Guidelines for Complications of Cancer Treatment Vol VIII Part B

Though there are many chemotherapeutic drugs which mayaffect pulmonary function below we discuss the most commondrugs causing pulmonary toxicity.Bleomycin: Although the pathophysiology of bleomycininducedlung injury is not completely understood, one of theputative mechanisms is the lack of bleomycin hydrolase, anenzyme responsible for the inactivation of bleomycin in normaland tumoral tissues 6 . Owing to the low activity of bleomycinhydrolase in the skin and lungs, these organs are the mostcommonly affected by bleomycin toxicity 7 . Pulmonary fibrosisfollowing exposure to bleomycin is estimated to occur inapproximately 10% of patients 8 The risk factors for thedevelopment of pulmonary toxicity in patients treated withbleomycin include the cumulative dose, age, use of radiationtherapy, renal dysfunction, and high concentrations of inspiredoxygen. The incidence of bleomycin-related pulmonarytoxicity appears to be directly related to the cumulative dose,occurring in 3% to 5% of patients receiving a total dose ofless than 300 units and 20% of those receiving doses higherthan 500 units 9 .Bleomycin should be discontinued in patients with highlysuspicious or documented lung toxicity. Although there is noproven effective therapy, patients are usually treated with highdosecorticosteroids. Patients surviving the pneumonitisepisode almost always recover completely with no residualpulmonary symptoms or radiologic abnormalities.Methotrexate: The incidence of pulmonary toxicity in patientsreceiving methotrexate is approximately 7% 10 . Risk factors inpatients with rheumatoid arthritis include age older than 60,rheumatoid pleuropulmonary involvement, previous use ofdisease-modifying antirheumatic drugs, low serum albumin,and diabetes mellitusFludrabine:The incidence of fludarabine-related lung toxicityin patients with chronic lymphoproliferative disorders in a443