Pneumotox » Drug » Crizotinib

Crizotinib

4

In some countries it is believed that ILD develops in up to 2-4% of patients who receive the drug. Prior ILD may be a risk factor (PMID 25413260). Separating drug-induced ILD from disease progression, radiation pneumonitis, hemorrhage or an infection can be arduous. PMID 29174221

Last update : 01/03/2020

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

2

I.b Pneumonitis (ILD)

4

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

-

II.b ARDS - Acute lung injury

2

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

1

III.h Major/massive hemoptysis

1

V.f Pneumothorax

-

VIII.a Angioedema (may cause UAO, asphyxia and death)

1

X.g Hypersensitivity reaction (may manifest with fever and/or skin, throat or airway involvement)

1

XI.w Cavitation/necrosis of lung tumor or metastases

1

XII.ag Bradycardia

2

XII.ai Cardiotoxicity

2

XV.a Path: NSIP-cellular pattern (see also Ia, Ib)

1

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

-

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

1

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

1

XIX.a BAL: An excess proportion of lymphocytes

1

Diagnosing DIRD

1

Drug and radiation history

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

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

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

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