Patient Profile 1: A Patient With HER2+ Metastatic BC Treated With T-DXd who Develops ILD


After reviewing the historical use of ADCs, panelists discuss the first patient profile of HER2+ metastatic breast cancer managed with trastuzumab deruxtecan.


Sarah Donahue, MPH, NP, AOCNP: Hello, and welcome to this OncLive® Peer Exchange, “ADCs in the Treatment of Breast Cancer and Gastric Cancer and Managing Adverse Events Associated With ADCs.” I’m Sarah Donahue. I’m a nurse practitioner at UCSF Helen Diller Family Comprehensive Cancer Center in San Francisco, California. I’m joined today by a panel of colleagues who treat breast cancer and gastric cancer, and I would like to welcome them all. They’ll each say their name now.

Jamie Carroll, APRN, CNP, MSN: Welcome. My name is Jamie Carroll. I’m a nurse practitioner, I specialize in breast cancer, and I work at the Mayo Clinic in Rochester, Minnesota.

Elizabeth Prechtel Dunphy, DNP, CRNP, AOCN: Hi, my name is Liz Prechtel Dunphy. I’m a GI [gastrointestinal] oncology nurse practitioner at the Abramson Cancer Center at Penn Presbyterian Medical Center in Philadelphia, Pennsylvania. In addition to my clinical role, I am also a faculty member at the school of nursing in the oncology minor postmaster certificate program.

Theresa Wicklin Gillespie, PhD, MA, RN, FAAN: Hi, I’m Theresa Gillespie. I’m an oncology nurse and a professor at the Emory University School of Medicine and the Winship Cancer Institute in Atlanta, Georgia.

Sarah Donahue, MPH, NP, AOCNP: Welcome everyone. Let’s get started on the first topic. Antibody-drug conjugates, what are they? These are antibodies that are given IV [intravenously], they have attached to them a drug, chemotherapy, that then gets dumped into the cancer cells. These antibodies bind to a cancer cell and to a specific receptor, they dump their chemotherapy there, and then the chemotherapy acts on the cell. The antibody itself can also act on the cell by preventing that receptor from working.

Historically, the first approved antibody-drug conjugate was gemtuzumab ozogamicin. This antibody-drug conjugate did just like I said, it brought the chemotherapy to the cancer. Now we have several that are approved. We have trastuzumab emtansine, we have trastuzumab deruxtecan, sacituzumab govitecan, there are so many of them. So, we’ll move on now to our first module.

Today we’ll be giving you 4 case studies. The first is a 53-year-old female, she palpates a right breast mass, an ultrasound is ordered, and it shows a 1.8-cm mass as well as an enlarged right axillary node. The biopsy of the breast and the axilla shows hormone-positive or estrogen receptor-positive, HER2-positive, invasive ductal carcinoma. An MRI shows several masses on the right breast with intervening nonmass enhancement involving the entire breast measuring up to 10.4 cm. A CT of the chest, abdomen and pelvis for staging was performed and showed several liver lesions measuring up to 2 cm. She then had a liver biopsy that showed hormone-positive, HER2+, metastatic breast cancer.

She’s then given first-line therapy with docetaxel, trastuzumab, and pertuzumab. After receiving 6 cycles of this, she goes on to restaging scans that show significant improvement in her liver lesions. She stops the docetaxel and continues trastuzumab and pertuzumab alone. We add letrozole at that time. She does really well for 4 years, and she’s having these restaging scans every 6 months by the end of it. But she starts to develop headaches, and an MRI of the brain is done, and it shows numerous brain lesions. Her CT of the chest, abdomen, and pelvis is thankfully stable, and she gets whole brain radiation. She stops the letrozole and pertuzumab, but she continues the trastuzumab, and capecitabine is added as well as tucatinib. Capecitabine is 3500 mg per day for 14 days on, 7 days off, and the tucatinib is 300 mg PO [orally] twice daily.

Six months later, she develops progressive disease in her brain, and she is then started on trastuzumab deruxtecan. Her first CT of the chest, abdomen, and pelvis 3 months later shows consolidations with surrounding ground glass opacities throughout the left lower lobe; she denied shortness of breath and cough. Trastuzumab deruxtecan is held, and prednisone 0.5 mg/kg per day is started with a slow taper, down 10 mg every week. Three weeks later, we perform a repeat CT of the chest, and it shows resolved ground glass opacities, and the consolidations are also resolved. So, the trastuzumab deruxtecan is resumed.

Transcript edited for clarity.

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