Lung disease from chemotherapy – am I at risk?

This study looked at whether certain risk factors could identify patients who may experience severe lung disease from the chemotherapy used to treat their lung cancer.

Interstitial lung disease (ILD) is a scarring of the lung tissue, which makes it hard to breathe. Some patients who already have ILD are at risk for drug induced interstitial lung disease (DILD). DILD can be a side effect of chemotherapy for lung cancer. This means that lung cancer patients are at higher risk of developing DILD.

By identifying risk factors for developing DILD, treatments can be tailored and chemotherapy avoided in these patients if necessary.

This study examined the records of 459 Japanese patients with lung cancer to determine risk factors for developing DILD. These patients were treated with chemotherapy. Over 80% of patients were current or former smokers.

62.5% of patients for ILD before the start of chemotherapy. 17.1% of these patients had ILD. These patients were given chemotherapy less frequently.

7.2% of patients developed chemotherapy-induced DILD. Of these patients, 36.4% had squamous cell carcinoma and 33.3% had pre-existing ILD. Patients with squamous cell carcinoma were over twice as likely to get DILD. Patients with pre-existing ILD were 5 times more likely to develop DILD.

94.3% of the patients had shortness of breath before their DILD began. Almost 6% of patients experienced no symptoms at all.

While DILD was associated with treatments such as gefitinib (Iressa, an EGFR-TK inhibitor) and the chemotherapies paclitaxel (Abraxane) and vinorelbine (Navelbine), only one, pemetrexed (Alimta) was not linked to it. Patients using EGFR–TK inhibitors (such as etuximab [Erbitux], erlotinib [Tarceva]) were 7.7 times more likely to experience early death after DILD. Patients who underwent 2 or more chemotherapy regimens were 6 times more likely to develop severe DILD.

This study concluded that preexisting ILD increased the risk of developing DILD. In addition, EGFR-TK inhibitor use and having 2 or more prior chemotherapy regimens are associated with a poorer prognosis. The authors suggest that the risk of DILD should be explained to patients in these groups.

This study was based in Japan. Results for non-Japanese patients were not available and the authors note that ILD may be more common in Japanese patients than in other ethnicities.

This was a retrospective study, based on the review of medical records.

Please discuss the risks of DILD with your doctor.