Progress of Anticancer Drug-induced Organizing Pneumonia

doi:10.12114/j.issn.1007-9572.2021.01.035

Abstract

Abstract:

Drug-induced lung injury has received more and more attention. The most common pattern is interstitial lung disease. The diagnosis, treatment and prognosis of drug-induced interstitial lung disease (DIILD) have been explored in many researches. However, there are still many subtypes of DIILD, including usual interstitial pneumonia, non-specific interstitial pneumonia, organizing pneumonia, hypersensitivity pneumonia and diffuse alveolar damage depending on the pathology. Each subtype may be different in treatment and management and further clarification is needed. This paper focused on the common subcategory of organizing pneumonia, naming it as drug-induced organizing pneumonia (DIOP) , explored the most common anticancer drugs, understood the potential mechanism of anticancer drugs to cause OP, and explored the diagnosis, differential diagnosis, treatment and prognosis of DIOP, so as to make a better guide on the diagnosis and treatment of organizing pneumonia induced by anticancer drugs.

Key words: Lung diseases, interstitial, Organizing pneumonia, Antineoplastic agents, Glucocorticoids, Review

摘要：

药物引起的肺损害越来越受到重视，其中最常见的表现是间质性肺疾病（ILD），已有不少研究探讨药物诱导的ILD（DIILD）的诊断、治疗及预后，但DIILD中仍有很多亚型，根据病理不同可分为普通型间质性肺炎、非特异性间质性肺炎、机化性肺炎（OP）、过敏性肺炎、弥漫性肺泡损伤等，每一亚型的治疗和管理策略可能存在差异，需要进一步阐明。本文聚焦于DIILD中较为常见的OP亚类，定义药物诱导的OP（DIOP），对药物中最常见的抗肿瘤药物进行研究，了解抗肿瘤药物潜在的致OP机制，研究DIOP的诊断、鉴别诊断、治疗及预后，旨在更好地指导抗肿瘤药物诱导的OP相关诊疗。

关键词: 肺疾病，间质性, 机化性肺炎, 抗肿瘤药, 糖皮质激素类, 综述

Ting PAN,Tieying SUN. Progress of Anticancer Drug-induced Organizing Pneumonia[J]. Chinese General Practice, 2022, 25(14): 1772-1778. DOI: 10.12114/j.issn.1007-9572.2021.01.035.
潘婷,孙铁英. 抗肿瘤药物诱导的机化性肺炎的研究进展[J]. 中国全科医学, 2022, 25(14): 1772-1778. DOI: 10.12114/j.issn.1007-9572.2021.01.035.

Figures/Tables 8

Table 1 Classification of anticancer drugs inducing organizing pneumonia

	种类	代表药物
传统化疗药物	抗肿瘤抗生素抗代谢药铂类拓扑异构酶抑制剂蛋白酶体抑制剂	博来霉素阿扎胞苷、吉西他滨、地西他滨奥沙利铂伊立替康硼替佐米
分子靶向药物	mTOR抑制剂 TKI抑制剂 EGFR抑制剂 ALK抑制剂抗CD20抑制剂	雷帕霉素、依维莫司西妥昔单抗、吉非替尼克唑替尼、塞来替尼利妥昔单抗
免疫治疗药物	CTLA-4抑制剂 PD-1抑制剂 PD-L1抑制剂	ipilimumab nivolumab，pembrolizumab durvalumab
临床试验新药^a	抗体药物偶联物 PI3K/AKT/mTOR抑制剂表观遗传学药物

Figure 1 CT after 21 days of azacitidine use：consolidation of adjacent pleura with surrounding ground-glass shadow and bronchial inflation sign

Figure 2 CT after 4 weeks of everolimus use：central bronchial consolidation with bilateral extensive slight reticular shadow and septal thickening

Figure 3 CT after nivolumab use for 4 months：multiple consolidations in the periphery of the middle and lower lung and subpleural

Figure 4 Another patient's CT after using nivolumab for 4 months：multiple consolidations predominantly in the periphery and under the pleura

Figure 5 Azacitidine，CT-guided needle biopsy pathology：organizing pneumonia，chronic non-specific inflammation with macrophages

Figure 6 Everolimus，pulmonary cuneiectomy histopathology：organizing pneumonia，with features of acute lung injury

Figure 7 Pembrolizumab，pathology of lung biopsy under bronchoscopy：organizing pneumonia，thickening of the alveolar compartment，mild chronic inflammation

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