Suggested guidelines for evaluating and managing respiratory side effects associated with temsirolimus treatment

Adverse event	Evaluation	Management
Dyspnea	PFTs Chest X-ray Chest CT scan CBC	If imaging does not reveal ILD, provide supportive care and treat other factors contributing to dyspnea (eg, anemia) If imaging suggests interstitial lung disease, see below for management
ILD in asymptomatic patients	PFTs Chest CT scan	No specific therapy or drug interruption if PFTs are normal and radiographic changes are mild
ILD in patients with mild symptoms	PFTs Chest CT scan	May require temporary treatment interruption, depending on severity of PFT and CT abnormalities Will need ongoing monitoring of PFTs and chest CT
ILD in patients with underlying lung disease or moderate symptoms/PFT/CT abnormalities	PFTs Chest CT scan Diagnostic testing for opportunistic infection	May require temsirolimus discontinuation Will need frequent monitoring of PFTs and chest CT
ILD in patients with severe or progressive symptoms/PFT abnormalities	PFTs Chest CT scan Diagnostic testing for opportunistic infection	Discontinue temsirolimus Administer high dose glucocorticoids

Pneum_ILD_temsirolimus.htm

CBC: complete blood count; CT: computed tomography; DLCO: diffusing capacity for carbon monoxide; ILD: radiographic evidence of interstitial lung disease; PFTs: pulmonary function tests.

Adapted from: Bellmunt, J, Szczylik, C, Feingold, J, et al. Temsirolimus safety profile and management of toxic effects in patients with advanced renal cell carcinoma and poor prognostic features. Ann Oncol 2008; 19:1387.

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Suggested guidelines for evaluating and managing respiratory side effects associated with temsirolimus treatment