Proactive ILD Monitoring and Patient Education in ADC Therapy for Breast and Lung Cancer

In this segment, Dr. Hope Rugo and Nurse Practitioners Liz Castronovo and Stephanie McDonald discuss clinical assessment strategies and patient education approaches for monitoring interstitial lung disease (ILD) during antibody-drug conjugate (ADC) therapy. In both breast and lung cancer settings, they advocate proactive ILD surveillance to maximize cancer control while minimizing pulmonary safety risks.

Castronovo addresses the challenge of evaluating respiratory symptoms in lung cancer patients who often present with baseline shortness of breath and cough. She emphasizes establishing familiarity with each patient's baseline status and maintaining a low threshold for CT imaging when changes occur. Her clinical evaluation includes assessing symptom duration, character of cough, ruling out viral infections (e.g., RSV), and using walk tests to detect oxygen desaturation in borderline cases. She notes the importance of ruling out alternative diagnoses such as RSV before attributing symptoms to drug toxicity.

McDonald describes a structured 60-minute education session conducted before treatment initiation, including a baseline physical exam with lung auscultation and lymph node assessment. She reinforces empowering patients to recognize changes from baseline and to promptly contact the care team if they experience a new cough, shortness of breath, unexplained fatigue, or fever.

The team discusses the effectiveness of imaging-driven monitoring to detect grade 1 ILD early, enabling timely steroid interventions and potential rechallenge.

Both clinicians stress that early intervention improves outcomes and helps maintain ADC therapy efficacy. Transparent communication about scan frequency helps patients understand the monitoring rationale—tumor assessment and ILD detection—without creating excessive treatment anxiety.