Pulmonary toxicity of antineoplastic drugs

Drug-induced pulmonary disease is an infrequent, but clinically significant, toxic manifestation of antineoplastic drug therapy. Pulmonary toxicity has been associated primarily with bleomycin therapy but also has been described with busulfan, cyclophosphamide, methotrexate, and the nitrosoureas. Cytotoxic drug-induced pulmonary disease is characterized by an insidious and nonspecific presentation. The common pathologic process of a fibrosing alveolitis follows a variety of toxic mechanisms associated with the chemotherapeutic agents. The importance of close clinical monitoring is emphasized by the necessity for early withdrawal of the drug in order to halt or reverse potentially lethal pulmonary disease. At the same time, the nonspecific nature of the lung disease and the multitude of potential insults to the lung in a cancer patient make an early aggressive evaluation mandatory. A lung biopsy is almost always indicated.