{"entity":{"id":"ild","kind":"term","name":"Interstitial lung disease (ILD) / pneumonitis","aka":[],"tldr":"Interstitial lung disease (ILD) is lung inflammation, a serious side effect of some ADCs (especially Enhertu) and immunotherapy.","summary":"Occurs in ~10-15% of T-DXd patients (grade 5 in ~1%); also with Dato-DXd, HER3-DXd, checkpoint inhibitors, and mTOR inhibitors. Requires monitoring, prompt steroids, and permanent discontinuation for grade ≥2 with T-DXd. Mechanism with DXd is incompletely understood (alveolar macrophage uptake proposed).","asOf":"2026-09-04","wikipedia":"https://en.wikipedia.org/wiki/Interstitial_lung_disease","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Interstitial_lung_disease"},{"label":"Powell et al., pooled analysis of interstitial lung disease in nine trastuzumab deruxtecan studies (ESMO Open 2022)","url":"https://doi.org/10.1016/j.esmoop.2022.100554"},{"label":"Macmillan: pembrolizumab","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/pembrolizumab"}],"tags":[],"related":[],"cancers":["tnbc"],"sections":[],"technologies":[],"targets":[],"drugs":["trastuzumab-deruxtecan","datopotamab-deruxtecan"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Two drugs used in triple-negative breast cancer can inflame the lungs: pembrolizumab (pneumonitis) and the deruxtecan antibody-drug conjugates (trastuzumab deruxtecan in HER2-low disease, datopotamab deruxtecan). In a pooled analysis of 1,150 people on trastuzumab deruxtecan, 15.4% developed drug-related interstitial lung disease, most low grade and 87% within the first 12 months, with 2.2% fatal. Macmillan's wording for pembrolizumab applies to both: breathlessness, a cough that does not go away, wheeze or a fever over 37.5 C means contacting the hospital straight away on the 24-hour number."],"category":"Side effects"},"route":"/terms/ild/","neighbours":{"cancer":[{"id":"gastric","kind":"cancer","name":"Gastric & gastro-oesophageal junction cancer","route":"/cancers/gastric/"},{"id":"her2-low-metastatic-breast-cancer","kind":"cancer","name":"HER2-low and HER2-ultralow metastatic breast cancer","route":"/cancers/her2-low-metastatic-breast-cancer/"},{"id":"her2-mutant-nsclc","kind":"cancer","name":"HER2-mutant non-small-cell lung cancer","route":"/cancers/her2-mutant-nsclc/"},{"id":"breast-her2-positive","kind":"cancer","name":"HER2-positive breast cancer","route":"/cancers/breast-her2-positive/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"},{"id":"stage-iii-unresectable-nsclc","kind":"cancer","name":"Unresectable stage III non-small-cell lung cancer","route":"/cancers/stage-iii-unresectable-nsclc/"}],"drug":[{"id":"bleomycin","kind":"drug","name":"Bleomycin","route":"/drugs/bleomycin/"},{"id":"datopotamab-deruxtecan","kind":"drug","name":"Datopotamab deruxtecan","route":"/drugs/datopotamab-deruxtecan/"},{"id":"trastuzumab-deruxtecan","kind":"drug","name":"Trastuzumab deruxtecan","route":"/drugs/trastuzumab-deruxtecan/"}],"trial":[{"id":"destiny-gastric04","kind":"trial","name":"DESTINY-Gastric04","route":"/trials/destiny-gastric04/"},{"id":"destiny-lung02","kind":"trial","name":"DESTINY-Lung02","route":"/trials/destiny-lung02/"}],"term":[{"id":"dxd","kind":"term","name":"DXd","route":"/terms/dxd/"},{"id":"adc-side-effects-breast","kind":"term","name":"Living with an antibody-drug conjugate: diarrhoea, blood counts, eyes and lungs","route":"/terms/adc-side-effects-breast/"},{"id":"tnbc-symptom-control-palliation","kind":"term","name":"Palliation in advanced triple-negative breast cancer: brain, bone, pleura, skin and end of life","route":"/terms/tnbc-symptom-control-palliation/"},{"id":"pneumonitis","kind":"term","name":"Pneumonitis","route":"/terms/pneumonitis/"},{"id":"therapeutic-index","kind":"term","name":"Therapeutic index (therapeutic window)","route":"/terms/therapeutic-index/"},{"id":"toxicity-grade","kind":"term","name":"Toxicity grade","route":"/terms/toxicity-grade/"},{"id":"urgent-help-tnbc","kind":"term","name":"When to seek urgent help with triple-negative breast cancer (NHS 111 and 999)","route":"/terms/urgent-help-tnbc/"}],"technology":[{"id":"adc","kind":"technology","name":"Antibody-drug conjugate (ADC)","route":"/technologies/adc/"}],"pairing":[{"id":"ild-overlap-caution","kind":"pairing","name":"Caution: DXd ADC + agents with pneumonitis risk","route":"/pairings/ild-overlap-caution/"}],"bottleneck":[{"id":"b-cachexia-supportive","kind":"bottleneck","name":"Cachexia, toxicity and the limits of the patient","route":"/bottlenecks/b-cachexia-supportive/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"},{"id":"b-dose-optimisation","kind":"bottleneck","name":"Wrong doses","route":"/bottlenecks/b-dose-optimisation/"}],"idea":[{"id":"idea-tr1-adc-dose-and-schedule-optimisation","kind":"idea","name":"Dose and schedule optimisation trials specific to antibody-drug conjugates","route":"/ideas/idea-tr1-adc-dose-and-schedule-optimisation/"},{"id":"idea-bio1-multi-organ-chip-tox","kind":"idea","name":"Linked human organ chips to predict side effects before people are dosed","route":"/ideas/idea-bio1-multi-organ-chip-tox/"},{"id":"idea-tr1-weight-based-vs-flat-dosing-trials","kind":"idea","name":"Test flat versus weight-based dosing of antibodies, and use dose banding to cut waste","route":"/ideas/idea-tr1-weight-based-vs-flat-dosing-trials/"}],"paper":[{"id":"paper-destiny-breast03-nejm-2022","kind":"paper","name":"DESTINY-Breast03: trastuzumab deruxtecan beats T-DM1 as second-line treatment of HER2-positive metastatic breast cancer","route":"/key-papers/paper-destiny-breast03-nejm-2022/"},{"id":"paper-destiny-breast04-nejm-2022","kind":"paper","name":"DESTINY-Breast04: trastuzumab deruxtecan works in HER2-low breast cancer, creating a new treatable group","route":"/key-papers/paper-destiny-breast04-nejm-2022/"},{"id":"paper-destiny-breast06-nejm-2024","kind":"paper","name":"DESTINY-Breast06: trastuzumab deruxtecan before any chemotherapy in hormone-receptor-positive, HER2-low or ultralow breast cancer","route":"/key-papers/paper-destiny-breast06-nejm-2024/"}]}}