Management of drug-induced interstitial lung disease in the era of evolving lung cancer therapies: A mini-review.

The therapeutic landscape for lung cancer has been transformed by the introduction of molecular targeted therapies, immune checkpoint inhibitors (ICIs), and antibody-drug conjugates (ADCs). However, this expansion of treatment options has been accompanied by an increasing incidence of drug-induced interstitial lung disease (DIILD), which can significantly impact clinical outcomes. This review provides a comprehensive overview of DIILD in lung cancer management. Distinct clinical features and management strategies for various classes of antineoplastic agents are discussed. A high incidence of epidermal growth factor receptor-tyrosine kinase inhibitor-associated ILD in the Japanese population and emerging risks associated with sequential therapy using osimertinib following ICIs are highlighted. Unique "off-target" pulmonary toxicities of newer ADCs and the complex "two-hit" interactions between systemic therapies and local interventions like pleurodesis are also examined. Furthermore, a standardized five-step diagnostic approach based on systematic exclusion and multidisciplinary team consensus is proposed. Vigilant monitoring, early detection, and integrated management involving patient education and shared decision-making remain essential for optimizing patient safety in the era of precision oncology.