Dr. Paplomata on Managing Trastuzumab Deruxtecan–Induced ILD in HER2+ Breast Cancer

Elisavet Paplomata, MD, assistant professor, University of Wisconsin School of Medicine and Public Health, oncologist, University of Wisconsin Carbone Cancer Center, discusses management strategies for fam-trastuzumab deruxtecan-nxki (Enhertu)–induced interstitial lung disease (ILD) in HER2-positive breast cancer.

ILD is a potentially serious toxicity that can arise with trastuzumab deruxtecan, Paplomata says. Patients receiving trastuzumab deruxtecan require thorough examinations.

Typically, grade 1 ILD is asymptomatic and is identified incidentally through scans, Paplomata says. However, in cases of grade 1 ILD, trastuzumab deruxtecan should be held and the patient should be started on steroid treatment.

Patients may resume trastuzumab deruxtecan if the ILD returns to grade 0, says Paplomata. However, patients with grade 2 or greater ILD should stop trastuzumab deruxtecan and start steroids.

Currently, patients who are candidates for trastuzumab deruxtecan are not recommended to undergo pulmonary function tests up front, Paplomata explains.

Patients with a history of lung disease or prior ILD should not be considered for treatment with the agent.

Additionally, patients with central nervous system metastases should receive a TKI versus trastuzumab deruxtecan, concludes Paplomata.