title: Interstitial lung disease during targeted therapy in metastatic renal cell carcinoma: a case series from three centres.
abstract: Interstitial lung disease (ILD) is an adverse event which occurs also during targeted treatment of patients with metastatic renal cell carcinoma (mRCC). Experiences on ILD-management in mRCC remain limited. mRCC patients treated with everolimus, temsirolimus, or sunitinib at three centres from January 2006 until December 2009 were analysed, retrospectively. Medical records and imaging studies, as well as clinical course, the incidence, diagnostic measures, treatment, and outcome of ILD were assessed. Twenty-six ILD patients (11 %) were identified out of 237 mRCC patients. Median treatment until ILD-diagnosis was 3.8 (range: 1-21.5) months. The ILD-frequency was 2.7 % (n = 6/226) during sunitinib therapy and 19.8 % (n = 20/101) during m-TOR-inhibitor treatment. Cough was the prevailing symptom (69.2 %, n = 18). Bronchoalveolar lavage reviled often lymphocytic (42.9 %, n = 6/14) or eosinophilic cellularity (28.6 %, n = 4/14). Dose reduction (42.3 %, n = 11), treatment interruption (46.2 %, n = 12) or termination (23.1 %, n = 6), and steroid application (34.6 %, n = 9) were common measures in ILD. Interestingly, eosinophilic ILD required pulsed steroids. Improvement occurred in 73.7 % of symptomatic patients. Continuation of targeted therapies was warranted in 65.4 % of ILD patients. No patient died from ILD. ILD during targeted mRCC treatment is common, and supportive measures should be adapted to the clinical course, and potentially in dependence of BAL findings. Re-exposure to targeted therapies appears feasible.
authors.affiliation: Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School Hannover, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Ivanyi
authors.forename: Thomas
authors.initials: T
authors.lastname: Fuehner
authors.forename: Meike
authors.initials: M
authors.lastname: Adam
authors.forename: Christian
authors.initials: C
authors.lastname: Eichelberg
authors.forename: Edwin
authors.initials: E
authors.lastname: Herrmann
authors.forename: Axel Stuart
authors.initials: AS
authors.lastname: Merseburger
authors.forename: Arnold
authors.initials: A
authors.lastname: Ganser
authors.forename: Viktor
authors.initials: V
authors.lastname: Grünwald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D000068338:Everolimus; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011758:Pyrroles / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077210:Sunitinib
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; C401859:temsirolimus; D000068338:Everolimus; D000077210:Sunitinib; D020123:Sirolimus