Waxing and waning pattern of mTOR inhibitor-associated pneumonitis in renal cell carcinoma patients: A retrospective observational study

• Published in: Clinical imaging 2021-03, Vol.71, p.29-33
• Main Authors: Gluskin, Jill, Plodkowski, Andrew, Girshman, Jeffrey, Sarasohn, Debra, Viteri-Jusué, Ainhoa, Hayan, Sumar, Torrisi, Jean
• Format: Article
• Language: English
• Subjects: Antibiotics; Antineoplastic Agents - adverse effects; Asymptomatic; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - drug therapy; Chest; Compatibility; Computed tomography; Data collection; Drug dosages; Dyspnea; Electronic health records; Electronic medical records; Enzymes; Everolimus; Humans; Inhibitors; Kidney cancer; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - drug therapy; Medical imaging; Medical records; mTOR; Observational studies; Patients; Pleural effusion; Pneumonia - chemically induced; Pneumonia - diagnostic imaging; Pneumonitis; Population; Pulmonary chemotoxicity; Renal cell carcinoma; Retrospective Studies; Targeted cancer therapy; Temsirolimus; TOR protein; TOR Serine-Threonine Kinases - therapeutic use; Toxicity; Tumors
• ISSN: 0899-7071; 1873-4499
• DOI: 10.1016/j.clinimag.2020.10.052

mTOR inhibitor-associated pneumonitis is common and often asymptomatic. We describe a waxing and waning pattern of pneumonitis observed on computed tomography (CT) scans of patients with renal cell carcinoma who were being treated with mTOR inhibitor molecular targeted therapy. In this HIPAA-compliant, IRB-approved retrospective single-institution study, 25 renal cell carcinoma patients were identified who received single-therapy temsirolimus or everolimus between January 2011 and June 2015 and who had chest CT scans available for review both before and after initiation of mTOR inhibitor treatment. A detailed review of the electronic medical record and serial chest CT examinations was performed. Radiologic findings compatible with pneumonitis were identified in 13/25 (52%) patients on mTOR inhibitors in our study. Of the patients with CT findings of pneumonitis, 8/13 (62%) demonstrated a waxing and waning pattern; of whom 7 had clinical symptoms of pneumonitis. Of the 17 patients who received temsirolimus, 9/17 (53%) developed radiologic findings compatible with pneumonitis and 4/9 (44%) developed a waxing and waning pattern. Of the 8 patients who received everolimus, 4/8 (50%) had radiologic findings compatible with pneumonitis and 4/4 (100%) developed a waxing and waning pattern. Waxing and waning is an unrecognized pattern of mTOR inhibitor-associated pneumonitis. Recognition of this pattern will promote clinical-radiologic concordance and may facilitate patient management. •One-half of our patients on mTOR inhibitors developed pneumonitis (52%).•Of those with pneumonitis, two-thirds had a waxing and waning pattern.