DRUG-INDUCED PULMONARY-DISEASE .3. AGENTS USED TO TREAT NEOPLASMS OR ALTER THE IMMUNE SYSTEM INCLUDING A BRIEF REVIEW OF RADIATION-THERAPY

The most common adverse pulmonary responses produced by anticancer agents are interstitial pneumonitis and interstitial fibrosis. There is no sharp distinction between these two patterns of response and there may be progression from one state to another. In general, the presenting symptoms of interstitial pneumonitis are a more systemic, hypersensitivity response with fever, malaise, and a rapid decline in respiratory function. Although both entities can occur from days to years after medication is started and resolve from hours to months, interstitial pneumonitis is more likely to occur earlier and to resolve more quickly. Also, the pathologic differences are not profound. Interstitial pneumonitis shows evidence of larger numbers of inflammatory cells and less fibrosis than that of interstitial fibrosis. Of the two, interstitial pneumonitis is more likely to resolve upon withdrawal of the drug.