nach oben

Erschienen in:

10.01.2022 | Computertomografie | CME-Topic

Moderne Tumortherapien und ihre pulmonalen Nebenwirkungen

verfasst von: PD Dr. med. Katharina Hellbach

Erschienen in: best practice onkologie | Ausgabe 1-2/2022

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Strahlentherapie und in jüngerer Zeit insbesondere die medikamentöse molekulare Therapie sind zentrale Bestandteile der modernen Onkologie. Beide Therapieformen eignen sich dazu, Tumoren bei vergleichsweise geringen systemischen Nebenwirkungen effektiv zu behandeln. Dennoch haben auch diese Behandlungsansätze Nebenwirkungen, die zum einen durch die Toxizität der Strahlung, zum anderen durch immunmodulatorische Effekte der verabreichten Medikamente ausgelöst werden. Das pneumotoxische Potenzial dieser Therapieformen spiegelt sich unter anderem in der Entstehung von interstitiellen Pneumonitiden wider, die in fibrotische Lungengerüstveränderungen übergehen können. Erschwert wird die klinische Diagnose der Erkrankung durch die unspezifischen Symptome. Die Computertomographie (CT) stellt ein ausgezeichnetes Mittel dar, um korrespondierende Verdichtungen zu diagnostizieren und im zeitlichen Verlauf zu monitoren. Damit wird dem Radiologen im interdisziplinären Kontext eine wichtige Rolle bei der Diagnostik dieses Krankheitsbildes zuteil.

Foth H (1995) Role of the lung in accumulation and metabolism of xenobiotic compounds—implications for chemically induced toxicity. Crit Rev Toxicol 25(2):165–205. https://doi.org/10.3109/10408449509021612CrossRefPubMed

Shannon VR (2017) Pneumotoxicity associated with immune checkpoint inhibitor therapies. Curr Opin Pulm Med 23(4):305–316. https://doi.org/10.1097/MCP.0000000000000382CrossRefPubMed

Murdoch D, Sager J (2008) Will targeted therapy hold its promise? An evidence-based review. Curr Opin Oncol 20(1):104–111. https://doi.org/10.1097/CCO.0b013e3282f44b12CrossRefPubMed

Cruz BD, Barbosa MM, Torres LL, Azevedo PS, Silva VEA, Godman B, Alvares-Teodoro J (2021) Crizotinib versus conventional chemotherapy in first-line treatment for ALK-positive non-small cell lung cancer: a systematic review and meta-analysis. Oncol Ther. https://doi.org/10.1007/s40487-021-00155-3CrossRefPubMedPubMedCentral

Sun L, Guo YJ, Song J, Wang YR, Zhang SL, Huang LT, Zhao JZ, Jing W, Han CB, Ma JT (2021) Neoadjuvant EGFR-TKI therapy for EGFR-mutant NSCLC: a systematic review and pooled analysis of five prospective clinical trials. Front Oncol 10:586596. https://doi.org/10.3389/fonc.2020.586596CrossRefPubMedPubMedCentral

Zhao Z, Gao Y, Xue Q, Gao S, He J (2021) Safety and efficacy of neoadjuvant immune checkpoint inhibitor therapy in patients with resectable non-small-cell lung cancer: a systematic review. Target Oncol. https://doi.org/10.1007/s11523-021-00818-1CrossRefPubMed

Mitsui H, Nakajima J, Maruyama T, Hanajiri K, Omata M (2003) Clinical efficacy and toxiciy of gefitinib in patients with lung cancer. Lancet 361(9373):1993. https://doi.org/10.1016/s0140-6736(03)13574-xCrossRefPubMed

Friedman CF, Proverbs-Singh TA, Postow MA (2016) Treatment of the immune-related adverse effects of immune checkpoint inhibitors: a review. JAMA Oncol 2(10):1346–1353. https://doi.org/10.1001/jamaoncol.2016.1051CrossRefPubMed

Johkoh T, Lee KS, Nishino M, Travis WD, Ryu JH, Lee HY, Ryerson CJ, Franquet T, Bankier AA, Brown KK, Goo JM, Kauczor HU, Lynch DA, Nicholson AG, Richeldi L, Schaefer-Prokop CM, Verschakelen J, Raoof S, Rubin GD, Powell C, Inoue Y, Hatabu H (2021) Chest CT diagnosis and clinical management of drug-related pneumonitis in patients receiving molecular targeting agents and immune checkpoint inhibitors: a position paper from the Fleischner society. Radiology 298(3):550–566. https://doi.org/10.1148/radiol.2021203427CrossRefPubMed

10.

Cancer Therapy Evaluation Program (2017) Common terminology criteria for adverse events. Version 5.0. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf. Zugegriffen: 15. Juni 2021

11.

Naidoo J, Wang X, Woo KM, Iyriboz T, Halpenny D, Cunningham J, Chaft JE, Segal NH, Callahan MK, Lesokhin AM, Rosenberg J, Voss MH, Rudin CM, Rizvi H, Hou X, Rodriguez K, Albano M, Gordon RA, Leduc C, Rekhtman N, Harris B, Menzies AM, Guminski AD, Carlino MS, Kong BY, Wolchok JD, Postow MA, Long GV, Hellmann MD (2017) Pneumonitis in patients treated with anti-programmed death-1/programmed death ligand 1 therapy. J Clin Oncol 35(7):709–717. https://doi.org/10.1200/JCO.2016.68.2005 (Erratum in: J Clin Oncol. 2017 Aug 1;35(22):2590. PMID: 27646942)CrossRefPubMed

12.

Skeoch S, Weatherley N, Swift AJ, Oldroyd A, Johns C, Hayton C, Giollo A, Wild JM, Waterton JC, Buch M, Linton K, Bruce IN, Leonard C, Bianchi S, Chaudhuri N (2018) Drug-induced interstitial lung disease: a systematic review. J Clin Med 7(10):356. https://doi.org/10.3390/jcm7100356CrossRefPubMedCentral

13.

Kuhlman JE (1991) The role of chest computed tomography in the diagnosis of drug-related reactions. J Thorac Imaging 6(1):52–61. https://doi.org/10.1097/00005382-199101000-00008CrossRefPubMed

14.

Taylor CR (1990) Diagnostic imaging techniques in the evaluation of drug-induced pulmonary disease. Clin Chest Med 11(1):87–94CrossRef

15.

Rossi SE, Erasmus JJ, McAdams HP, Sporn TA, Goodman PC (2000) Pulmonary drug toxicity: radiologic and pathologic manifestations. Radiographics 20(5):1245–1259. https://doi.org/10.1148/radiographics.20.5.g00se081245CrossRefPubMed

16.

Ando M, Okamoto I, Yamamoto N, Takeda K, Tamura K, Seto T, Ariyoshi Y, Fukuoka M (2006) Predictive factors for interstitial lung disease, antitumor response, and survival in non-small-cell lung cancer patients treated with gefitinib. J Clin Oncol 24(16):2549–2556. https://doi.org/10.1200/JCO.2005.04.9866CrossRefPubMed

17.

Silva CI, Müller NL (2006) Drug-induced lung diseases: most common reaction patterns and corresponding high-resolution CT manifestations. Semin Ultrasound CT MR 27(2):111–116. https://doi.org/10.1053/j.sult.2006.01.001CrossRefPubMed

18.

Nishino M, Hatabu H, Hodi FS, Ramaiya NH (2017) Drug-related pneumonitis in the era of precision cancer therapy. JCO Precis Oncol 1:PO.17.00026. https://doi.org/10.1200/PO.17.00026CrossRefPubMedPubMedCentral

19.

Lee H, Lee HY, Sun JM, Lee SH, Kim Y, Park SE, Ahn JS, Park K, Ahn MJ (2018) Transient asymptomatic pulmonary opacities during osimertinib treatment and its clinical implication. J Thorac Oncol 13(8):1106–1112. https://doi.org/10.1016/j.jtho.2018.04.038CrossRefPubMed

20.

Nishino M, Hatabu H, Sholl LM, Ramaiya NH (2017) Thoracic complications of precision cancer therapies: a practical guide for radiologists in the new era of cancer care. Radiographics 37(5):1371–1387. https://doi.org/10.1148/rg.2017170015CrossRefPubMed

21.

Nishino M, Ramaiya NH, Awad MM, Sholl LM, Maattala JA, Taibi M, Hatabu H, Ott PA, Armand PF, Hodi FS (2016) PD‑1 inhibitor-related pneumonitis in advanced cancer patients: radiographic patterns and clinical course. Clin Cancer Res 22(24):6051–6060. https://doi.org/10.1158/1078-0432.CCR-16-1320CrossRefPubMedPubMedCentral

22.

Kubo K, Azuma A, Kanazawa M, Kameda H, Kusumoto M, Genma A, Saijo Y, Sakai F, Sugiyama Y, Tatsumi K, Dohi M, Tokuda H, Hashimoto S, Hattori N, Hanaoka M, Fukuda Y (2013) Japanese Respiratory Society Committee for formulation of Consensus statement for the diagnosis and treatment of drug-induced lung injuries. Consensus statement for the diagnosis and treatment of drug-induced lung injuries. Respir Investig 51(4):260–277. https://doi.org/10.1016/j.resinv.2013.09.001CrossRefPubMed

23.

Dy GK, Adjei AA (2013) Understanding, recognizing, and managing toxicities of targeted anticancer therapies. CA Cancer J Clin 63(4):249–279. https://doi.org/10.3322/caac.21184CrossRefPubMed

24.

Chopra A, Nautiyal A, Kalkanis A, Judson MA (2018) Drug-induced sarcoidosis-like reactions. Chest 154(3):664–677. https://doi.org/10.1016/j.chest.2018.03.056CrossRefPubMed

25.

Wang Y, Kong D, Wang C, Chen J, Li J, Liu Z, Li X, Wang Z, Yao G, Wang X (2020) A systematic review and meta-analysis of immune-related adverse events of anti-PD‑1 drugs in randomized controlled trials. Technol Cancer Res Treat. https://doi.org/10.1177/1533033820967454CrossRefPubMedPubMedCentral

26.

Matsuo Y, Shibuya K, Nakamura M, Narabayashi M, Sakanaka K, Ueki N et al (2012) Dose–volume metrics associated with radiation pneumonitis after stereotactic body radiation therapy for lung cancer. Int J Radiat Oncol Biol Phys 83(4):e545–e549CrossRef

27.

Vogelius IR, Bentzen SM (2012) A literature-based meta-analysis of clinical risk factors for development of radiation induced pneumonitis. Acta Oncol 51(8):975–983CrossRef

28.

Ren C, Ji T, Liu T, Dang J, Li G (2018) The risk and predictors for severe radiation pneumonitis in lung cancer patients treated with thoracic reirradiation. Radiat Oncol 13(1):69CrossRef

29.

Giridhar P, Rath Gk MS et al (2015) Giridhar PRGKMS. Radiation induced lung injury: prediction, assesment and management. Asian Pacif J Cancer Prev 16:2613–2617CrossRef

30.

Choi YW, Munden RF, Erasmus JJ, Park KJ, Chung WK, Jeon SC, Park CK (2004) Effects of radiation therapy on the lung: radiologic appearances and differential diagnosis. Radiographics 24(4):985–997. https://doi.org/10.1148/rg.244035160 (discussion 998)CrossRefPubMed

31.

Benveniste MF, Gomez D, Carter BW, Betancourt Cuellar SL, Shroff GS, Benveniste APA, Odisio EG, Marom EM (2019) Recognizing radiation therapy–related complications in the chest. Radiographics 39(2):344–366CrossRef

32.

Glazer HS, Levitt RG, Lee JK et al (1984) Differentiation of radiation fibrosis from recurrent pulmonary neoplasm by magnetic resonance imaging. AJR Am J Roentgenol 143(4):729–730CrossRef

33.

Huang K, Dahele M, Senan S, Guckenberger M, Rodrigues GB, Ward A, Boldt RG, Palma DA (2012) Radiographic changes after lung stereotactic ablative radiotherapy (SABR)—can we distinguish recurrence from fibrosis? A systematic review of the literature. Radiother Oncol 102(3):335–342. https://doi.org/10.1016/j.radonc.2011.12.018CrossRefPubMed

34.

Takeda A, Kunieda E, Takeda T, Tanaka M, Sanuki N, Fujii H, Shigematsu N, Kubo A (2008) Possible misinterpretation of demarcated solid patterns of radiation fibrosis on CT scans as tumor recurrence in patients receiving hypofractionated stereotactic radiotherapy for lung cancer. Int J Radiat Oncol Biol Phys 70(4):1057–1065. https://doi.org/10.1016/j.ijrobp.2007.07.2383CrossRefPubMed

35.

Huang K, Senthi S, Palma DA, Spoelstra FO, Warner A, Slotman BJ, Senan S (2013) High-risk CT features for detection of local recurrence after stereotactic ablative radiotherapy for lung cancer. Radiother Oncol 109(1):51–57. https://doi.org/10.1016/j.radonc.2013.06.047CrossRefPubMed

36.

Takeda A, Kunieda E, Fujii H, Yokosuka N, Aoki Y, Oooka Y, Oku Y, Ohashi T, Sanuki N, Mizuno T, Ozawa Y (2013) Evaluation for local failure by 18F-FDG PET/CT in comparison with CT findings after stereotactic body radiotherapy (SBRT) for localized non-small-cell lung cancer. Cancer Treat Res 79(3):248–253. https://doi.org/10.1016/j.lungcan.2012.11.008CrossRef

37.

Gould MK, Kuschner WG, Rydzak CE, Maclean CC, Demas AN, Shigemitsu H, Chan JK, Owens DK (2003) Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis. Ann Intern Med 139(11):879–892. https://doi.org/10.7326/0003-4819-139-11-200311180-00013CrossRefPubMed

38.

Levy A, Hollebecque A, Bourgier C, Loriot Y, Guigay J, Robert C et al (2013) Targeted therapy-induced radiation recall. Eur J Cancer 49(7):1662–1668CrossRef

39.

McGovern K, Ghaly M, Esposito M, Barnaby K, Seetharamu N (2019) Radiation recall pneumonitis in the setting of immunotherapy and radiation: a focused review. Future Sci OA 5(5):FSO378. https://doi.org/10.2144/fsoa-2018-0123CrossRefPubMedPubMedCentral

40.

Chiang CL, Chen YW, Wu MH, Huang HC, Tsai CM, Chiu CH (2016) Radiation recall pneumonitis induced by epidermal growth factor receptor-tyrosine kinase inhibitor in patients with advanced nonsmall-cell lung cancer. J Chin Med Assoc 79(5):248–255. https://doi.org/10.1016/j.jcma.2016.01.008CrossRefPubMed

41.

Awad R, Nott L (2016) Radiation recall pneumonitis induced by erlotinib after palliative thoracic radiotherapy for lung cancer: case report and literature review. Asia Pac J Clin Oncol 12(1):91–95. https://doi.org/10.1111/ajco.12447CrossRefPubMed

Titel: Moderne Tumortherapien und ihre pulmonalen Nebenwirkungen
verfasst von: PD Dr. med. Katharina Hellbach
Publikationsdatum: 10.01.2022
Verlag: Springer Medizin
Schlagwörter: Computertomografie
Strahlentherapie
Computertomografie
Gefitinib
Onkologie
Onkologische Erkrankungen in der Hausarztpraxis
Pneumonitis
Erschienen in: best practice onkologie / Ausgabe 1-2/2022
Print ISSN: 0946-4565
Elektronische ISSN: 1862-8559
DOI: https://doi.org/10.1007/s11654-021-00360-6

Lungenkrebsscreening

Lungenkarzinome
Übersichtsartikel

Chirurgische Therapie des Ösophaguskarzinoms – neue Technologien, moderne Konzepte

Operationen des Ösophagus
Übersichtsartikel

Mehr Patienten in die onkologischen Praxen, bessere sektorenübergreifende Versorgung

Hämatologie
Nachrichten

Digitale Gesundheitsanwendungen (DiGAs) – Anspruchs- und Zulassungsvoraussetzungen

Digitale Gesundheitsanwendungen
Praxis konkret

onko-aktuell

onko-aktuell

Qualitätssicherung bei hämatoonkologischen Schwerpunktpraxen

Onkologie
Übersichtsartikel