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Optimizing Outcomes in Ovarian and Endometrial Cancers: The Role of Antibody-Drug Conjugates - Episode 7

Navigating T-DXd-Related Toxicity: Mitigation and Management Strategies in Gynecological Cancer

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Panelists discuss how managing interstitial lung disease (ILD) associated with antibody-drug conjugates (ADCs) such as mirvetuximab soravtansine requires proactive monitoring, including baseline and ongoing chest CT scans, early intervention with steroids, and close collaboration with pulmonologists and radiologists to minimize risks and ensure patient safety during treatment.

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In managing adverse events such as ILD, which can be associated with several ADCs such as mirvetuximab soravtansine, there is an emphasis on vigilance and proactive management strategies. Kathleen Moore, MD, MS, stresses that ILD is a concern not just with one specific drug but with many ADCs in development, and it is crucial to be aware of it with agents such as deruxtecan as well. Monitoring for ILD starts with a thorough review of the patient’s baseline chest CT, even if the clinician is not a radiologist. This helps assess the lung status and detect any subtle abnormalities, such as ground glass opacities or fibrotic changes, which could indicate a risk for pneumonitis.

Once therapy begins, it is critical to track any changes in the lungs, especially in patients with a history of immunotherapy or previous ADC treatments such as mirvetuximab soravtansine. If any new inflammatory changes are observed on imaging, clinical correlation is essential. Even if the patient feels fine and reports symptom improvement, it is crucial to err on the side of caution. In such cases, a referral to a pulmonologist is recommended for further evaluation. Early recognition and intervention with steroids are key strategies, as they can help mitigate potential complications and reduce the risk of long-term damage.

Ritu Salani, MD, MBA, adds that setting clear expectations with patients about the possibility of holding therapy in case of concerns helps manage their expectations and encourages cooperation. As part of her own practice, she employs high-resolution CT scans every 6 weeks, reviewing them closely with the pulmonologist and radiologist to ensure that any early signs of ILD are detected and managed promptly.

In short, the key to managing ILD with ADCs is thorough baseline and ongoing monitoring, proactive communication with pulmonologists and radiologists, and careful use of steroids to address any inflammatory changes. By taking these steps, clinicians can help ensure that the risks of ILD are minimized while continuing to offer the potential benefits of these promising therapies.

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