Nurses, Talk AEs, Interstitial Lung Disease, Before Treating With T-DXd

Before starting them on trastuzumab deruxtecan (T-DXd; Enhertu), oncology nurses should discuss the use of anti-emetics as well as the potential for hair loss and interstitial lung disease with their patients, explained Nancy U. Lin, MD.

Lin is a professor of Medicine at Harvard Medical School and a medical oncologist at the Dana-Farber Cancer Institute in Boston. At the 2024 ESMO Congress, she discussed findings from the phase 3b/4 DESTINYBreast-12 trial, which showed that trastuzumab deruxtecan led to promising response rates and progression-free survival in patients with HER2-positive metastatic breast cancer—even in the presence of brain metastases.

READ MORE: T-DXd Demonstrated Intracranial Activity in HER2+ Breast Cancer

However, trastuzumab deruxtecan can lead to nausea/vomiting, hair loss, and interstitial lung disease. Oncology nurses can be instrumental in discussing these adverse events with patients before they start therapy so that they know what to expect. In particular, it is essential that patients and their loved ones know the signs of interstitial lung disease, which can include shortness of breath and cough, Lin said.

Transcript

Before starting a patient on [trastuzumab deruxtecan], I think some of the highlights for counseling include teaching about antiemetic regimens and antiemetic use, making sure that patients are properly pre-medicated and that they understand what to do if they have nausea following the infusion.

The other important consideration is just to remind people about the potential for hair loss with [trastuzumab deruxtecan], because that obviously, is something that you don't want patients to be surprised by. About 25 to 30% of patients will lose their hair with [trastuzumab deruxtecan]; not everybody will.

And finally, is the risk of interstitial lung disease. So the symptoms of this are shortness of breath and cough. It's very important that patients are counseled about this. If they're on vacation, if they're traveling, or they're going to an emergency room that doesn't know them or doesn't know about [trastuzumab deruxtecan] they really need to be sensitized to this, because it's so important to treat [interstitial lung disease] and manage it properly from the get go to prevent bad outcomes.

Reference

1. Lin NU, Ciruelos E, Jerusalem G, et al. Trastuzumab deruxtecan in patients with HER2+ advanced/metastatic breast cancer with or without brain metastases: DESTINY-Breast12 primary results. Presented at: 2024 ESMO Congress; September 13-17, 2024; Barcelona, Spain. Presentation LBA18.