Comparative aspects of pulmonary toxicity induced by cytotoxic agents with emphasis on lomustine, and a veterinary case report

Abstract

In veterinary oncology the use of the nitrosourea compound lomustine is increasing. veterinary oncologists need to be aware of the pulmonary toxicity of this drug. Because of the lack of veterinary publications on this subject, the incidence and pathophysiology in human cancer patients of pulmonary toxicity induced by cytotoxic agents in general and by nitrosoureas in particular are discussed. Three clinical syndromes can be recognized, the most devastating of which is interstitial pneumonitis resulting in pulmonary fibrosis. Disturbances in the homeostatic mechanisms of the oxidant/antioxidant-, immunologic-, matrix repair-, proteolytic-, and central nervous systems are some of the major mechanisms of pulmonary injury in human medicine. Risk factors such as cumulative dose, age, radiation, oxygen administration and multi-drug regimens are recognized. For the first time in veterinarv medicine, a case report of a dog with pulmonary fibrosis, probably caused by chronic lomustine administration, is presented.