A brief review of the full spectrum of risk factors that impact the likelihood of interstitial lung disease.
Joyce A. O’Shaughnessy, MD: Let’s talk about risk factors, because we can be vigilant, but unfortunately, it seems like anybody is at risk. You can’t predict. However, are there certain risk factors? I mentioned a couple of them. Would you guys mention anything else? Charles, you’re nodding a little bit there.
Charles A. Powell, MD, MBA: Yes. I’m glad, Mark, you referenced that publication. That was published concomitantly in CHEST and also in Radiology. That was from the Fleischner Society.
Mark D. Pegram, MD: Exactly.
Charles A. Powell, MD, MBA: There was also a publication in the same year from the Fleischner Society, of which I’m a part, where we talked about potential risk factors for drug-induced lung disease, or interstitial lung disease [ILD] and IPF [idiopathic pulmonary fibrosis] in particular. What that publication referred to is that in many individuals who are having surveillance chest imaging, for whatever purpose, typically screening for lung cancer, there will be the appearance of small nonspecific changes in the bases of the lungs in particular. They’re not associated with any symptoms or any change in lung function, and that finding is called an interstitial lung abnormality [ILA].
When one looks at studies that have correlated the presence of interstitial lung abnormalities with those exposed to cancer drugs in particular that may be associated with pneumonitis, there’s a clear association across numerous studies that suggest that the presence of interstitial lung abnormalities is an indicator of risk for the subsequent development of pneumonitis related to cancer therapy. The ILA potentially is an indicator of the exposure of the lung being injurious in that particular individual. We have individual differences to response to the same agents, and the ILA may be an indicator of an individual who may be at increased risk of developing lung toxicity after exposure to a cancer agent. That is a risk factor, too. The data about the increased incidence in Japan and Korea in particular for many drugs, TKIs [tyrosine kinase inhibitors] just as another example, are very intriguing, and it’s certainly important to understand what may underlie that geographical or ethnic distribution of risk.
Mark D. Pegram, MD: Smoking is another risk factor. We mentioned COPD [chronic obstructive pulmonary disease] but also asthma, prior thoracic radiation. Joyce mentioned pre-existing ILD. Poor performance status is associated. We mentioned race, older age, male predominance with this condition, there is a tendency in some studies. And Joyce already mentioned multiple prior lines of chemotherapy is a risk factor.
Joyce A. O’Shaughnessy, MD: Lots of risk factors. That’s very interesting about the interstitial lung abnormalities. That’s very interesting because we do see those all the time. It’s actually complicating when we’re trying to monitor for this.
Transcript edited for clarity.