Drug-induced interstitial lung disease in lung cancer patients

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 pulmonary AE but can be life-threatening. The presentation of D-ILD is variable and nonspecific, both from a clinical and radiologic point of view. Good management of D-ILD therefore requires a high level of suspicion, which should be established through education of both patients and clinicians. Upon suspicion, clinicians should promptly evaluate lung cancer patients with new respiratory complaints and/or new radiographic abnormalities for the presence of D-ILD. The differential diagnosis is, however, broad, encompassing infectious and non-infectious causes. Clinical, laboratory, microbial and imaging findings should be incorporated to adjudicate the possibility of D-ILD. In the absence of a conclusive diagnostic test, D-ILD is a challenging 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. Incidence under current standard systemic treatments for lung cancer, risk factors, clinical and radiographic presentations, and management of D-ILD will be discussed in this review. In addition, a practical framework of differential diagnosis is provided.