Pulmonary toxicities from targeted therapies: a review

Abstract

Pulmonary toxicity is rarely seen with most commonly used targeted therapies. The endothelial growth factor receptor (EGFR) small-molecule tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib can cause interstitial lung disease (ILD). BCR-ABL tyrosine kinase inhibitors imatinib and dasatinib can cause pleural effusions. Infusion-related bronchospasm is common with the monoclonal antibodies to EGFR cetuximab and panitumumab, and case reports of bronchiolitis and pulmonary fibrosis have been described. Up to one-sixth of patients taking mammalian target of rapamycin (mTOR) inhibitors get a reversible interstitial pneumonitis. Bevacizumab, the monoclonal antibody to vascular endothelial growth factor (VEGF), has been associated with hemoptysis and pulmonary embolism particularly in patients with squamous cell lung cancer. Infusion-related bronchospasms, acute respiratory distress syndrome (ARDS), and interstitial pneumonitis can be seen with the anti-lymphocyte monoclonal antibodies rituximab, ofatumumab, and alemtuzumab. While most pulmonary toxicities from these therapies are mild and resolve promptly with dose reduction or discontinuation, it is important for the clinician to recognize these potential toxicities when faced with treatment-related complications. Discerning these pulmonary adverse effects may help in making decisions on diagnostic testing and therapy, particularly for those with pulmonary and cardiovascular co-morbidities.

Toxicité pulmonaire des médicaments : ce que le réanimateur doit connaître ?

“…Pour les thérapies ciblées, le gefitinib agirait sur des mécanismes de régénération (réparation) de l'épithélium alvéolaire favorisant la survenue de PM [14,28], le dasatinib ciblerait la voie du PDGF (Platelet Derived Growth Factor) favorisant la survenue d'une hypertension artérielle pulmonaire [10,11]. La toxicité des inhibiteurs des points de contrôle immunitaire résulte possiblement d'une réaction exagérée de l'auto-immunité.…”

“…• la liste des médicaments susceptibles de se compliquer d'IRAM s'étoffe régulièrement (Tableaux 1-3) [3,[10][11][12][13][14][15]. Mais tous les médicaments ne sont pas responsables d'IRA avec la même fréquence ;…”

Effect and molecular mechanism of mTOR inhibitor rapamycin on temozolomide‑induced autophagic death of U251 glioma cells

“…In addition, RAPA is used to prevent rejection following organ transplantation, with few side effects. In previous studies, RAPA demonstrated antitumor activity, in addition to specific autophagy inhibition (12)(13)(14). The present study aimed to investigate the combined biological effect of TMZ and RAPA on the proliferation, survival, apoptosis, cell cycle distribution and autophagy of cerebral glioma cells, and the underlying molecular mechanisms involved, in order to develop more effective treatments for patients with glioma.…”

Lung cancer and intensive care: which patient how long?

“…Akciğer kanseri tedavisi için güncel algoritmaların kullanılması, agresif cerrahi yöntemler, kemoterapi ve radyoterapi modalitelerinin birlikte kullanımıyla cerrahi için uygun olmayan hastalarda dahi 5 yıllık sağkalım %16'ya ulaşmıştır (5,6). Bu durum; gerek hastalığın kendine, gerekse radyasyon terapisi, tirozin kinaz inhibitörleri gibi tedavilerle ilişkili komplikasyonlara ve komorbiditelere bağlı durumların daha sık karşımıza çıkmasına neden olmuştur (7,8). Başta akut solunum yetmezliği olmak üzere bu hasta grubunun yoğun bakım ihtiyacı ve yoğun bakım ünitelerine (YBÜ) kabulü artmıştır (9).…”