Incidence and Radiological Spectrum of Interstitial Lung Disease in Patients With Lung Cancer Treated With Tyrosine Kinase Inhibitors: A Single-Center Observational Study

Background Tyrosine kinase inhibitors (TKIs) have improved outcomes in driver mutation-positive non-small cell lung cancer (NSCLC), yet drug-induced interstitial lung disease (ILD) remains an uncommon but clinically relevant toxicity. Objectives To determine the incidence and radiological spectrum of ILD among lung cancer patients receiving TKIs, describe accompanying adverse effects, identify clinical and treatment-related risk factors, and estimate progression-free survival (PFS). Methods This single-center observational study included consecutive mutation-positive lung cancer patients treated with TKIs between January 2024 and September 2025 at a tertiary institute in Eastern India. Baseline demographic, clinical, radiological, and molecular data were recorded. Patients were followed for 12 months with structured clinical assessment, laboratory monitoring, and imaging. ILD was classified as TKI-attributable or all-cause. Results Among 106 patients, most were aged 50 years or older (80.2%), male participants (54.7%), non-smokers (85.8%), and had advanced-stage disease (93.4%). Epidermal Growth Factor Receptor (EGFR) exon19 (50.9%) and exon21 (16.0%) mutations dominated in the group. Erlotinib (48.1%) and osimertinib (22.6%) were most frequently used. TKI-induced ILD occurred in 3.7% of patients, while all-cause ILD occurred in 16.0%. Radiologically, 95.3% of the study group showed no ILD pattern. Disease control was achieved in 68.8% of cases. Mean PFS was 10.4 ± 2.91 months, with a 12-month survival of 61.2%. Mild toxicities predominated; 84.0% had no Common Terminology Criteria for Adverse Events (CTCAE)-graded toxicity at one year. Smoking status correlated with treatment response (p=0.045), and Eastern Cooperative Oncology Group (ECOG) performance predicted PFS (p=0.048). No baseline factor independently predicted ILD. Conclusions TKIs demonstrated favorable disease control with low attributable ILD. Continued monitoring and structured risk assessment remain essential.