and steroids, are effective, allowing continued treatment in most cases.
Area of Science:
- Oncology
- Pulmonology
- Pharmacology
Background:
- Interstitial lung disease (ILD) is a known adverse event during targeted therapy for metastatic renal cell carcinoma (mRCC).
- Limited data exists on the management and outcomes of ILD in mRCC patients.
Purpose of the Study:
- To investigate the incidence, clinical presentation, management, and outcomes of ILD in mRCC patients treated with targeted therapies.
- To assess the feasibility of continuing targeted therapies after ILD diagnosis.
Main Methods:
- Retrospective analysis of mRCC patients treated with everolimus, temsirolimus, or sunitinib from 2006-2009.
- Assessment of medical records, imaging, clinical course, ILD incidence, diagnostics, treatment, and outcomes.
- Bronchoalveolar lavage (BAL) findings were analyzed for cellularity.
Main Results:
- 26 out of 237 mRCC patients (11%) developed ILD.
- ILD incidence was higher with mTOR inhibitors (19.8%) than sunitinib (2.7%).
- Cough was the most common symptom; BAL revealed lymphocytic or eosinophilic patterns. Management included dose reduction, interruption, or steroids, with improvement in 73.7% of symptomatic patients. Continuation of targeted therapy was possible in 65.4% of patients, and no deaths from ILD occurred.
Conclusions:
- ILD is a frequent complication of targeted therapy in mRCC.
- Supportive measures, potentially guided by BAL findings, are crucial for ILD management.
- Re-challenge with targeted therapies appears feasible and safe in mRCC patients who develop ILD.
