Side Effect: Interstitial Lung Disease (ILD)

What is Interstitial Lung Disease (ILD)?

Interstitial lung disease (ILD) is a condition where the tissue that surrounds the air sacs in the lungs becomes inflamed and can lead to scarring. This can lead to poorer lung function and trouble with breathing.

What does Interstitial Lung Disease (ILD) look like?

The severity and specific symptoms if ILD can vary widely depending upon the cause and classification of ILD (mild, moderate, or severe). Symptoms of ILD can include:

• shortness of breath
• chronic cough
• fatigue
• chest discomfort
• pain

Diagnosing ILD typically requires radiographic imaging, such as an X-ray and/or CT scan, pulmonary function tests (also known as PFTs), and sometimes a lung biopsy.

Who gets Interstitial Lung Disease (ILD)?

ILD can be caused by certain autoimmune diseases, exposure to environmental toxins, or by medications. Some cancers themselves can cause ILD due to the direct involvement of the lungs by the cancer.

Certain chemotherapy medications have been associated with the development of ILD such as:

• Bleomycin
  • Bleomycin used in Hodgkin's lymphoma treatment
  • Bleomycin used in testicular cancer treatment
• Everolimus
  • Everolimus used in kidney cancer treatment
  • Everolimus used in breast cancer treatment
• Enhertu® (fam-trastuzumab deruxtecan)
• Ibrance® (palbociclib)
• Kisqali® (ribociclib)
• Verzenio® (abemaciclib)

How to treat Interstitial Lung Disease (ILD)

The management of ILD typically involves a combination of supportive care measures, medication adjustments, and discontinuation of the offending agent whether that be a drug, chemotherapy, or an environmental toxin.

It may include:

• Discontinuation of the Causative Agent:
  • If the ILD is drug-induced, discontinuing the medication that is thought to be causing ILD is crucial.
• Supportive care:
  • Oxygen Therapy: If a person is having difficulty maintaining adequate oxygen levels, supplemental oxygen therapy may be provided.
  • Pulmonary Rehabilitation: This involves a combination of exercise, education, and support to improve lung function and overall quality of life.
• Medications used in the treatment of interstitial lung disease:
  • Bronchodilators: These can help open up airways and make breathing easier.
  • Corticosteroids (often referred to as “steroids”): These are often the first-line treatment for ILD. They work by reducing inflammation in the lungs. Prednisone is commonly used, but the specific type of corticosteroid, the dosage, and duration would be determined by the treating physician.
    • Note: Corticosteroids are not the same as anabolic steroids such as testosterone. They should not be confused with each other.
  • Immunosuppressive Agents: In more severe cases, especially when corticosteroids alone are not effective, immunosuppressive drugs such as azathioprine, mycophenolate mofetil, or cyclophosphamide may be considered.
  • Antifibrotic Agents, such as pirfenidone and nintedanib, used in idiopathic pulmonary fibrosis may be considered in certain cases of ILD.
• Lung Transplantation:
  • In severe cases of ILD, lung transplantation may be an option for select patients.

It is important to remember that the choice of treatment will depend upon various factors including the specific type, cause, and severity of ILD, the individual's overall health, and the presence of other medical conditions.