Clinical Guidance on the Monitoring and Management of Trastuzumab Deruxtecan (T-DXd)-Related Adverse Events: Insights from an Asia-Pacific Multidisciplinary Panel
- Author(s)
- Chiu, JWY; Lee, SC; Ho, JC; Park, YH; Chao, TC; Kim, SB; Lim, E; Lin, CH; Loi, S; Low, SY; Teo, LLS; Yeo, W; Dent, R;
- Journal Title
- Drug Safety
- Publication Type
- Review
- Abstract
- Trastuzumab deruxtecan (T-DXd)-an antibody-drug conjugate targeting the human epidermal growth factor receptor 2 (HER2)-improved outcomes of patients with HER2-positive and HER2-low metastatic breast cancer. Guidance on monitoring and managing T-DXd-related adverse events (AEs) is an emerging unmet need as translating clinical trial experience into real-world practice may be difficult due to practical and cultural considerations and differences in health care infrastructure. Thus, 13 experts including oncologists, pulmonologists and a radiologist from the Asia-Pacific region gathered to provide recommendations for T-DXd-related AE monitoring and management by using the latest evidence from the DESTINY-Breast trials, our own clinical trial experience and loco-regional health care considerations. While subgroup analysis of Asian (excluding Japanese) versus overall population in the DESTINY-Breast03 uncovered no major differences in the AE profile, we concluded that proactive monitoring and management are essential in maximising the benefits with T-DXd. As interstitial lung disease (ILD)/pneumonitis is a serious AE, patients should undergo regular computed tomography scans, but the frequency may have to account for the median time of ILD/pneumonitis onset and access. Trastuzumab deruxtecan appears to be a highly emetic regimen, and prophylaxis with serotonin receptor antagonists and dexamethasone (with or without neurokinin-1 receptor antagonist) should be considered. Health care professionals should be vigilant for treatable causes of fatigue, and patients should be encouraged to use support groups and practice low-intensity exercises. To increase treatment acceptance, patients should be made aware of alopecia risk prior to starting T-DXd. Detailed monitoring and management recommendations for T-DXd-related AEs are discussed further.
- Publisher
- Springer Nature
- Keywords
- Humans; Asia; *Immunoconjugates; *Lung Diseases, Interstitial; *Pneumonia
- Department(s)
- Medical Oncology
- PubMed ID
- 37552439
- Publisher's Version
- https://doi.org/10.1007/s40264-023-01328-x
- Open Access at Publisher's Site
10.1007/s40264-023-01328-x- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2023-10-25 06:32:59
Last Modified: 2024-07-10 06:24:55