Radiological patterns of drug induced interstitial lung disease (DILD) in early phase oncology clinical trials.

Purpose: Drug induced interstitial lung disease (DILD) is a rare, but potentially fatal toxicity. Clinical and radiological features of DILD in the early experimental setting are poorly described. Experimental Design: 2499 consecutive advanced cancer patients on phase I clinical trials were included. DILD was identified by a dedicated radiologist and investigators, categorized per internationally recognized radiological patterns and graded per CTCAE and the Royal Marsden Hospital DILD score. Clinical and radiological features of DILD were analysed. Results: 60 patients overall (2.4%) developed DILD. Median time to onset of DILD was 63 days (range 14-336 days). 45% of patients who developed DILD were clinically asymptomatic. Incidence was highest in patients receiving drug conjugates (7.4%), followed by inhibitors of the PI3K/AKT/mTOR pathway (3.9%). Commonest pattern seen was hypersensitivity pneumonitis (33.3%), followed by non-specific interstitial pneumonia (30%) and cryptogenic organising pneumonia (26.7%). A higher DILD score (OR 1.47, 95% CI: 1.19-1.81, p