Pulmonary Toxicity of Chemotherapy

OVERVIEW

General principles

  • rule out pulmonary oedema from congestive cardiac failure
  • rule out lung infection (normal and opportunistic organisms)
  • rule out lung infiltration by cancer cells
  • determine time from chemotherapy to onset of respiratory symptoms -> compare with literature -> re-challenge
  • check clinical manifestations and laboratory test abnormalities consistent with lung toxicity induced by suspected drug
  • determine whether symptoms resolve after the drug is stopped and steroids are given

SPECIFIC AGENTS

Bleomycin

  • 3-40% of patients
  • pneumonitis with diffuse pulmonary infiltrates and fibrosis
  • risk factors:
    -> higher cumulative bleomycin dose
    -> renal failure
    -> > 70 years
    -> smoker
    -> radiation to chest
    -> high O2 concentrations
    -> G-CSF
    -> administration of other chemotherapeutic with lung toxicity

Methotrexate

  • acute/subacute pneumonitis simulating infection

ATRA Lung

  • All Trans-Retinoic Acid – helps differentiate APL blasts and improve remission and relapse rates
  • occurs day 2-21 days into treatment
  • features: fever, leukocytosis, SOB, weight gain, pleural effusions, infiltrates

Other

  • fludarabine
  • gemcitabine
  • cytarabine
  • cyclophosphamide

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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