Yale School of Medicine’s Jennifer Possick, MD, and Kathleen McAvoy, MD, have published new research that aims to help clinicians better understand and recognize pneumonitis before it escalates. The paper, “Update on Drug-Induced Pneumonitis in Lung Cancer,” appears in Seminars in Respiratory and Critical Care Medicine.
According to a university press release, advances in lung cancer treatment have come a long way to improve outcomes and survival rates. Targeted drugs, immunotherapies and emerging antibody-drug conjugates are helping many patients live longer and healthier. However, the advancement carries risks, including drug-induced pneumonitis — an inflammatory reaction in the lungs that ranges from mild to life-threatening — that the researchers frequently observe in patients.
Jennifer Possick, MDYale School of Medicine
Many drugs used to treat lung cancer can trigger lung inflammation, including epidermal growth factor receptor (EGFR) inhibitors, anaplastic lymphoma kinase (ALK) inhibitors, immune checkpoint inhibitors and several antibody-drug conjugates. Patients who have underlying lung disease or prior radiation are at an increased risk of developing pneumonitis, though even people without those factors can develop drug reactions.
“Some people with serious underlying lung disease can receive treatment safely and benefit tremendously,” Dr. Possick said. “The challenge is that we do not yet have a reliable way to predict who will do well and who might have a dangerous reaction.”
Identifying pneumonitis requires teamwork, with pulmonologists, radiologists, oncologists and pharmacists all playing a role to piece together the clinical picture, she said.
“We’re not on one side and the oncologist is on the other with the patient stuck in the middle. We’re holding hands around the patient to figure out the safest way forward,” Dr. Possick said.
Kathleen McAvoy, MDYale School of Medicine
“It’s very grassroots right now. There is no single test that tells us who is at risk,” said Dr. McAvoy.
Until that’s available, the duo said the most powerful tool is awareness among clinicians and patients to recognize small signs or shifts that serve as a flag for further evaluation.
“If someone tells us their cough seems different than usual or they cannot walk as far as last week, those clues can matter more than anything else,” Dr. Possick said.
She and Dr. McAvoy also said they hope their recently published research helps guide clinicians and benefit patients.
“The review draws attention and provides comprehensive information to a phenomenon that is rising in importance but is still not fully understood and definitely requires much more research,” said Naftali Kaminski, MD, who is the Boehringer Ingelheim Pharmaceuticals, Inc. Professor of Medicine and section chief of Yale-PCCSM.
