Optimizing Treatment Management of Trastuzumab Deruxtecan in Clinical Practice of Breast Cancer

Trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate targeting HER2, evaluated in the phase II DESTINY-Breast01 and phase III DESTINY-Breast03 trials for HER2-positive unresectable/metastatic breast cancer. It shows a generally manageable safety profile, with common low-grade hematologic and gastrointestinal adverse events. However, interstitial lung disease (ILD)/pneumonitis can be severe. The review focuses on managing adverse events such as nausea, vomiting, neutropenia, infusion-related reactions, alopecia, fatigue, ILD/pneumonitis, and left ventricular dysfunction in these patients. Approximately 20 additional studies are ongoing, including those for HER2-low breast cancer and other solid tumors.