ILD Monitoring in HER2-Positive Early Breast Cancer

Dr. Jason Mouabbi and Dr. Ruta Rao discuss balancing the efficacy of T-DXd with safety considerations in the treatment of HER2-positive early breast cancer, with particular emphasis on interstitial lung disease (ILD) in the curative setting. Dr. Rao highlights the importance of assessing ILD risk factors, educating patients and the treatment team, and coordinating with radiologists to support timely identification of pulmonary findings. She discusses the distinction between asymptomatic radiographic ILD and symptomatic disease, noting the different implications for continuation or discontinuation of T-DXd. Dr. Mouabbi emphasizes the importance of the structured CT monitoring used in DESTINY-Breast05, including baseline and follow-up imaging, particularly in patients receiving radiation therapy. The physicians also discuss the need for collaboration among medical oncology, radiology, and radiation oncology teams because radiation-related pulmonary changes can complicate interpretation of imaging. The segment reinforces careful monitoring and multidisciplinary coordination as important components of safely incorporating T-DXd into HER2-positive early breast cancer treatment.