PMID- 29487226
OWN - NLM
STAT- MEDLINE
DCOM- 20190919
LR  - 20211204
IS  - 1549-490X (Electronic)
IS  - 1083-7159 (Print)
IS  - 1083-7159 (Linking)
VI  - 23
IP  - 6
DP  - 2018 Jun
TI  - Emerging Perspectives on mTOR Inhibitor-Associated Pneumonitis in Breast Cancer.
PG  - 660-669
LID - 10.1634/theoncologist.2017-0343 [doi]
AB  - Substantial improvements in the early detection and treatment of breast cancer 
      have led to improvements in survival, but breast cancer remains a significant 
      cause of morbidity and mortality in women. In 2012, the mammalian target of 
      rapamycin (mTOR) inhibitor everolimus was approved by the U.S. Food and Drug 
      Administration for the treatment of advanced breast cancer in patients resistant 
      to endocrine therapy. Although everolimus is generally well tolerated, mTOR 
      inhibitor-associated pneumonitis is one of the most common adverse drug events 
      leading to treatment discontinuation. To date, the underlying pathophysiology of 
      this toxicity is unclear, and this uncertainty may hinder the optimization of 
      management strategies. However, experiences from breast cancer and renal cell 
      carcinoma clinical trials indicate that mTOR inhibitor-associated pneumonitis can 
      be effectively managed by early detection, accurate diagnosis, and prompt 
      intervention that generally involves everolimus dose reductions, interruptions, 
      or discontinuation. Management can be achieved by a multidisciplinary approach 
      that involves the collaborative efforts of nurses, oncologists, radiologists, 
      infectious disease specialists, pulmonologists, clinical pharmacists, and 
      pathologists. Comprehensive education must be provided to all health care 
      professionals involved in managing patients receiving everolimus therapy. 
      Although general recommendations on the management of mTOR inhibitor-associated 
      pneumonitis have been published, there is a lack of consensus on the optimal 
      management of this potentially serious complication. This article provides an 
      overview of mTOR inhibitor-associated pneumonitis, with a focus on the detection, 
      accurate diagnosis, and optimal management of this class-related complication of 
      mTOR inhibitor therapy. IMPLICATIONS FOR PRACTICE: This article summarizes the 
      pathogenesis, clinical presentation, incidence, detection, and optimal management 
      of everolimus-related noninfectious pneumonitis in breast cancer. In particular, 
      this article provides a detailed overview of the important aspects of the 
      detection, accurate diagnosis, and appropriate management of mammalian target of 
      rapamycin inhibitor-associated pneumonitis. In addition, this article emphasizes 
      that effective management of this adverse drug event in patients with breast 
      cancer will require a multidisciplinary approach and collaboration among various 
      health care professionals.
CI  - (c) AlphaMed Press 2018.
FAU - Alvarez, Ricardo H
AU  - Alvarez RH
AD  - Cancer Treatment Centers of America, Newnan, Georgia, USA 
      ricardo.alvarez@ctca-hope.com.
FAU - Bechara, Rabih I
AU  - Bechara RI
AD  - Cancer Treatment Centers of America, Newnan, Georgia, USA.
FAU - Naughton, Michael J
AU  - Naughton MJ
AD  - Siteman Cancer Center, Washington University School of Medicine, St. Louis, 
      Missouri, USA.
FAU - Adachi, Javier A
AU  - Adachi JA
AD  - The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
FAU - Reuben, James M
AU  - Reuben JM
AD  - The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20180227
PL  - England
TA  - Oncologist
JT  - The oncologist
JID - 9607837
RN  - EC 2.7.1.1 (MTOR protein, human)
RN  - EC 2.7.11.1 (TOR Serine-Threonine Kinases)
SB  - IM
MH  - Breast Neoplasms/*complications/pathology
MH  - Female
MH  - Humans
MH  - Pneumonia/*chemically induced
MH  - TOR Serine-Threonine Kinases/*antagonists & inhibitors
PMC - PMC6067931
OTO - NOTNLM
OT  - Adverse drug event
OT  - Breast cancer
OT  - Everolimus
OT  - Pneumonitis
COIS- Disclosures of potential conflicts of interest may be found at the end of this 
      article.
EDAT- 2018/03/01 06:00
MHDA- 2019/09/20 06:00
PMCR- 2019/06/01
CRDT- 2018/03/01 06:00
PHST- 2017/07/21 00:00 [received]
PHST- 2018/01/03 00:00 [accepted]
PHST- 2018/03/01 06:00 [pubmed]
PHST- 2019/09/20 06:00 [medline]
PHST- 2018/03/01 06:00 [entrez]
PHST- 2019/06/01 00:00 [pmc-release]
AID - theoncologist.2017-0343 [pii]
AID - ONCO12401 [pii]
AID - 10.1634/theoncologist.2017-0343 [doi]
PST - ppublish
SO  - Oncologist. 2018 Jun;23(6):660-669. doi: 10.1634/theoncologist.2017-0343. Epub 
      2018 Feb 27.