Download Pulmonary Toxicity of Chemotheraputics

Pulmonary Toxicity of Chemotheraputics
30/4/11
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GENERAL PRINCIPLES
1. rule out pulmonary oedema from congestive cardiac failure
2. rule out lung infection (normal and opportunistic organisms)
3. rule out lung infiltration by cancer cells
4. determine time from chemotherapy to onset of respiratory symptoms -> compare with
literature -> rechallenge.
5. check clinical manifestations and laboratory test abnormalities consistent with lung toxicity
induced by suspected drug.
6. determine whether symptoms resolve after the drug is stopped and steroids are given.
SPECIFICS
Bleomycin
- 3-40% of patients
- pneumonitis with diffuse pulmonary infiltrates and fibrosis
- risk factors:
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higher cumulative bleomycin dose
renal failure
> 70 years
smoker
radiation to chest
high O2 concentrations
G-CSF
administration of other chemotherapeutics with lung toxicity
Methotrexate
- acute/subacute pneumonitis simulating infection
ATRA Lung
- All Trans-Retinoic Acid – helps differentiate APL blasts and improve remission and relapse
rates
- occurs day 2-21 days into treatment
- features: fever, leukocytosis, SOB, weight gain, pleural effusions, infiltrates
Other
- fludarabine
- gemcitabine
Jeremy Fernando (2011)
- cytarabine
- cyclophosphamide
Jeremy Fernando (2011)