In short: Various cancer treatments, such as immunotherapy, targeted therapy, chemotherapy and radiation, can harm the lungs. The most important of these side effects is pneumonitis, an inflammation of the lung tissue. Early recognition and accurate diagnosis make it possible to treat it, and often also to continue the cancer treatment.
What is pneumonitis
Pneumonitis is a non-infectious inflammation of the lung tissue. It can occur after immunotherapy (PD-1, PD-L1 and CTLA-4 inhibitors), after certain targeted therapies, antibody-drug conjugates (ADCs) and chemotherapy, and after radiation to the chest. Radiation pneumonitis usually appears one to six months after radiotherapy.
Symptoms
- New or worsening shortness of breath
- Dry cough
- Falling oxygen saturation
- Sometimes fever
The symptoms resemble those of infection or of cancer progression, so the differential diagnosis is key.
How it is diagnosed
Chest CT, pulmonary function tests and diffusing capacity, and tests to rule out infection. Bronchoscopy with BAL is sometimes needed. Grading the severity (grades 1 to 4, per CTCAE) guides treatment.
Treatment
Treatment is tailored to severity: close monitoring, temporarily pausing the cancer treatment, corticosteroids and, in cases that do not respond, additional immune-modulating treatment. The decision whether and when to resume cancer treatment is made together with the treating oncologist.
Pulmonary support throughout cancer treatment
In addition to pneumonitis, we also manage infections in immunocompromised patients, blood clots in the lungs, pleural effusion, and worsening of pre-existing lung disease such as COPD or interstitial lung disease. For people with underlying lung disease, it is advisable to assess lung status before treatment begins.
Frequently asked questions
Do I have to stop immunotherapy?
Not always. In mild pneumonitis it is sometimes possible to continue with close monitoring. At higher grades of severity, treatment is stopped temporarily or permanently. The decision is shared between the pulmonologist and the oncologist.
Does pneumonitis go away?
In most cases it improves with appropriate treatment. Some patients are left with lasting changes in the lungs, so follow-up continues.
Related topics
General information only; it does not replace a medical consultation. עברית