Drug-Induced Interstitial Lung Disease in Lung Cancer Patients

Background: Pulmonary toxicity is a possible adverse event (AE) of all systemic treatments for lung cancer. Drug-induced parenchymal and interstitial lung disease (D-ILD) is a rare but potentially life-threatening pulmonary AE. Its clinical and radiological manifestations are highly variable and nonspecific, making recognition and diagnosis particularly challenging. Summary: Effective management of D-ILD requires a high degree of clinical suspicion, supported by education of both patients and healthcare providers. Any lung cancer patient who develops new respiratory symptoms and/or new radiographic abnormalities should be promptly evaluated for possible D-ILD. However, the differential diagnosis is broad, including both infectious and noninfectious etiologies. Clinical, laboratory, microbial, and imaging findings should be incorporated to adjudicate the possibility of D-ILD. Given the absence of a definitive diagnostic test, D-ILD remains a complex diagnosis of exclusion that benefits from a multidisciplinary approach. Pulmonologists play an active role in an integrated diagnostic work-up and management of D-ILD, and they should therefore remain actively engaged in this clinically relevant subject. Key Messages: This review discusses the incidence, risk factors, clinical and radiographic features, and management strategies for D-ILD in the context of current systemic treatments for lung cancer. A practical framework for differential diagnosis is also provided to support clinical decision-making.