Pneumotox » Drug » Erlotinib

Erlotinib

Most of the signal in the literature emanates from Japan (e.g. PMID 22610257). Reviews at PMID 20016372, 24332320. Recurrence may not lead to relapse (PMID 25550194), thus challenging causality

Last update : 31/05/2016

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

I.b Pneumonitis (ILD)

I.d Organizing pneumonia pattern (an area or areas of consolidation on imaging)

I.g Pulmonary fibrosis

I.l Diffuse alveolar damage (DAD) (see alsoo under IIb and XVf)

I.w Rapidly progressive ILD/pulmonary fibrosis (Hamman-Rich syndrome)

I.ad Radiation recall pneumonitis

II.b ARDS - Acute lung injury

III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

V.a Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

V.f Pneumothorax

XI.w Cavitation/necrosis of lung tumor or metastases

XII.f Cardiomyopathy (acute, subacute, chronic)

XV.c Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)

XV.f Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

XVI.n Imaging: Intralobular septal thickening - Crazy paving

XVI.af Imaging: Lung cysts or bullae (see also XVI ah/bf)

XVI.ay Imaging: Asymmetrical, predominantly unilateral involvement

XVI.bw Imaging: Air or an air crescent around lung tumor or metastase(s)

XXI.e Rechallenge may not necessarily lead to relapse of AE/ILD

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France