Clinical Guidance on the Monitoring and Management of Trastuzumab Deruxtecan (T-DXd)-Related Adverse Events: Insights from an Asia-Pacific Multidisciplinary Panel

    August 2023 in “ Drug safety ”
    Joanne Chiu, Soo Chin Lee, J. C. Ho, Yeon Hee Park, Ta‐Chung Chao, Sung‐Bae Kim, Elgene Lim, Ching‐Hung Lin, Sherene Loi, Su Ying Low, Lynette Ls Teo, Yeon Hee Park, Rebecca Dent
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    TLDR Proactive monitoring and management are essential to maximize the benefits of Trastuzumab Deruxtecan while minimizing serious side effects.
    Trastuzumab deruxtecan (T-DXd) has shown improved outcomes for patients with HER2-positive and HER2-low metastatic breast cancer, but managing its adverse events (AEs) in real-world practice presents challenges. A panel of 13 Asia-Pacific experts provided recommendations based on the DESTINY-Breast trials and regional healthcare considerations. They emphasized proactive monitoring and management to maximize T-DXd benefits, particularly for serious AEs like interstitial lung disease (ILD)/pneumonitis, recommending regular CT scans. T-DXd is highly emetic, so prophylaxis with serotonin receptor antagonists and dexamethasone is advised. Vigilance for treatable fatigue causes and patient awareness of alopecia risk are also crucial. Detailed AE management strategies are discussed.
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