The adverse reaction of imatinib are important factors which determine medication compliance. Many patients reduce their imatinib compliance due to improper treatment of drug adverse reaction, which affects the treatment effect [1]. Interstitial lung disease is a relatively rare adverse reaction during the TKI treatment of patients with GIST. However, once diagnosed as interstitial lung disease caused by TKI, the patients need close attention and appropriate treatment. Limited literature suggests that interstitial lung disease may affect individuals of Asian descent more than other races and males more than females [2]. It is proved that the existence of interstitial lung disease before treatment is the risk factor of this disease resulted from TKI therapy [3]. The mechanisms of interstitial lung disease caused by TKI remain debatable. The main hypotheses are hypersensitivity reaction, the pharmaco­logical action of TKI, the inhibition of PDGFRA inducing pulmonary brosis, and inammatory cell inltration [4, 5]. The symptoms are usually fever of unknown origin, cough, dyspnea, and hypereosinophilia. Chest X-ray, CT, and high­resolution CT may help diagnose interstitial lung disease. Typical CT characteristics include ground-glass attenuation, irregular liner or reticular areas of attenuation with bronchiec­tasis and bronchiectasis. Among the thousands of GISTs treated in our center, only four cases of pulmonary interstitial brosis secondary to imatinib therapy have been encountered, which is consistent with the overall incidence reported in the literature [6]. The patient experienced severe pulmonary inter­stitial brosis, and the timing of occurrence was consistent with a previous literature report. Regardless of the improper selection of the initial treatment dose, the time and course of pulmonary interstitial brosis showed a signicant correlation with imatinib treatment. At the same time, mild interstitial changes in both lungs were seen in the rst CT.From the per­spective of treatment, the possibility of adverse reactions related to imatinib treatment should be considered at that time, and imatinib treatment should be terminated immediately, which may avoid the aggravation of subsequent lung injury. In this case, the patient’s condition was relieved after drug with­drawal, so it could be determined that imatinib treatment caused the interstitial pneumonia. For such patients with seri­ous side effects, they should resolutely choose to stop the drug before further treatment. For example, the continued applica­tion of imatinib can lead to repeated attacks of interstitial pneumonia, severe pulmonary brosis, and respiratory failure. Since the blood concentration of imatinib had not been mea­sured prior to ceasing therapy, only sunitinib (second-line drug) could be selected.

LinShen

The reported incidence of interstitial lung disease, also

0.5% [6]. In addition, interstitial lung disease has also been reported in the course of treatment with many small mole­cule TKIs, such as getinib and afatinib [7]. Interstitial lung disease caused by imatinib is mostly reversed after termina­tion of imatinib treatment, without serious complications [8]. Therefore, there is no need to be too concerned about similar adverse reactions. The key to treatment lies in early evalua­tion and accurate diagnosis. Once it is diagnosed as lung injury caused by a TKI, the offending medication should be ceased immediately [9].

At present, the clinical problem is whether imatinib can continue to be used for follow-up treatment once it is deter­mined that imatinib causes interstitial lung disease and the patient’s lung injury recovers.

ment, and replacement second-line drug treatment. The changes of chest CT should also be closely monitored during follow-up treatment.