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Breast Cancer — SCE Medical Oncology MCQ

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HardBreast CancerBreast CancerSCE Medical Oncology

A 62-year-old woman on letrozole + palbociclib for metastatic breast cancer presents with progressive dyspnoea. CT shows new bilateral pulmonary infiltrates. CT pulmonary angiogram is negative for PE. Palbociclib is known to very rarely cause which pulmonary complication?

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Correct answer: C — Drug-induced interstitial lung disease/pneumonitis

ILD/pneumonitis is a rare but recognised class-effect adverse reaction of CDK4/6 inhibitors (palbociclib, ribociclib, abemaciclib). It occurs in <1-3% of patients but can be fatal. If suspected, the CDK4/6 inhibitor should be permanently discontinued and infection excluded. Corticosteroid therapy may be required. This must be differentiated from disease progression (lymphangitis carcinomatosa) and pulmonary embolism.

Reference: BNF Palbociclib monograph; ESMO 2024 Metastatic Breast Cancer Guidelines