Li Xiao, Gu Yong-Li, Liu Xu-Chao, Sun Zeng-Xian, Sun Ying
Department of Pharmacy, The First People's Hospital of Lianyungang, Lianyungang, China.
Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, China.
Front Pharmacol. 2023 Aug 28;14:1218480. doi: 10.3389/fphar.2023.1218480. eCollection 2023.
To summarize the situation of antineoplastic agents-induced interstitial lung diseases (ILD), provide reference for strengthening clinical management of druginduced interstitial lung diseases (DILD). We retrospectively investigated the medical records of 12 patients with antineoplastic agents-induced ILD in a hospital between January and December 2020. Data collected included patients' characteristic (gender, age, ECOG PS score, smoking history, primary tumor, concurrent diseases or complications.) and treatment conditions (DILD-causing drugs, clinical symptoms, chest CT, DILD treatment drugs, onset cycle, onset time, severity of DILD, DILD course and prognosis.). The median age of 12 DILD cases was 68%, 66.67% of the patients were male, lung cancer accounted for 58.33% (7/12). DILD was induced by cytotoxicity drugs, targeted drugs and immune checkpoint inhibitors (ICIs), of which ICIs accounted for 66.67% (8/12). Scattered patchy, cord-like, grid-like or flocculent shadows were observed on chest CT, mainly under the pleura of lungs. Once DILD occurs, the suspected antineoplastic agents were stopped and glucocorticoid was given, among which 83.33% (10/12) patients were treated with antibiotics. Finally, 16.67% (2/12) were cured, 33.33% (4/12) were improved, 16.67% (2/12) were not cured and 33.33% (4/12) were dead. Antineoplastic agents-induced ILD is mostly found in elderly male lung cancer patients with smoking history. The clinical symptoms of DILD are diverse and lack of specificity. ICIs-ILD has the characteristic of high incidence and poor prognosis compared with other antineoplastic agents. Comprehensive evaluation before medication, regular review, early and adequate glucocorticoid shock therapy after onset can improve the prognosis of DILD patients.
总结抗肿瘤药物所致间质性肺疾病(ILD)的情况,为加强药物性间质性肺疾病(DILD)的临床管理提供参考。我们回顾性调查了2020年1月至12月某医院12例抗肿瘤药物所致ILD患者的病历。收集的数据包括患者特征(性别、年龄、东部肿瘤协作组体能状态评分、吸烟史、原发肿瘤、合并疾病或并发症)和治疗情况(导致DILD的药物、临床症状、胸部CT、DILD治疗药物、发病周期、发病时间、DILD严重程度、DILD病程及预后)。12例DILD病例的中位年龄为68岁,66.67%的患者为男性,肺癌占58.33%(7/12)。DILD由细胞毒性药物、靶向药物和免疫检查点抑制剂(ICI)引起,其中ICI占66.67%(8/12)。胸部CT可见散在斑片状、条索状、网格状或絮状阴影,主要位于肺胸膜下。一旦发生DILD,停用可疑抗肿瘤药物并给予糖皮质激素,其中83.33%(10/12)的患者接受了抗生素治疗。最终,16.67%(2/12)治愈,33.33%(4/12)好转,16.67%(2/12)未治愈,33.33%(4/12)死亡。抗肿瘤药物所致ILD多见于有吸烟史的老年男性肺癌患者。DILD的临床症状多样且缺乏特异性。与其他抗肿瘤药物相比,ICI-ILD具有发病率高、预后差的特点。用药前综合评估、定期复查、发病后早期足量糖皮质激素冲击治疗可改善DILD患者的预后。