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Management of pulmonary toxicity associated with targeted anticancer therapies
Laure-Anne Teuwen1, Tom Van den Mooter2, Luc Dirix3
1a 1 Sint-Augustinus, Resident in Internal Medicine , Oosterveldlaan 24, 2610 Wilrijk-Antwerp, Belgium.
Introduction:
Targeted anticancer therapies act by interfering with defined molecular entities and/or biologic pathways. Because of their more specific mechanism of action, adverse events (AEs) on healthy tissues are intended to be minimal, resulting in a different toxicity profile from that observed with conventional cytotoxic chemotherapy. Pulmonary AEs are rare but potentially life-threatening and it is, therefore, critical to recognize early on and manage appropriately.
Areas Covered:
In this review, we aim to offer an overview of both more frequent and rare pulmonary AEs caused by targeted anticancer therapies and discuss possible treatment algorithms. Anti-vascular endothelial growth factor, anti-human epidermal growth factor receptor and anti-CD20 therapy will be reviewed, as well as immune checkpoint inhibitors, anaplastic lymphoma kinase inhibitors and mammalian target of rapamycin inhibitors.
Expert Opinion:
Novel agents used in the treatment of cancer have specific side-effects, the result of allergic reactions, on-target and off-target effects. Clinical syndromes associated with pulmonary toxicity vary from bronchospasms, hypersensitivity reactions, pneumonitis, acute respiratory distress, lung bleeding, pleural effusion to pneumothorax. Knowledge of risk factors, a high index of suspicion and a complete diagnostic work-up are essential for limiting the risk of these events becoming life threatening. The development of treatment algorithms is extremely helpful in managing these events. It is probable that these toxicities will be even more frequent with the introduction of combination therapies with the obvious challenge of discerning the responsible agent.
Insights
Targeted anticancer therapies can cause rare but serious lung side effects. Early recognition and management are crucial for patient safety and effective treatment outcomes.
Area of Science:
- Oncology
- Pulmonology
- Pharmacology
Background:
- Targeted anticancer therapies offer specific mechanisms of action with potentially reduced toxicity to healthy tissues compared to traditional chemotherapy.
- However, these novel agents can cause rare, yet life-threatening, pulmonary adverse events (AEs) that require prompt recognition and management.
- Understanding the unique toxicity profiles of these therapies is critical for patient safety.
Purpose of the Study:
- To provide a comprehensive overview of frequent and rare pulmonary adverse events associated with targeted anticancer therapies.
- To discuss potential treatment algorithms for managing these pulmonary toxicities.
- To review specific targeted therapies including anti-VEGF, anti-EGFR, anti-CD20, immune checkpoint inhibitors, ALK inhibitors, and mTOR inhibitors.
Main Methods:
- Systematic review of literature on pulmonary adverse events from targeted anticancer therapies.
- Analysis of clinical syndromes associated with pulmonary toxicity, including bronchospasms, pneumonitis, and lung bleeding.
- Discussion of diagnostic work-up, risk factors, and management strategies.
Main Results:
- Pulmonary toxicities manifest in various clinical syndromes, such as hypersensitivity reactions, pneumonitis, acute respiratory distress, and pneumothorax.
- Effective management relies on recognizing risk factors, maintaining a high index of suspicion, and conducting thorough diagnostic evaluations.
- Treatment algorithms are essential for guiding the appropriate care of patients experiencing these AEs.
Conclusions:
- Novel cancer agents can induce specific pulmonary side effects through on-target, off-target, or allergic mechanisms.
- Early identification and a systematic approach to management are vital to mitigate the life-threatening potential of these pulmonary toxicities.
- The increasing use of combination therapies presents challenges in attributing specific AEs to individual agents, necessitating careful clinical assessment.
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