Haralambos Raftopoulos, MD, associate professor, Hofstra North Shore-LIJ School of Medicine, discusses pulmonary toxicity with EGFR tyrosine kinase inhibitors (TKIs).
To date, researchers and oncologists know most about the EGFR TKIs erlotinib and gefitinib in the context of interstitial lung disease or pulmonary infiltration.
In a large meta-analysis, 1-2% of patients developed some form of interstitial lung disease, ranging from asymptomatic to highly symptomatic. Deaths were most commonly observed in patients who had preexisting lung conditions.
In the initial evaluation of erlotinib and gefitinib, it was hypothesized that combining either agent with gemcitabine-cisplatin would create additive toxicity. In fact, Raftopoulos says, patients who received EGFR TKIs experienced lower incidences of dyspnea and pulmonary toxicity compared with placebo and chemotherapy.
Pulmonary toxicity may have components driven by EGFR in some instances. It may be that EGFR inhibitors may be helping in these situations but contributing to pulmonary toxicity by a different mechanism.
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