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Chest CT Diagnosis and Clinical Management of Drug-related Pneumonitis in Patients Receiving Molecular Targeting Agents and Immune Checkpoint Inhibitors: A Position Paper from the Fleischner Society.

Publication ,  Journal Article
Johkoh, T; Lee, KS; Nishino, M; Travis, WD; Ryu, JH; Lee, HY; Ryerson, CJ; Franquet, T; Bankier, AA; Brown, KK; Goo, JM; Kauczor, H-U ...
Published in: Radiology
March 2021

Use of molecular targeting agents and immune checkpoint inhibitors (ICIs) has increased the frequency and broadened the spectrum of lung toxicity, particularly in patients with cancer. The diagnosis of drug-related pneumonitis (DRP) is usually achieved by excluding other potential known causes. Awareness of the incidence and risk factors for DRP is becoming increasingly important. The severity of symptoms associated with DRP may range from mild or none to life-threatening with rapid progression to death. Imaging features of DRP should be assessed in consideration of the distribution of lung parenchymal abnormalities (radiologic pattern approach). The CT patterns reflect acute (diffuse alveolar damage) interstitial pneumonia and transient (simple pulmonary eosinophilia) lung abnormality, subacute interstitial disease (organizing pneumonia and hypersensitivity pneumonitis), and chronic interstitial disease (nonspecific interstitial pneumonia). A single drug can be associated with multiple radiologic patterns. Treatment of a patient suspected of having DRP generally consists of drug discontinuation, immunosuppressive therapy, or both, along with supportive measures eventually including supplemental oxygen and intensive care. In this position paper, the authors provide diagnostic criteria and management recommendations for DRP that should be of interest to radiologists, clinicians, clinical trialists, and trial sponsors, among others. This article is a simultaneous joint publication in Radiology and CHEST. The articles are identical except for stylistic changes in keeping with each journal's style. Either version may be used in citing this article. Published under a CC BY 4.0 license. Online supplemental material is available for this article.

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Published In

Radiology

DOI

EISSN

1527-1315

Publication Date

March 2021

Volume

298

Issue

3

Start / End Page

550 / 566

Location

United States

Related Subject Headings

  • Nuclear Medicine & Medical Imaging
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Johkoh, T., Lee, K. S., Nishino, M., Travis, W. D., Ryu, J. H., Lee, H. Y., … Hatabu, H. (2021). Chest CT Diagnosis and Clinical Management of Drug-related Pneumonitis in Patients Receiving Molecular Targeting Agents and Immune Checkpoint Inhibitors: A Position Paper from the Fleischner Society. Radiology, 298(3), 550–566. https://doi.org/10.1148/radiol.2021203427
Johkoh, Takeshi, Kyung Soo Lee, Mizuki Nishino, William D. Travis, Jay H. Ryu, Ho Yun Lee, Christopher J. Ryerson, et al. “Chest CT Diagnosis and Clinical Management of Drug-related Pneumonitis in Patients Receiving Molecular Targeting Agents and Immune Checkpoint Inhibitors: A Position Paper from the Fleischner Society.Radiology 298, no. 3 (March 2021): 550–66. https://doi.org/10.1148/radiol.2021203427.
Johkoh T, Lee KS, Nishino M, Travis WD, Ryu JH, Lee HY, Ryerson CJ, Franquet T, Bankier AA, Brown KK, Goo JM, Kauczor H-U, Lynch DA, Nicholson AG, Richeldi L, Schaefer-Prokop CM, Verschakelen J, Raoof S, Rubin GD, Powell C, Inoue Y, Hatabu H. Chest CT Diagnosis and Clinical Management of Drug-related Pneumonitis in Patients Receiving Molecular Targeting Agents and Immune Checkpoint Inhibitors: A Position Paper from the Fleischner Society. Radiology. 2021 Mar;298(3):550–566.

Published In

Radiology

DOI

EISSN

1527-1315

Publication Date

March 2021

Volume

298

Issue

3

Start / End Page

550 / 566

Location

United States

Related Subject Headings

  • Nuclear Medicine & Medical Imaging
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences