Lowell L. Hart, MD, FACP, scientific director of clinical research at Florida Cancer Specialists & Research Institute, and associate professor of internal medicine at Wake Forest School of Medicine, discusses detection and treatment of interstitial lung disease for patients with HER2-positive breast cancer who received fam-trastuzumab deruxtecan-nxki (Enhertu; DS-8201).

The best way to detect interstitial lung disease early is to keep a high index of suspicion and closely monitor patients for unexplained cough, pulmonary symptoms, or shortness of breath upon exertion, explains Hart. If patients exhibit any of these symptoms, they should get imaging, such as a CT scan. If interstitial infiltrates are found and the patient does not have an infection, the interstitial lung disease is likely related to the drug, says Hart.

To treat drug-related interstitial lung disease, the patient must stop treatment and begin therapy with steroids, whether oral prednisone or intravenous steroids, according to Hart. If the patient requires hospitalization for interstitial lung disease, Hart recommends getting a pulmonary expert involved.

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Lowell L. Hart, MD, FACP, discusses detection and treatment of interstitial lung disease for patients with HER2-positive breast cancer who received fam-trastuzumab deruxtecan-nxki.

Dr. Hart on Detecting and Treating Interstitial Lung Disease in HER2+ Breast Cancer

Lowell L. Hart, MD, FACP, scientific director of Clinical Research at Florida Cancer Specialists & Research Institute, and associate professor of Internal Medicine at Wake Forest School of Medicine, discusses the utility of antibody-drug conjugates (ADCs) in HER2-positive breast cancer.

In February 2013, ado-trastuzumab emtansine (T-DM1; Kadcyla) was approved to treat patients with metastatic HER2-positive breast cancer who had previously received trastuzumab (Herceptin) and a taxane. The label was updated in May 2019 to include use as adjuvant treatment in patients with HER2-positive early breast cancer who have residual invasive disease after neoadjuvant chemotherapy and trastuzumab (Herceptin)-based treatment.

Historically, patients with residual disease at the time of surgery continued on trastuzumab for the remainder of a year. Now, patients are given T-DM1 rather than trastuzumab according to data from the phase III KATHERINE trial, explains Hart.

Another ADC, trastuzumab deruxtecan (T-DXd; DS-8201), demonstrated an objective response rate of approximately 61% in patients with heavily pretreated advanced disease in the randomized phase II DESTINY-Breast01 trial. Data from the trial were presented at the 2019 San Antonio Breast Cancer Symposium. T-DXd has a higher drug to antibody ratio and a different payload than T-DM1, concludes Hart.

Lowell L. Hart, MD, FACP, discusses the utility of antibody-drug conjugates in HER2-positive breast cancer.

Lowell L. Hart, MD, FACP

Articles

Dr. Hart on Detecting and Treating Interstitial Lung Disease in HER2+ Breast Cancer

Dr. Hart on Antibody-Drug Conjugates in HER2+ Breast Cancer