Safety, ILD Monitoring, and the Future of HER2-Positive Breast Cancer Care

Segment 5 addresses safety considerations, particularly interstitial lung disease (ILD), and concludes with reflections on the future of HER2-positive breast cancer treatment. The panel contrasts ILD rates observed in metastatic trials, where T-DXd was given for prolonged durations, with the much lower rates seen in neoadjuvant settings using limited cycles. DESTINY-Breast11 demonstrated ILD rates of approximately 4–5%, reinforcing the importance of treatment duration and vigilant monitoring.

Strategies for ILD surveillance are discussed, including regular imaging every 6 weeks in curative-intent settings and heightened awareness when combining systemic therapy with radiation. Data from DESTINY-Breast05 revealed notable rates of radiation pneumonitis when closely monitored, highlighting the importance of proactive assessment and early steroid intervention. The panelists emphasize that prompt recognition and management are critical to minimizing serious outcomes.

Supportive care advances are also highlighted, with olanzapine described as a highly effective option for managing delayed nausea associated with T-DXd. The discussion concludes on an optimistic note, emphasizing that recent trial results represent a new era in HER2-positive breast cancer, with unprecedented improvements in survival, disease control, and personalization of care across both metastatic and curative settings.