# Balancing Innovation and Safety: Prediction, Prevention, and Management of Pneumonitis in Lung Cancer Patients Receiving Novel Anti-Cancer Agents

## TL;DR

This review discusses the risk of pneumonitis in lung cancer patients using new cancer treatments and emphasizes the need for better prediction and management strategies.

## Contribution

The paper provides a comprehensive overview of pneumonitis risk with novel anti-cancer agents and highlights emerging biomarkers and management strategies.

## Key findings

- Pneumonitis is a significant risk in lung cancer patients receiving novel therapies like antibody–drug conjugates and bispecific antibodies.
- Underlying pulmonary conditions in lung cancer patients increase susceptibility to severe pneumonitis outcomes.
- Emerging predictive biomarkers and improved risk stratification are critical for minimizing pneumonitis in cancer treatment.

## Abstract

Pneumonitis is a potential toxicity of common anti-cancer therapies, including radiotherapy, chemotherapy, immunotherapy, and targeted therapy. Due to underlying disease and comorbidities, lung cancer patients are at high risk of developing fatal cases of pneumonitis or permanent impairment of their respiratory function. Novel anti-cancer agents, including antibody–drug conjugates and bispecific antibodies, have recently been incorporated into clinical use for lung cancer patients due to their demonstrated antitumor activity. However, these medications may be associated with an increased probability of pneumonitis; therefore, implementation of strategies to optimize risk stratification and management of pneumonitis is urgently needed to improve patient care.

Pneumonitis is characterized as inflammation of the lung parenchyma, and a potential adverse effect of several anti-cancer therapies. Diagnosing pneumonitis can be particularly challenging in lung cancer patients due to inherent similarities in symptoms and radiological presentation associated with pneumonitis, as well as other common conditions such as infection or disease progression. Furthermore, many lung cancer patients have underlying pulmonary conditions that might render them more susceptible to severe or fatal outcomes from pneumonitis. Novel anti-cancer agents, such as antibody–drug conjugates (ADCs) and bispecific antibodies (BsAbs), are being incorporated into the treatment of lung cancer; therefore, understanding the risk and mechanisms underlying the potential development of pneumonitis with these new therapies is important to ensure continuous improvements in patient care. This narrative review provides an overview of the incidence of pneumonitis observed with novel anti-cancer agents, characterizes potential pathophysiological mechanisms underlying pneumonitis risk and emerging predictive biomarkers, highlights management strategies, and explores future directions for minimizing the risk of pneumonitis for lung cancer patients.