title: Management of pulmonary toxicity associated with targeted anticancer therapies.
abstract: BACKGROUND
  Targeted anticancer therapies act by interfering with defined molecular entities and/or biologic pathways. Because of their more specific mechanism of action, adverse events (AEs) on healthy tissues are intended to be minimal, resulting in a different toxicity profile from that observed with conventional cytotoxic chemotherapy. Pulmonary AEs are rare but potentially life-threatening and it is, therefore, critical to recognize early on and manage appropriately.
  
  
  METHODS
  In this review, we aim to offer an overview of both more frequent and rare pulmonary AEs caused by targeted anticancer therapies and discuss possible treatment algorithms. Anti-vascular endothelial growth factor, anti-human epidermal growth factor receptor and anti-CD20 therapy will be reviewed, as well as immune checkpoint inhibitors, anaplastic lymphoma kinase inhibitors and mammalian target of rapamycin inhibitors.
  
  
  CONCLUSIONS
  Novel agents used in the treatment of cancer have specific side-effects, the result of allergic reactions, on-target and off-target effects. Clinical syndromes associated with pulmonary toxicity vary from bronchospasms, hypersensitivity reactions, pneumonitis, acute respiratory distress, lung bleeding, pleural effusion to pneumothorax. Knowledge of risk factors, a high index of suspicion and a complete diagnostic work-up are essential for limiting the risk of these events becoming life threatening. The development of treatment algorithms is extremely helpful in managing these events. It is probable that these toxicities will be even more frequent with the introduction of combination therapies with the obvious challenge of discerning the responsible agent.
authors: a 1 Sint-Augustinus, Resident in Internal Medicine , Oosterveldlaan 24, 2610 Wilrijk-Antwerp, Belgium.
authors: Laure-Anne
authors: LA
authors: Teuwen
authors: b 2 Sint-Augustinus, Resident in Medical Oncology , Oosterveldlaan 24, 2610 Wilrijk-Antwerp, Belgium.
authors: Tom
authors: T
authors: Van den Mooter
authors: c 3 Sint-Augustinus, Medical Oncology , Oosterveldlaan 24, 2610 Wilrijk-Antwerp, Belgium +32 34 433 737 ; +32 34 430 09 ; luc.dirix@gza.be.
authors: Luc
authors: L
authors: Dirix
mesh_terms: D000465:Algorithms; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D058990:Molecular Targeted Therapy; D009369:Neoplasms / Q000188:drug therapy*; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents
keywords: anaplastic lymphoma kinase-inhibitors; immune checkpoint inhibitors; interstitial lung disease; lung toxicity; mammalian target of rapamycin; monoclonal antibodies; pneumonitis; pulmonary toxicity; targeted anticancer therapy; tyrosine kinase inhibitors