Medical Oncologist
Lung side effects
Interstitial Lung Disease (ILD): — The Side Effect You Must Not Ignore
Interstitial lung disease from a cancer drug is inflammation inside the lung tissue itself — caused by the treatment, not the tumour. It can move from mild to severe within days. Any new breathing change during cancer treatment needs to be reported the same day, not at your next scheduled visit.
Medically reviewed by Dr. T. Raghavender Reddy, Medical Oncologist, MBBS · DM (Medical Oncology) · MD (Radiation Oncology) · Last reviewed August 2026
- It is not ordinary breathlessness — ILD inflames the lung tissue itself, not just airways — which is why rest does not reliably settle it.
- It can worsen fast — What starts as mild shortness of breath can become severe within days if the inflammation is not treated.
- Your drug may need to be paused — Your oncologist decides whether to hold treatment. Reporting early keeps more options open.
- Treatable when caught early — Most drug-related ILD responds well to prompt treatment. Delay is what makes it dangerous.
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Interstitial lung disease from a cancer drug is inflammation of the lung tissue caused by the treatment itself, not the cancer. It can progress from mild to severe within days. NCCN and ASCO guidance treats any new shortness of breath, dry cough, or reduced exercise tolerance during treatment as needing same-day assessment — not a wait-and-see approach.
If a symptom below applies to you, do not wait for a callback. Call 1800-202-8726 or go to your nearest emergency department.
How do you tell ordinary breathlessness from drug-related ILD?
| Feature | Ordinary breathlessness | Possible drug-related ILD — needs urgent review |
|---|---|---|
| Onset | Gradual, linked to exertion or low haemoglobin | New or worsening, not explained by exertion alone |
| Cough | Absent or a pre-existing pattern | New dry cough that appeared or worsened since starting the drug |
| Fever | Rare | Can accompany ILD — any fever alongside new breathlessness is significant |
| Response to rest | Improves with rest | Persists or worsens even at rest |
| Exercise tolerance | Stable from your recent baseline | Clearly reduced since starting the drug — shorter distances, stairs harder |
| Typically starts | Linked to a prior cause — anaemia, prior lung condition | Usually weeks to months after starting treatment, but can occur at any point including after stopping |
What should you note before calling your team?
- When the breathlessness or cough first appeared, and whether it has changed day on day since then.
- Whether symptoms are worse at rest, on exertion, or both.
- Your temperature — take it if you can and write the reading down.
- Your pulse oximeter reading, if you have one at home, and what your usual baseline is.
- Every drug you are currently taking, including anything from a pharmacy, supplements, or home remedies.
- Any other new symptoms — chest tightness, fatigue, or reduced appetite — and when they began.
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Call the helpline. It is always better to check than to wait.
When should you call your oncology team today?
Call the same day if you have developed any new shortness of breath, a new dry cough, or noticed that your ability to walk or climb stairs has dropped since starting treatment. You do not need to wait until you are severely unwell.
Do not take over-the-counter cough medicines or try to manage new breathing symptoms yourself. Masking the symptom delays the assessment that can catch ILD early, when it is most treatable.
**Call today — not at your next appointment — if: your breathing has changed in any way since starting your cancer drug, a new dry cough has appeared, you feel less able to walk or climb stairs than you did recently, or you have any fever alongside these symptoms.**
If you are unsure whether your symptoms are serious enough to call about, call anyway. Your team would far rather hear from you early.
What else do you need to know about drug-related ILD?
Which cancer drugs can cause ILD?
A range of drugs used in cancer treatment carry a lung risk, including checkpoint inhibitors such as pembrolizumab and nivolumab, targeted therapies used for lung cancer and certain other solid tumours, and some older chemotherapy agents. The risk varies by drug class and by individual patient factors. Your oncologist will have discussed the lung risk specific to your treatment — and if you are not sure, that is a question worth raising at your next visit. Knowing the risk is not a reason to be frightened; it is a reason to report any new symptom quickly rather than waiting to see if it settles.
Will my cancer drug have to stop permanently?
Not necessarily, and this is one of the most important things to understand. Mild reactions are often managed with a short pause in treatment, and many patients are able to restart once the inflammation has settled and they have been assessed. More severe reactions may require the drug to be stopped permanently, and that decision depends on how serious the ILD is and how well it responds to treatment. Reporting symptoms early is precisely what keeps the option of restarting available. Your oncologist will weigh the risk of continuing against the benefit the drug has been providing.
What tests will my team arrange?
Your team will usually arrange a chest X-ray and a CT scan of your lungs to assess the extent and pattern of the inflammation. Blood tests and, in some cases, a formal measurement of your lung function may also be done. A lung specialist is often involved alongside your oncologist. These tests help confirm whether the change is caused by the drug, by the cancer itself, or by something else such as an infection — because the correct treatment differs for each. Sometimes more than one cause is present at the same time.
Can I use home remedies or Ayurvedic preparations for the cough?
Please tell your oncology team about anything you are taking or considering, including home remedies, Ayurvedic preparations, herbal teas, or supplements. Some preparations can interact with cancer drugs; others may settle the cough symptom while the underlying inflammation continues, which delays the correct treatment and hides the worsening your team needs to see. This is not about dismissing traditional practices — it is about giving your team a complete picture so they can assess your symptoms accurately and keep you safe. Tell them before you start anything new, not afterwards.
Is drug-related ILD the same as a chest infection?
No, though the symptoms can overlap and both can cause cough, breathlessness and fever. A chest infection is caused by a bacterium, virus, or fungus and improves with antibiotics or antiviral treatment. Drug-related ILD is inflammation driven by an immune reaction to the drug, and it needs a different approach — typically steroids for immune-mediated reactions, alongside pausing the causative drug. Treating one as the other delays the correct treatment. Your team may need to rule out infection before confirming an ILD diagnosis, and sometimes both are present at the same time.
Did you know?
Drug-related ILD can develop weeks to months after starting treatment — and in some patients, it appears after the drug has already been stopped.
This delayed and unpredictable timing is why new breathing symptoms are taken seriously at any point during or after cancer treatment, not only in the first few weeks.
Source: NCCN Guidelines for Management of Immunotherapy-Related Toxicities; ESMO Clinical Practice Guidelines on Toxicity Management
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Common questions
Frequently asked questions
What does drug-related ILD feel like?
The most common symptoms are a new dry cough that was not present before, shortness of breath beyond what you would expect from exertion or low haemoglobin, and a reduced ability to do things you could manage recently — walking a shorter distance than usual, or getting breathless climbing stairs. Some people also notice a low-grade fever or chest tightness. These symptoms are easy to dismiss as tiredness or a passing chest problem, which is why they are worth reporting even when they feel mild.
How quickly does ILD from a cancer drug develop?
It can develop at any point during treatment, but most cases appear weeks to months after starting. Some patients develop it after the drug has already been stopped. This unpredictable timing means there is no safe window in which you can assume new breathlessness is unrelated to your treatment. Any new breathing symptom during or after cancer treatment should be reported promptly rather than waited out.
Can drug-related ILD be treated?
Yes, and most cases respond well when identified early. Immune-mediated ILD — the kind caused by checkpoint inhibitors — is typically treated with corticosteroids alongside pausing or stopping the causative drug. Other forms of drug-related ILD are managed differently depending on the cause and severity. Your oncologist will decide the approach based on what the scans show and how severe the reaction is. The outcome is significantly better when ILD is caught at an early stage, which is why prompt reporting matters more than anything else.
Will I need to be admitted to hospital?
That depends on how serious the ILD is when it is first assessed. Mild reactions may be managed with close outpatient monitoring and medication. More severe reactions usually need hospital admission for monitoring, oxygen support, and treatment. If there is any uncertainty when you call, your team may ask you to come in the same day rather than wait at home. Going in when asked is the right decision, even if it turns out to be less serious than it felt.
Can ILD happen with targeted therapy, or only with immunotherapy?
ILD can occur with both. Checkpoint inhibitors used in immunotherapy carry a well-documented lung risk, and NCCN and ESMO guidance includes lung toxicity monitoring as a standard part of immunotherapy management. Targeted therapies — particularly those used for certain lung cancers — can also cause drug-related lung inflammation. The pattern and onset may differ between drug classes, but the principle is the same: any new breathing symptom during treatment is worth reporting, whatever drug you are taking.