Expert Perspectives on Navigating Treatment-Related Adverse Events With T-DXd

Clinical Brief: Managing Side Effects of T-DXd

Key Themes:

• Patient Variability: Significant variation in patient tolerance of T-DXd, with some remaining on therapy for years while others experience intolerable toxicity
• Prophylactic Antiemetics: Multiple antiemetics recommended prophylactically with T-DXd administration to manage nausea
• ILD Management: Regular monitoring, patient education, and prompt intervention are critical for managing ILD risk

Key Points for Physicians:

• Employ aggressive prophylactic antiemetics with T-DXd administration
• Monitor for ILD with more frequent imaging (eg, every 9 weeks) than typical treatment protocols
• Educate patients about the importance of identifying grade 1 (asymptomatic) ILD, as grade 2 or higher requires permanent discontinuation
• Inform patients about potential alopecia, which cannot be prevented with cold caps due to the prolonged drug exposure

Notable Insights:

• The “5-S” approach for ILD management: screening, scanning, synergy, suspending treatment, and steroids
• Fatal ILD cases have occurred despite intensive monitoring in clinical trials
• Patient experiences with T-DXd can vary dramatically, with some tolerating it well for years while others experience intolerable toxicity after just a few doses

Clinical Significance:

Successful management of T-DXd therapy requires proactive adverse effect management, vigilant monitoring for ILD, and patient education to maximize treatment benefit while minimizing toxicity and maintaining quality of life.