Dr. Olajide on Managing Risk of Interstitial Lung Disease With Trastuzumab Deruxtecan in Breast Cancer

Oludamilola (Lola) A. Olajide, MD, adjunct professor and medical oncologist, Rex Cancer Center, UNC Health, discusses managing the risk of interstitial lung disease (ILD) with fam-trastuzumab deruxtecan-nxki (Enhertu) in breast cancer.

The FDA granted an accelerated approval to trastuzumab deruxtecan in December 2019 for the treatment of patients with unresectable or metastatic HER2-positive breast cancer who have received ≥2 prior anti—HER2-based regimens in the metastatic setting. The approval was based on findings from the phase II DESTINY-Breast01 trial, in which trastuzumab deruxtecan elicited a 60.3% objective response rate.

Of note, 13.6% of the 184 patients treated experienced treatment-related ILD in the DESTINY-Breast01 trial, says Olajide. While subsequent trials suggest a 2% risk of developing ILD with the agent, the toxicity can be fatal.

As such, patient screening and careful monitoring is critical, says Olajide. Additionally, educating patients on the potential toxicity is important so they can inform on-call physicians in the emergency room.

Should ILD occur, treatment with trastuzumab deruxtecan should be stopped and steroids should be initiated, says Olajide. Importantly, pulmonologists should be consulted if patients do not respond to steroids.