Dr. Powell on Managing Trastuzumab Deruxtecan–Induced ILD in HER2+ Breast Cancer

Charles Powell, MD, MBA, director of the Mount Sinai-National Jewish Health Respiratory Institute, and a professor of medicine, pulmonary, and critical care and sleep medicine at Mount Sinai, discusses managing fam-trastuzumab deruxtecan-nxki (Enhertu)–induced interstitial lung disease (ILD) in HER2-positive breast cancer.

Drug-related lung toxicities can occur with many different oncologic medications, says Powell. According to findings from the phase 2 DESTINY-Breast01 trial (NCT03248492), which the FDA approval of trastuzumab deruxtecan in HER2-positive breast cancer was based on, 2.6% of patients died from treatment-related ILD.

The first step to managing treatment-related ILD is to ensure ILD is detected and diagnosed early, says Powell. Once the diagnosis is confirmed, the drug should be discontinued as soon as possible, Powell adds.

At the time of ILD presentation, it is important to determine the severity of the pneumonitis to determine whether the patient requires additional treatment beyond drug cessation, Powell explains. Generally, low-dose steroids, like prednisone, can be effective in treating ILD, Powell says. For patients with more severe pneumonitis, increasing the steroid dose or adding other agents can be beneficial, concludes Powell.