Patient Profile 4: Managing AEs in Patients Receiving Treatment for HER2+ BC


A brief discussion on optimally managing adverse events while treating patients with HER2+ breast cancer.

Shanu Modi, MD:
But of course, there are other toxicities of T-DXd [trastuzumab deruxtecan] that we should talk about. You briefly mentioned nausea and this comes up a lot. Has your center or do you all approach these patients with prophylactic antiemetics or do you wait for people to develop nausea? How do you do it at your place?

Sara Tolaney, MD, MPH: We do use prophylactic antiemetics. Most of us will use either something like Decadron® with ondansetron or Decadron Aloxi®, palonosetron hydrochloride some people escalate to Decadron Aloxi® in men if they issues but then it’s that sort of after that 3 to 5 days after being on treatment I still see the nausea on week 2 and sometimes on week 3, so using ondansetron as needed in week 2 and week 3 I have found to be beneficial to patients. It’s important when they start so they realize that nausea can still occur in a delayed manner and just warning them and making sure they are prepared. How has your group been doing that?

Shanu Modi, MD: Very similar. Given the incidence of nausea, it’s a moderately emetogenic regimen,our standard is as you alluded to is to use long-acting 5-HT3 antagonist and some steroids and most of the patients will go home with script for Zofran® or ondansetron or something like that. For the majority of people that works pretty well. There are always those occasional patients who still need something more, good to have some backup plans. What about the hair thinning issue? Is that come up, is that a reason that some patients decline T-DXd therapy? I've have had at least one patient tell me she wanted to put it off because she wasn’t ready to potentially lose her hair.

Sara Tolaney, MD, MPH: It’s interesting. I just had this discussion a month or so ago with this incredible patient I have that’s a nurse who has two young children who she hasn’t told that she has metastatic disease. And she’s- did scalp cooling with THP and never lost her hair and did great. And then when I brought up T-DXd as second-line and obviously there’s an alternative with other things like we talked about T-DM1 or capecitabine. But obviously my preference in her, she had visceral disease of this to think about T-DXd here. We had this whole conversation and about it, 10% sort of grade 2 alopecia rate. But most people don’t lose their hair and are fine on T-DXd. We have a trial with scalp cooling for T-DXd, and.

Shanu Modi, MD: I was going to ask if you can share any early results for all of that.

Sara Tolaney, MD, MPH: It’s so hard because obviously how do I know if it’s really working or not in a sense that most people do keep their hair. I don't know if it’s benefits but she’s kept her hair with the scalp cooling. But again, who knows if that’s because of scalp cooling or she would’ve kept it anyway. But she’s been doing it and thank goodness it’s been nice for her. It’s made her feel much more comfortable with things at home too.

Transcript edited for clarity.

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