Managing Toxicities and Ensuring Safe Delivery of HER2-Targeted Therapy in Patients with HER2-Mutated NSCLC

This segment focuses on the practical, day-to-day management of treatment-related toxicities across HER2-targeted therapies. Dr. Patel introduces the spectrum of adverse events associated with both ADCs and TKIs, including cardiac dysfunction, GI disturbances, dermatologic toxicities, CNS effects, and liver enzyme elevations.

Dr. Riess outlines his monitoring strategy for trastuzumab deruxtecan (T-DXd), which includes routine echocardiograms to evaluate for potential cardiac dysfunction. He also highlights the importance of vigilance for pneumonitis, a known but manageable risk with ADCs, requiring prompt recognition, drug holds, and corticosteroids when indicated.

For TKIs such as zongertinib, early-phase liver enzyme abnormalities and dermatologic toxicity are noted as common but manageable with dose modifications. The speakers emphasize structured follow-up during the first two months of therapy: visits every two weeks, frequent laboratory monitoring, and close coordination with advanced practitioners and pharmacists.

The discussion reinforces the value of multidisciplinary support, as proactive toxicity management enables patients to remain on therapy longer and derive maximum benefit. Dr. Riess explains that individualized approaches, including dose holds, reductions, and supportive medications, are often necessary to maintain safety without compromising efficacy.

This segment conveys a practical message: although HER2-targeted therapies offer substantial clinical benefit, safe and effective use requires structured monitoring, early intervention, and coordinated care.