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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: Chest
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.

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Published In

Chest

DOI

EISSN

1931-3543

Publication Date

March 2021

Volume

159

Issue

3

Start / End Page

1107 / 1125

Location

United States

Related Subject Headings

  • Risk Adjustment
  • Respiratory System
  • Patient Care Management
  • Neoplasms
  • Molecular Targeted Therapy
  • Lung
  • Immune Checkpoint Inhibitors
  • Humans
  • Drug-Related Side Effects and Adverse Reactions
  • Alveolitis, Extrinsic Allergic
 

Citation

APA
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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. Chest, 159(3), 1107–1125. https://doi.org/10.1016/j.chest.2020.11.027
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.Chest 159, no. 3 (March 2021): 1107–25. https://doi.org/10.1016/j.chest.2020.11.027.
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. Chest. 2021 Mar;159(3):1107–1125.

Published In

Chest

DOI

EISSN

1931-3543

Publication Date

March 2021

Volume

159

Issue

3

Start / End Page

1107 / 1125

Location

United States

Related Subject Headings

  • Risk Adjustment
  • Respiratory System
  • Patient Care Management
  • Neoplasms
  • Molecular Targeted Therapy
  • Lung
  • Immune Checkpoint Inhibitors
  • Humans
  • Drug-Related Side Effects and Adverse Reactions
  • Alveolitis, Extrinsic Allergic