[Management of side effects of targeted therapies in renal cancer: pulmonary side effects]

Several types of pulmonary complications can occur during treatment with targeted therapies: haemoptysis; cough; dyspnoea; pleural effusions, etc. Only bevacizumab seems to be associated with an increased risk of haemoptysis, but this risk is low (less than 2% for haemoptysis greater or equal to grade 3). There are no validated predictive criteria for haemoptysis with bevacizumab in pulmonary metastases of renal cancer. In cases of haemoptysis, its severity must be evaluated and appropriate examinations used to determine its cause. Administration of an mTOR inhibitor, in particular everolimus, is associated with the occurrence of both asymptomatic and potentially life-threatening pneumopathies. In cases of respiratory symptoms with normal chest radiography, a chest CT scan must be carried out, due to its superior sensitivity and specificity in the diagnosis of pneumopathies with everolimus. In cases of pneumopathies with mTOR inhibitors, specialist advice (pulmonologist) is recommended. A bronchoscopy with lavage must be discussed if an opportunistic infection is suspected. A temporary stop to mTOR inhibitor, dose reduction and treatment with corticosteroids are discussed depending on the symptoms.