Optimizing treatment management of trastuzumab deruxtecan in clinical practice of breast cancer

ESMO Open

article

H.S. Rugo¹  G. Bianchini²  J. Cortes⁴  J.-W. Henning⁷  M. Untch⁸ 

[1] University of California San Francisco Helen Diller Family Comprehensive Cancer Center;IRCCS Ospedale San Raffaele;Università Vita-Salute San Raffaele;Oncology Department, International Breast Cancer Center ,(IBCC), Quiron Group;Medica Scientia Innovation Research;Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid;Tom Baker Cancer Centre, University of Calgary;Helios Klinikum Berlin-Buch

关键词: trastuzumab deruxtecan;    adverse event;    breast cancer;    nausea;    vomiting;    interstitial lung disease;   

DOI  :  10.1016/j.esmoop.2022.100553

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Introduction The antibody-drug conjugate trastuzumab deruxtecan (T-DXd) targets human epidermal growth factor receptor 2 (HER2) and has been evaluated in patients with HER2-positive unresectable/metastatic breast cancer in the phase II DESTINY-Breast01 trial (NCT03248492; DS8201-A-U201) and the randomized phase III DESTINY-Breast03 trial (NCT03529110; DS8201-A-U302). Approximately 20 additional studies are ongoing in breast cancer, including HER2-low breast cancer, and other solid tumor types within the DESTINY trial program. T-DXd has demonstrated a generally manageable safety profile, with low-grade hematologic and gastrointestinal adverse events (AEs) among the most common; interstitial lung disease (ILD)/pneumonitis has been observed in patients receiving T-DXd and can be severe. This review discusses the management of common AEs and AEs of special interest in patients with HER2-positive unresectable/metastatic breast cancer, including nausea and vomiting, neutropenia, infusion-related reactions, alopecia, fatigue, ILD/pneumonitis, and left ventricular dysfunction.Methods Expert opinions, institutional protocols, and strategies to help optimize AE management and maximize the potential benefits of T-DXd in patients with breast cancer from five oncologists treating patients with T-DXd in North America and Europe are discussed.Results Prophylaxis for nausea and vomiting and proactive management of ILD/pneumonitis are especially important in treating patients with T-DXd. Management strategies for other T-DXd-related AEs of interest (e.g. neutropenia, infusion-related reactions, alopecia, fatigue, and left ventricular dysfunction) are also discussed.Conclusions This review provides context for understanding the usage, monitoring, and management practices of other health care providers and institutions with experience using T-DXd to help with safe and effective management of T-DXd-related AEs, particularly since the duration of T-DXd treatment may be quite long. Proper management of T-DXd-related AEs will allow optimal exposure and benefit from T-DXd and will help avoid premature discontinuation or improper dose reductions.

【 授权许可】

CC BY|CC BY-NC-ND