NEW BIOMARKERS ARE NEEDED - URGENTLY!

One of the dreaded complications of chemotherapy is Pulmonary fibrosis or interstitial pneumonitis which ultimately takes the patient's life when Complete Response may have been achieved.   It is a dramatic event in the life of our patients, many survive and many have a limited fibrosis that allows life to go on after high doses of steroids.  Some patients suffer consequences of exposure to high dose steroids.   Suffice is to say that so far the Advisory committee has not called for any standard monitoring of this abnormal side effect, opting instead for a Head in the sand and crossing finger policy.  Oncologists hide behind the statement that the "patient was warned this could happen".  Knowing what we know, it is time to be rational about this and go after this side effect, understand it and monitor it carefully as we treat our patients!
So far repeated  pulmonary function testing has been our recourse in patients who are taking Bleomycin.  Those on Mitomycin, rarely do we give them a second dose...But when is comes to Gemzar for example, warning the patient that interstitial Pneumonitis could result, is all we do.  It is unclear whether what happens in the lung with Bleomycin Vs Gemzar is the same phenomenon at various intensities.  All we know is that the 2 phenomena both result in a limitation of lung function as a result of fibrosis.  Studies have suggested that the early use of Growth factors to maintain the hematologic status of the patient may exacerbate or increase the frequency/occurrence of pulmonary fibrosis. In the treatment of Hodgkin disease, we try to avoid prompt use of growth factors to that end!
Fibrosis involves cyclins for sure, but no one has come forward to propose a clear Interleukin or other to be monitored as we treat our patients.  The call for new bio-markers is therefore appropriate and pertinent!  Something is happening in our patients at various levels, let's go and define it pronto instead of clinging to lingering politics of prayers, crossing the fingers and keeping our head in the sand !