Drug-Induced Pulmonary Toxicity in the Era of Immunotherapy and Biologics: A Narrative Review of Mechanism, Diagnosis, and Management

Drug-induced interstitial lung disease (DI-ILD) has emerged as a clinically significant complication associated with a broadening spectrum of therapeutic agents. DI-ILD can result in significant morbidity and mortality if not promptly diagnosed and treated. In this review, we synthesize current evidence concerning the epidemiology, risk factors, pathophysiological mechanisms, clinical manifestations, diagnostic approaches, and management strategies of DI-ILD, with focused emphasis on three major therapeutic groups: immune checkpoint inhibitors (ICIs), chimeric antigen receptor T-cell (CAR-T) therapies, and biological agents; adding other commonly used drugs known for causing DI-ILD as well, such as: amiodarone, methotrexate, and nitrofurantoin. Early recognition, drug discontinuation, tailored immunosuppression, and supportive care are pivotal to improving outcomes. Enhanced medical awareness and a multidisciplinary care approach are essential to mitigate morbidity and mortality. By synthesizing current knowledge, this review aims to enhance awareness and understanding of DI-ILD, thereby facilitating earlier diagnosis and more effective management strategies for this potentially severe adverse drug event.