Pulmonary Toxicity of Chemotherapy: Mechanisms, Challenges, and the Promise of Natural Therapeutics and Antioxidants

Chemotherapy remains a cornerstone in cancer treatment, yet its associated toxic effects, particularly pulmonary complications, pose significant clinical challenges. Chemotherapeutic agents, either alone or in combination, can induce severe pulmonary toxicity through mechanisms involving direct cytotoxicity, oxidative stress, and inflammatory responses. Drug-induced lung injuries, including interstitial pneumonitis, acute respiratory distress syndrome, and fibrosis, are commonly observed, with agents such as bleomycin, cyclophosphamide, and busulfan. Approximately 10% of patients undergoing chemotherapy experience pulmonary complications, necessitating effective management strategies. Emerging evidence suggests that natural products, particularly antioxidants and plant-derived compounds like ellagic acid, can mitigate chemotherapy-induced pulmonary toxicity by counteracting oxidative stress and inflammation. We aim to summarize the toxic implications of chemotherapeutic drugs on the respiratory system, elucidating the underlying pathophysiological mechanisms. It also explores potential therapeutic interventions, including natural products, to reduce pulmonary toxicity. A thorough understanding of overall mechanisms will aid in the advancement of targeted strategies to improve the efficacy of cancer treatment while minimizing adverse effects.