Chemotherapy for patients with cancer and pulmonary comorbidities

Abstract

Surgery and radiation to the lung, and chemotherapy of cytotoxic, molecular targeted agents and immune check point inhibitors (ICI) sometimes cause acute lung injury with high lethality rate. The risk factors for it include existing lung lesions, and interstitial lung diseases (ILD), including idiopathic pulmonary fibrosis (IPF), are especially important. The prediction of the occurrence, however, is difficult because ILD factors and agents at high risk are not fully understood. Anti-fibrotic agents, pirfenidone and nintedanib, are under investigation for their efficacy in reducing the occurrence of chemotherapy- induced acute exacerbation of IPF. Besides, mechanisms underlying lung injury may be different among cytotoxic, molecular targeted agents and ICI. For example, lung injury with mTOR inhibitors usually is not so serious that the agents can be continued. Cases of acute onset of tuberculosis and non-tuberculous mycobacteriosis during the use of ICI are reported, and speculated mechanisms for them includes IRIS (immune reconstitution inflammatory syndrome). On such cases, risk evaluation prior to therapy, close monitoring and prompt differential diagnosis followed by adequate treatment surely ameliorate the situation. The problems and possible solutions will be discussed.