Drug-induced pulmonary toxicity in breast cancer patients treated with systemic therapy: a systematic literature review

ABSTRACT

Introduction

Drug-induced pulmonary toxicity (DIPT) associated with breast cancer (BC) therapy has been a major concern in recent times. DIPT may not be attributed to a single type of therapy because of the concomitant use of other anticancer drugs or along with radiotherapy, which is an independent risk factor for pulmonary toxicity.

Areas covered

In this systematic literature review, we evaluated the probable cause and prevalence of DIPT in various systemic therapies used in BC treatment. A literature search was conducted in PubMed, Embase and Cochrane database, up to October 2020. Clinical studies reporting DIPT and related clinical manifestations due to systemic therapy in BC treatment were included. A total of 1749 articles were retrieved, and 193 articles were included.

Expert opinion

: The leading cause of DIPT among patients with BC was targeted therapy followed by chemotherapy containing regimens. A total of 17 studies reported 35 deaths (15 deaths in chemotherapy) due to DIPT. Physicians must take extra precaution while prescribing systemic therapy known to be associated with DIPT and need to be familiar with early diagnosis of DIPT in order to avoid respiratory-related complications during treatment in BC patients.

KEYWORDS:

• Drug-induced pulmonary toxicity
• breast cancer
• chemotherapy
• systematic literature review
• systemic therapy

Article highlights

• Drug-induced pulmonary toxicity (DIPT) associated with breast cancer (BC) therapy has emerged as a major concern seeking immediate attention especially in recent decades.

• A literature search was conducted in PubMed, Embase, and Cochrane database, until October, 2020. Clinical studies reporting DIPT and related clinical manifestations due to systemic therapy in BC treatment were included

• The leading cause of DIPT among patients with BC was targeted therapy followed by chemotherapy containing regimens.

• Other systemic therapy, inducing pulmonary toxicity, were endocrine therapy and immunotherapy containing regimens.

• The common DIPT and its clinical manifestations observed among included studies were dyspnea [any grade average percentage of patients (minimum, maximum incidence: 15.6 (0.02–48.0)], cough [14.7 (0.42–40.4)], epistaxis [22.3 (3–65.9)], pneumonia/pneumonitis/lung infection/ lung abscess [9.49 (0.02–51.2)], interstitial lung disease [27.7 (1.2–55)], and pleural effusion [18.5 (9.6–32.7)].

• Most of the DIPT cases were more prevalent in targeted therapy containing regimens particularly with anti-HER2/TKI inhibitors.

• A total of 17 studies reported 35 deaths (15 deaths in chemotherapy) due to DIPT. Among them, 11, 3, 2, and 1 studies used targeted therapy, chemotherapy, endocrine, and immunotherapy respectively.

• This provides evidence of an increase in the incidence of DIPTs associated with BC treatment and, hence, the need to be considered by physicians while prescribing drugs.

Acknowledgments

The authors would like to thank Dr. Amit Bhat, Indegene, Lifesystems Pvt. Ltd., for providing writing assistance and editorial support during development of the manuscript.

Author contributions

All authors contributed equally.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Supplemental data

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was funded by Astra Zeneca, China.