Optimizing the Management of ILD: Take-Home Messages


Experts highlight key messages regarding optimal identification and management of interstitial lung disease.


Joyce A. O’Shaughnessy, MD: Let’s transition then to summarizing some take-home points that you think are some of the most important things people should take away from our discussion today. Mark, I’ll start with you.

Mark D. Pegram, MD: Thank you, Joyce. I would say remember the fundamentals, renewed focus on pulmonary review of systems, careful pulmonary physical examination using a stethoscope. There may be things that are subtle that you might be able to hear that may not yet be radiographically apparent fully. That said, it’s important to review the radiographic findings and do your restaging as scheduled on time and not delay them unnecessarily. Remember our pulmonary consultant colleagues and collaborate with them. They don’t want to get involved in a case that’s already in the ICU [intensive care unit] intubated. Early referral to pulmonology is key, especially for symptomatic patients or for patients, as Charles mentioned, for whom we’re considering a new form of treatment and they have underlying risk factors for ILD [interstitial lung disease].

Finally, inform patients and your allied health personnel what to look out for, when they should call, what demands an earlier clinic appointment and follow-up, earlier look on scans, etc. Then remember that drug-induced lung disease can be acute, but it can also be insidious, and it can have rather long latencies like we see in the case of sometimes with immune checkpoint inhibition. With trastuzumab deruxtecan it could happen months into the treatment course, and pulmonary fibrosis with bleomycin or carmustine could happen years or even a decade after exposure. Those are my key summary points from today’s discussion. Thank you.

Joyce A. O’Shaughnessy, MD: Thank you, awesome. How about you, Charles? What would you add?

Charles A. Powell, MD, MBA: My 2 takeaways are first, drug-induced ILD or drug-related pneumonitis is a diagnosis of exclusion. It’s important to embark upon that diagnostic pathway to exclude other causes of the radiographic or symptomatic findings, and we outlined the process for that. The second takeaway is that when detected early, drug-related pneumonitis is manageable and treatable, and it’s important to keep that in mind, and it’s important to be aggressive with our educational efforts, so that patients and treating physicians are aware. We’re talking about new cancer agents that are incredibly powerful, offering patients opportunities for response and survival benefits after they’ve progressed through multiple other prior regimens. These drugs have potential to be incredibly effective and yes, some are associated with an increased risk of drug-related pneumonitis. Using this type of multidisciplinary approach that we’ve been talking about, where there’s a partnership between patient, the treating oncologist, and the pulmonologist, and emphasis on early detection, then really the therapeutic benefits can be realized with mitigation of the toxicity.

Joyce A. O’Shaughnessy, MD: Super. It’s been great talking to you, highly educational for me. I learned a great deal, and this is going to be a really useful program for people. I thank you so much for your time. I think we covered the waterfront of the key topics. I hope this has been useful to you and will help you taking care of your patients in your practice. Thanks very much for listening.

Transcript edited for clarity.

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