Common Adverse Events With Trastuzumab Deruxtecan for Breast Cancer

Given the evolving role of trastuzumab deruxtecan (Enhertu) in the treatment of breast cancer, especially those who are HER2 positive, staying vigilant in looking for signs of adverse events (AEs) is crucial, per the recommendation of an expert in the field.

In an interview with Oncology Nursing News, Erica S. Doubleday, MS, FNP-C, BSN, RN, highlighted some of the AEs nurses and APPs should be aware of when working with patients treated with trastuzumab deruxtecan, including interstitial lung disease, nausea, and diarrhea.

Doubleday emphasized that interstitial lung disease is an AE to look for with extra caution, as it can cause death and may not be reported by the patient, while AEs like diarrhea may be more familiar and easily managed for patients.

Doubleday is the director of APPs Oncology Service Line Hematology and Medical Oncology at Ochsner Health System.

Transcript:

So when it comes to Enhertu, obviously we're going to be getting labs on these patients every time we come because we do worry about neutropenia, anemia, and thrombocytopenia. And I think that's something as APPs that we're already—and as nurses—well-versed in.

… The biggest side effect that I think we really need to watch out for with Enhertu is interstitial lung disease. [It’s] very nerve wracking, because it's not the easiest thing to catch. Patients get very anxious when they're short of breath, and they will report it. But then there's some patients that have—they don't want to report [shortness] of breath because they know we're going to stop their treatment. So making sure we're asking those patients [about] any changing in their breathing habits is incredibly important.

And then holding the treatment and starting with steroids is something that, as providers, as nurses, we can make those recommendations, because interstitial lung disease, if we don't treat it, it is deadly.

… A couple of the other side effect managements [is] nausea. Again, I think that’s something we’re well-versed in. We use a lot of olanzapine where I work, and that's really been a game changer for us in terms of controlling the nausea for the patients, so I highly recommend doing that. The other thing that I've had to supplement with is additional fluids.

… But those are probably the key side effects that I've seen. We always know diarrhea is also a possibility, but these patients that are HER2-postive are so used to diarrhea.…They've been through the gambit of medications that cause diarrhea, so I feel like most of them already have a really good hold on it.

This transcript has been edited for clarity and conciseness.