Dr. Sam on Managing ILD With Trastuzumab Deruxtecan in HER2+ Breast Cancer

Christine Sam, MD, assistant member, Department of Individualized Cancer Management/Senior Adult Oncology Program, Moffitt Cancer Center, shares strategies to manage interstitial lung disease (ILD) experienced with fam-trastuzumab deruxtecan-nxki (Enhertu) in patients with HER2-positive breast cancer.

ILD continues to be a risk for patients with HER2-positive breast cancer who have received treatment with this antibody-drug conjugate. Early recognition and staying vigilant about this adverse effect is key, according to Sam. Grade 1 ILD is considered to be asymptomatic, but if there is any concern like fibrosis or concern for ILD on imaging, then it must be worked up immediately, Sam says. There can be other causes for the appearance of ILD on imaging, but if it is determined to be because of the drug, then the treatment must be held, Sam explains.

If the effect proves to be asymptomatic, then the agent can be reintroduced upon resolution of the effect, Sam adds. If symptomatic, the treatment must be discontinued. Moreover, for any patient who has symptomatic ILD, early treatment is important. They should receive high-dose steroids, administered over a long taper, to ensure the resolution of symptoms, Sam concludes.