The Evaluation of the Oncologic Patient for Drug-Induced Pneumonitis

Terra C. Swanson; Brent W. Kinder; Joshua M. Clark

doi:10.1055/a-2703-4574

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med
DOI: 10.1055/a-2703-4574

Review Article

The Evaluation of the Oncologic Patient for Drug-Induced Pneumonitis

Authors

Terra C. Swanson

¹Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
Brent W. Kinder

¹Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
Joshua M. Clark

²Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States

Abstract

The National Cancer Institute (NCI) estimates that over 2 million Americans will be diagnosed with cancer in 2025. A significant proportion of these patients will receive chemotherapeutics, radiation, molecularly targeted therapies, or immunotherapies—many of which are associated with pulmonary toxicity. Drug-induced interstitial lung disease (D-ILD) is a growing and well-recognized complication of cancer-related therapies, carrying substantial morbidity and mortality. In addition to its direct health impact, D-ILD often necessitates modification or discontinuation of cancer treatment, further complicating oncologic care. As such, pulmonologists must be proficient in the evaluation and management of suspected D-ILD. In this review, we propose a structured approach to assessing patients with malignancy who present with diffuse parenchymal lung disease. We also summarize commonly implicated cancer therapies and their associated pulmonary toxicities.

Keywords

drug-induced pneumonitis - drug-induced interstitial lung disease - interstitial lung disease - cancer therapy-related complications

Full Text

References

References
1 Camus P, Bonniaud P, Fanton A, Camus C, Baudaun N, Foucher P. Drug-induced and iatrogenic infiltrative lung disease. Clin Chest Med 2004; 25 (03) 479-519 , vi
2 Duchemann B, Annesi-Maesano I, Jacobe de Naurois C. et al. Prevalence and incidence of interstitial lung diseases in a multi-ethnic county of Greater Paris. Eur Respir J 2017; 50 (02) 1602419
3 Hyldgaard C, Hilberg O, Muller A, Bendstrup E. A cohort study of interstitial lung diseases in central Denmark. Respir Med 2014; 108 (05) 793-799
4 Skeoch S, Weatherley N, Swift AJ. et al. Drug-induced interstitial lung disease: A systematic review. J Clin Med 2018; 7 (10) 356
5 Dhokarh R, Li G, Schmickl CN. et al. Drug-associated acute lung injury: A population-based cohort study. Chest 2012; 142 (04) 845-850
6 Nishino M, Giobbie-Hurder A, Hatabu H, Ramaiya NH, Hodi FS. Incidence of programmed cell death 1 inhibitor-related pneumonitis in patients with advanced cancer: A systematic review and meta-analysis. JAMA Oncol 2016; 2 (12) 1607-1616
7 Atchley WT, Alvarez C, Saxena-Beem S. et al. Immune checkpoint inhibitor-related pneumonitis in lung cancer: Real-world incidence, risk factors, and management practices across six health care centers in North Carolina. Chest 2021; 160 (02) 731-742
8 Suresh K, Psoter KJ, Voong KR. et al. Impact of checkpoint inhibitor pneumonitis on survival in NSCLC patients receiving immune checkpoint immunotherapy. J Thorac Oncol 2019; 14 (03) 494-502
9 Kaku S, Horinouchi H, Watanabe H. et al. Incidence and prognostic factors in severe drug-induced interstitial lung disease caused by antineoplastic drug therapy in the real world. J Cancer Res Clin Oncol 2022; 148 (07) 1737-1746
10 Higenbottam T, Kuwano K, Nemery B, Fujita Y. Understanding the mechanisms of drug-associated interstitial lung disease. Br J Cancer 2004; 91 (Suppl. 02) S31-S37
11 Matsuno O. Drug-induced interstitial lung disease: Mechanisms and best diagnostic approaches. Respir Res 2012; 13 (01) 39
12 Ghanbar MI, Suresh K. Pulmonary toxicity of immune checkpoint immunotherapy. J Clin Invest 2024; 134 (02) e170503
13 Haslam A, Gill J, Prasad V. Estimation of the percentage of US patients with cancer who are eligible for immune checkpoint inhibitor drugs. JAMA Netw Open 2020; 3 (03) e200423
14 Wang DY, Salem J-E, Cohen JV. et al. Fatal toxic effects associated with immune checkpoint inhibitors: A systematic review and meta-analysis. JAMA Oncol 2018; 4 (12) 1721-1728
15 Bondeelle L, Di Blasi R, Samy L. et al. CAR T cells-associated delayed lung toxicity – a case series. Eur Respir J 2020; 56: 746
16 Santomasso BD, Nastoupil LJ, Adkins S. et al. Management of immune-related adverse events in patients treated with chimeric antigen receptor T-cell therapy: ASCO Guideline. J Clin Oncol 2021; 39 (35) 3978-3992
17 Rugo HS, Crossno CL, Gesthalter YB. et al. Real-world perspectives and practices for pneumonitis/interstitial lung disease associated with trastuzumab deruxtecan use in human epidermal growth factor receptor 2-expressing metastatic breast cancer. JCO Oncol Pract 2023; 19 (08) 539-546
18 Clark J, Blake A, Vasher S. et al. Near fatal case of mirvetuximab soravtansine-gynx induced interstitial lung disease and a review of the primary literature. Gynecol Oncol Rep 2024; 55: 101486
19 Kalchiem-Dekel O, Galvin JR, Burke AP, Atamas SP, Todd NW. Interstitial lung disease and pulmonary fibrosis: A practical approach for general medicine physicians with focus on the medical history. J Clin Med 2018; 7 (12) 476
20 Conte P, Ascierto PA, Patelli G. et al. Drug-induced interstitial lung disease during cancer therapies: expert opinion on diagnosis and treatment. ESMO Open 2022; 7 (02) 100404
21 Kubo K, Azuma A, Kanazawa M. et al; 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 2013; 51 (04) 260-277
22 Saleem F, Ryerson CJ, Sarma N. et al. Predicting new-onset exertional and resting hypoxemia in fibrotic interstitial lung disease. Ann Am Thorac Soc 2023; 20 (12) 1726-1734
23 Kinder BW, Collard HR, Koth L. et al. Idiopathic nonspecific interstitial pneumonia: lung manifestation of undifferentiated connective tissue disease?. Am J Respir Crit Care Med 2007; 176 (07) 691-697
24 Fischer A, Antoniou KM, Brown KK. et al; “ERS/ATS Task Force on Undifferentiated Forms of CTD-ILD”. An official European Respiratory Society/American Thoracic Society research statement: Interstitial pneumonia with autoimmune features. Eur Respir J 2015; 46 (04) 976-987
25 Powell CA, Modi S, Iwata H. et al. Pooled analysis of drug-related interstitial lung disease and/or pneumonitis in nine trastuzumab deruxtecan monotherapy studies. ESMO Open 2022; 7 (04) 100554
26 Sleijfer S. Bleomycin-induced pneumonitis. Chest 2001; 120 (02) 617-624
27 Hanania AN, Mainwaring W, Ghebre YT, Hanania NA, Ludwig M. Radiation-induced lung injury: Assessment and management. Chest 2019; 156 (01) 150-162
28 Rahi MS, Parekh J, Pednekar P. et al. Radiation-induced lung injury-current perspectives and management. Clin Pract 2021; 11 (03) 410-429
29 Burris III HA, Hurtig J. Radiation recall with anticancer agents. Oncologist 2010; 15 (11) 1227-1237
30 Crestani B, Valeyre D, Roden S, Wallaert B, Dalphin JC, Cordier JF. Bronchiolitis obliterans organizing pneumonia syndrome primed by radiation therapy to the breast. The Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires (GERM“O”P). Am J Respir Crit Care Med 1998; 158 (06) 1929-1935
31 Murofushi KN, Oguchi M, Gosho M, Kozuka T, Sakurai H. Radiation-induced bronchiolitis obliterans organizing pneumonia (BOOP) syndrome in breast cancer patients is associated with age. Radiat Oncol 2015 10. -1039
32 Azhar M, Soto F, Vazquez-Gonzalez NA. et al. Incidence and risk factors for pneumonitis due to trastuzumab deruxtecan in females with breast cancer. Chest 2024; 166 (04) A3513-A3514
33 Oishi K, Hozumi H, Yoshizawa N. et al. Association of interstitial lung abnormalities with cytotoxic agent-induced pneumonitis in patients with malignancy. Respir Med 2025; 237: 107924
34 Murata D, Azuma K, Matama G. et al. Clinical significance of interstitial lung abnormalities and immune checkpoint inhibitor-induced interstitial lung disease in patients with non-small cell lung cancer. Thorac Cancer 2023; 14 (01) 73-80
35 Shimoji K, Masuda T, Yamaguchi K. et al. Association of preexisting interstitial lung abnormalities with immune checkpoint inhibitor-induced interstitial lung disease among patients with nonlung cancers. JAMA Netw Open 2020; 3 (11) e2022906
36 Johkoh T, Lee KS, Nishino M. et al. 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 2021; 298 (03) 550-566
37 Distefano G, Fanzone L, Palermo M. et al. HRCT patterns of drug-induced interstitial lung diseases: A review. Diagnostics (Basel) 2020; 10 (04) 244
38 Bui A, Han S, Alexander M, Toner G, Irving L, Manser R. Pulmonary function testing for the early detection of drug-induced lung disease: a systematic review in adults treated with drugs associated with pulmonary toxicity. Intern Med J 2020; 50 (11) 1311-1325
39 Lauritsen J, Kier MGG, Bandak M. et al. Pulmonary function in patients with germ cell cancer treated with bleomycin, etoposide, and cisplatin. J Clin Oncol 2016; 34 (13) 1492-1499
40 Roncolato FT, Chatfield M, Houghton B. et al; Australian and New Zealand Urogenital Prostate Cancer Trials Group (ANZUP). The effect of pulmonary function testing on bleomycin dosing in germ cell tumours. Intern Med J 2016; 46 (08) 893-898
41 Franzen D, Schad K, Kowalski B. et al. Ipilimumab and early signs of pulmonary toxicity in patients with metastastic melanoma: a prospective observational study. Cancer Immunol Immunother 2018; 67 (01) 127-134
42 Reuss JE, Brigham E, Psoter KJ. et al. Pretreatment lung function and checkpoint inhibitor pneumonitis in NSCLC. JTO Clin Res Rep 2021; 2 (10) 100220
43 Wong A, Riley M, Wang J. et al. Predictive Value of Pre-Treatment Abnormalities on Chest Imaging and Pulmonary Function Tests (PFTs) for Immune Checkpoint Inhibitor Pneumonitis. In: C38. Rare and Common ILDs: Epidemiology, Diagnosis, and Management. American Thoracic Society; 2022: A4024
44 Park HK, Yoon C-S, Na Y-O. et al. Serum KL-6 levels predict the occurrence and severity of treatment-related interstitial lung disease in lung cancer. Sci Rep 2023; 13 (01) 18126
45 Meyer KC, Raghu G, Baughman RP. et al; American Thoracic Society Committee on BAL in Interstitial Lung Disease. An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. Am J Respir Crit Care Med 2012; 185 (09) 1004-1014
46 Bonella F, Uzaslan E, Guzman J, Costabel U. Bronchoalveolar lavage in drug-induced lung disease. In: Camus P, Rosenow III EC. eds. Drug-Induced and Iatrogenic Respiratory Disease. United States: CRC Press; 2010: 32-39
47 Costabel U, Uzaslan E, Guzman J. Bronchoalveolar lavage in drug-induced lung disease. Clin Chest Med 2004; 25 (01) 25-35
48 Bartal C, Sagy I, Barski L. Drug-induced eosinophilic pneumonia: A review of 196 case reports. Medicine (Baltimore) 2018; 97 (04) e9688
49 Travis WD, Fielder DB. Pathology of drug-induced respiratory disease. In: Camus P, Rosenow EC. eds. Drug-Induced and Iatrogenic Respiratory Disease. 2010: 43-51
50 Spagnolo P, Bonniaud P, Rossi G, Sverzellati N, Cottin V. Drug-induced interstitial lung disease. Eur Respir J 2022; 60 (04) 2102776
51 Haanen J, Obeid M, Spain L. et al; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33 (12) 1217-1238
52 Brahmer JR, Abu-Sbeih H, Ascierto PA. et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer 2021; 9 (06) e002435
53 Thompson JA, Schneider BJ, Brahmer J. et al. NCCN Guidelines® Insights: Management of immunotherapy-related toxicities, Version 2.2024. J Natl Compr Canc Netw 2024; 22 (09) 582-592
54 Fontes E Sousa M, Campainha S, Marques ID. et al. Diagnosis and management of drug-induced interstitial lung disease in the context of anti-cancer therapy: A multidisciplinary viewpoint by Portuguese experts. Clin Drug Investig 2024; 44 (11) 801-810
55 Tarantino P, Modi S, Tolaney SM. et al. Interstitial lung disease induced by anti-ERBB2 antibody-drug conjugates: A review. JAMA Oncol 2021; 7 (12) 1873-1881
56 Srivali N, De Giacomi F, Moua T, Ryu JH. Corticosteroid therapy for treating acute exacerbation of interstitial lung diseases: A systematic review. Thorax 2025; 80 (03) 140-149
57 Karayama M, Inui N, Inoue Y. et al. Six-week oral prednisolone therapy for immune-related pneumonitis: a single-arm phase II study. J Immunother Cancer 2023; 11 (07) e007056
58 Umemura S, Yamane H, Suwaki T. et al. Interstitial lung disease associated with gemcitabine treatment in patients with non-small-cell lung cancer and pancreatic cancer. J Cancer Res Clin Oncol 2011; 137 (10) 1469-1475
59 White DA, Stover DE. Severe bleomycin-induced pneumonitis. Clinical features and response to corticosteroids. Chest 1984; 86 (05) 723-728
60 Sugimoto H, Enomoto T, Okuno M, Chayahara N, Morita H, Nakata K. Drug-induced interstitial lung disease from PARP inhibitors (olaparib and niraparib) for ovarian Cancer. AIM Clinical Cases 2023; 2: e220711
61 Hordequin L, Eberst G, Guion-Dusserre M, Gondouin A, Barnig C, Westeel V. Immunoglobulins as a treatment modality for corticosteroid-refractory pemetrexed-induced interstitial lung disease, case report. Respir Med Res 2023; 83: 101000
62 Stroud CR, Hegde A, Cherry C. et al. Tocilizumab for the management of immune mediated adverse events secondary to PD-1 blockade. J Oncol Pharm Pract 2019; 25 (03) 551-557
63 Davis T, Fedorov K, Gregos PS. et al. High dose cyclophosphamide for the treatment of severe immune checkpoint inhibitor related adverse events. J Oncol Res Ther 2023; 8 (04) 10194
64 Utsumi H, Araya J, Okuda K. et al. Successful treatment of steroid-refractory immune checkpoint inhibitor-related pneumonitis with triple combination therapy: a case report. Cancer Immunol Immunother 2020; 69 (10) 2033-2039
65 Katahara H, Baba K, Nakajima H. et al. Cyclophosphamide for anticancer therapy-induced interstitial lung disease in the modern era: a retrospective cohort study. Front Oncol 2025; 15: 1567317
66 Anoop TM, Joseph R, Unnikrishnan P, Thomas F, Venugopal M. Taxane-induced acute interstitial pneumonitis in patients with breast cancer and outcome of taxane rechallenge. Lung India 2022; 39 (02) 158-168
67 de Weger VA, Schutte T, Konings IRHM, Menke-van der Houven van Oordt CW. Successful trastuzumab-deruxtecan rechallenge after interstitial lung disease: A case report. J Breast Cancer 2023; 26 (05) 519-523
68 Haanen J, Ernstoff M, Wang Y. et al. Rechallenge patients with immune checkpoint inhibitors following severe immune-related adverse events: review of the literature and suggested prophylactic strategy. J Immunother Cancer 2020; 8 (01) e000604
69 Martins F, Sofiya L, Sykiotis GP. et al. Adverse effects of immune-checkpoint inhibitors: Epidemiology, management and surveillance. Nat Rev Clin Oncol 2019; 16 (09) 563-580
70 Long K, Suresh K. Pulmonary toxicity of systemic lung cancer therapy. Respirology 2020; 25 (Suppl. 02) 72-79
71 Gu L, Khadaroo PA, Su H. et al. The safety and tolerability of combined immune checkpoint inhibitors (anti-PD-1/PD-L1 plus anti-CTLA-4): a systematic review and meta-analysis. BMC Cancer 2019; 19 (01) 559
72 Cho JY, Kim J, Lee JS. et al. Characteristics, incidence, and risk factors of immune checkpoint inhibitor-related pneumonitis in patients with non-small cell lung cancer. Lung Cancer 2018; 125: 150-156
73 Sakata Y, Kawamura K, Ichikado K. et al. The association between tumor burden and severe immune-related adverse events in non-small cell lung cancer patients responding to immune-checkpoint inhibitor treatment. Lung Cancer 2019; 130: 159-161
74 Delaunay M, Cadranel J, Lusque A. et al. Immune-checkpoint inhibitors associated with interstitial lung disease in cancer patients. Eur Respir J 2017; 50 (02) 1700050
75 Suzuki Y, Karayama M, Uto T. et al. Assessment of immune-related interstitial lung disease in patients with NSCLC treated with immune checkpoint inhibitors: A multicenter prospective study. J Thorac Oncol 2020; 15 (08) 1317-1327
76 Chuzi S, Tavora F, Cruz M. et al. Clinical features, diagnostic challenges, and management strategies in checkpoint inhibitor-related pneumonitis. Cancer Manag Res 2017; 9: 207-213
77 Montemayor K, Ghanbar MI, Koch AL, Suresh K, Stephens RS. Managing immune checkpoint inhibitor pneumonitis in the ICU. CHEST Crit Care 2025; 3 (01) 100126
78 Daetwyler E, Wallrabenstein T, König D. et al. Corticosteroid-resistant immune-related adverse events: a systematic review. J Immunother Cancer 2024; 12 (01) e007409
79 Li R, Hua M, Li J. et al. The safety of trastuzumab deruxtecan (DS-8201) with a focus on interstitial lung disease and/or pneumonitis: A systematic review and single-arm meta-analysis. Cancer 2024; 130 (17) 2968-2977
80 Hackshaw MD, Danysh HE, Singh J. et al. Incidence of pneumonitis/interstitial lung disease induced by HER2-targeting therapy for HER2-positive metastatic breast cancer. Breast Cancer Res Treat 2020; 183 (01) 23-39
81 Enhertu (fam-trastuzumab deruxtecan-nxki) Package Labeling. Accessed July 23, 2025 at: https://daiichisankyo.us/prescribing-information-portlet/getPIContent?productName=Enhertu&inline=true
82 Tamiya A, Naito T, Miura S. et al. Interstitial lung disease associated with docetaxel in patients with advanced non-small cell lung cancer. Anticancer Res 2012; 32 (03) 1103-1106
83 Vahid B, Marik PE. Pulmonary complications of novel antineoplastic agents for solid tumors. Chest 2008; 133 (02) 528-538
84 Dimopoulou I, Bamias A, Lyberopoulos P, Dimopoulos MA. Pulmonary toxicity from novel antineoplastic agents. Ann Oncol 2006; 17 (03) 372-379
85 De Sanctis A, Taillade L, Vignot S. et al. Pulmonary toxicity related to systemic treatment of nonsmall cell lung cancer. Cancer 2011; 117 (14) 3069-3080
86 Genestreti G, Di Battista M, Trisolini R. et al. A commentary on interstitial pneumonitis induced by docetaxel: clinical cases and systematic review of the literature. Tumori 2015; 101 (03) e92-e95
87 Leger P, Limper AH, Maldonado F. Pulmonary toxicities from conventional chemotherapy. Clin Chest Med 2017; 38 (02) 209-222
88 Izzedine H, Mathian A, Amoura Z, Ng JH, Jhaveri KD. Anticancer drug-induced capillary leak syndrome. Kidney Int Rep 2022; 7 (05) 945-953
89 Ngeow J, Tan IB, Kanesvaran R. et al. Prognostic impact of bleomycin-induced pneumonitis on the outcome of Hodgkin's lymphoma. Ann Hematol 2011; 90 (01) 67-72
90 Suh CH, Park HS, Kim KW, Pyo J, Hatabu H, Nishino M. Pneumonitis in advanced non-small-cell lung cancer patients treated with EGFR tyrosine kinase inhibitor: Meta-analysis of 153 cohorts with 15,713 patients: Meta-analysis of incidence and risk factors of EGFR-TKI pneumonitis in NSCLC. Lung Cancer 2018; 123: 60-69
91 Endo M, Johkoh T, Kimura K, Yamamoto N. Imaging of gefitinib-related interstitial lung disease: Multi-institutional analysis by the West Japan Thoracic Oncology Group. Lung Cancer 2006; 52 (02) 135-140
92 Shi L, Tang J, Tong L, Liu Z. Risk of interstitial lung disease with gefitinib and erlotinib in advanced non-small cell lung cancer: a systematic review and meta-analysis of clinical trials. Lung Cancer 2014; 83 (02) 231-239
93 Roychowdhury DF, Cassidy CA, Peterson P, Arning M. A report on serious pulmonary toxicity associated with gemcitabine-based therapy. Invest New Drugs 2002; 20 (03) 311-315
94 Barlési F, Villani P, Doddoli C, Gimenez C, Kleisbauer J-P. Gemcitabine-induced severe pulmonary toxicity. Fundam Clin Pharmacol 2004; 18 (01) 85-91
95 Hamada T, Yasunaga H, Nakai Y. et al. Interstitial lung disease associated with gemcitabine: A Japanese retrospective cohort study. Respirology 2016; 21 (02) 338-343
96 Belknap SM, Kuzel TM, Yarnold PR. et al. Clinical features and correlates of gemcitabine-associated lung injury: findings from the RADAR project. Cancer 2006; 106 (09) 2051-2057
97 Abe M, Tsushima K, Ikari J. et al. Evaluation of the clinical characteristics of everolimus-induced lung injury and determination of associated risk factors. Respir Med 2018; 134: 6-11
98 Willemsen AECAB, Grutters JC, Gerritsen WR, van Erp NP, van Herpen CML, Tol J. mTOR inhibitor-induced interstitial lung disease in cancer patients: Comprehensive review and a practical management algorithm. Int J Cancer 2016; 138 (10) 2312-2321
99 Nishino M, Boswell EN, Hatabu H, Ghobrial IM, Ramaiya NH. Drug-related pneumonitis during mammalian target of rapamycin inhibitor therapy: Radiographic pattern-based approach in Waldenström macroglobulinemia as a paradigm. Oncologist 2015; 20 (09) 1077-1083
100 Zisman DA, McCune WJ, Tino G, Lynch III JP. Drug-induced pneumonitis: the role of methotrexate. Sarcoidosis Vasc Diffuse Lung Dis 2001; 18 (03) 243-252
101 White DA, Rankin JA, Stover DE, Gellene RA, Gupta S. Methotrexate pneumonitis. Bronchoalveolar lavage findings suggest an immunologic disorder. Am Rev Respir Dis 1989; 139 (01) 18-21
102 Schnabel A, Richter C, Bauerfeind S, Gross WL. Bronchoalveolar lavage cell profile in methotrexate induced pneumonitis. Thorax 1997; 52 (04) 377-379
103 Fuhrman C, Parrot A, Wislez M. et al. Spectrum of CD4 to CD8 T-cell ratios in lymphocytic alveolitis associated with methotrexate-induced pneumonitis. Am J Respir Crit Care Med 2001; 164 (07) 1186-1191
104 Akoun GM, Mayaud CM, Touboul JL, Denis MF, Milleron BJ, Perrot JY. Use of bronchoalveolar lavage in the evaluation of methotrexate lung disease. Thorax 1987; 42 (09) 652-655
105 Kremer JM, Alarcón GS, Weinblatt ME. et al. Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis: A multicenter study with literature review. Arthritis Rheum 1997; 40 (10) 1829-1837
106 Verweij J, van Zanten T, Souren T, Golding R, Pinedo HM. Prospective study on the dose relationship of mitomycin C-induced interstitial pneumonitis. Cancer 1987; 60 (04) 756-761
107 Gagnadoux F, Capron F, Lebeau B. Pulmonary veno-occlusive disease after neoadjuvant mitomycin chemotherapy and surgery for lung carcinoma. Lung Cancer 2002; 36 (02) 213-215
108 Buzdar AU, Legha SS, Luna MA, Tashima CK, Hortobagyi GN, Blumenschein GR. Pulmonary toxicity of mitomycin. Cancer 1980; 45 (02) 236-244