Navigating Treatment Sequencing in HER2+ Metastatic Breast Cancer: Evidence-Based Approaches - Episode 3
Expert Perspectives on Navigating Treatment-Related Adverse Events With T-DXd
Panelists discuss how they manage adverse effects of trastuzumab deruxtecan (T-DXd), particularly focusing on nausea, fatigue, and the critical monitoring needed for interstitial lung disease (ILD), with recommendations for prophylactic antiemetics and frequent imaging.
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Clinical Brief: Managing Side Effects of T-DXd
Key Themes:
- Patient Variability: Significant variation in patient tolerance of T-DXd, with some remaining on therapy for years while others experience intolerable toxicity
- Prophylactic Antiemetics: Multiple antiemetics recommended prophylactically with T-DXd administration to manage nausea
- ILD Management: Regular monitoring, patient education, and prompt intervention are critical for managing ILD risk
Key Points for Physicians:
- Employ aggressive prophylactic antiemetics with T-DXd administration
- Monitor for ILD with more frequent imaging (eg, every 9 weeks) than typical treatment protocols
- Educate patients about the importance of identifying grade 1 (asymptomatic) ILD, as grade 2 or higher requires permanent discontinuation
- Inform patients about potential alopecia, which cannot be prevented with cold caps due to the prolonged drug exposure
Notable Insights:
- The “5-S” approach for ILD management: screening, scanning, synergy, suspending treatment, and steroids
- Fatal ILD cases have occurred despite intensive monitoring in clinical trials
- Patient experiences with T-DXd can vary dramatically, with some tolerating it well for years while others experience intolerable toxicity after just a few doses
Clinical Significance:
Successful management of T-DXd therapy requires proactive adverse effect management, vigilant monitoring for ILD, and patient education to maximize treatment benefit while minimizing toxicity and maintaining quality of life.
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