Update on Drug-Induced Pneumonitis in Lung Cancer

Drug-induced pneumonitis is a significant and potentially life-threatening complication associated with multiple lung cancer therapies. As novel therapies are introduced and incorporated into updated treatment algorithms, it is crucial to anticipate, recognize, and manage these events readily and comprehensively. As experience with these agents accumulates in real-world settings, so too does our appreciation for patient risk factors, the need for personalized monitoring strategies, the heterogeneity of both clinical and radiographic presentations, and the persistent importance of a systematic approach to diagnosis and management. Novel therapies are responsible for significant improvements in lung cancer survival, but enthusiasm for this progress must be tempered by mitigation and management of inherent risks to avoid undue morbidity and mortality for our patients. Challenging clinical scenarios such as steroid-refractory pneumonitis highlight the importance of thorough evaluation, confident attribution, and aggressive early management. Future elucidation of the pathophysiology of these reactions will hopefully refine future diagnostic and therapeutic options. A collaborative, multidisciplinary approach is essential to optimize patient safety and outcomes in lung cancer care. In this manuscript we describe approaches to pre-treatment assessment, evaluation of suspected pneumonitis, and management of pneumonitis on a drug-specific basis. We emphasize emerging data and drug classes, while also highlighting remaining areas of uncertainty.

Publication History

Received: 31 March 2025

Accepted after revision: 25 July 2025

Accepted Manuscript online:
28 July 2025