Comprehensive management strategy of interstitial lung disease induced by trastuzumab deruxtecan
Trastuzumab deruxtecan (T-DXd) has demonstrated significant efficacy in clinical trials for human epidermal growth factor receptor 2 (HER2)-expressing breast cancer, gastric cancer, lung cancer and other solid tumors. Its overall safety profile is manageable and tolerable, including the clinically c...
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Editorial Office of China Oncology
2024-12-01
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| Series: | Zhongguo aizheng zazhi |
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| Online Access: | http://www.china-oncology.com/fileup/1007-3639/PDF/1737446449820-1755203622.pdf |
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| author | ZHANG Jian, HAN Qian, XU Fei, GAN Lu, CHEN Zhanhong, MA Li, WANG Hao, LIU Jieqiong, WU Xiaohong, CAI Li, ZHAO Bing, LÜ Zheng, LI Li, NI Sujie, HU Xichun |
| author_facet | ZHANG Jian, HAN Qian, XU Fei, GAN Lu, CHEN Zhanhong, MA Li, WANG Hao, LIU Jieqiong, WU Xiaohong, CAI Li, ZHAO Bing, LÜ Zheng, LI Li, NI Sujie, HU Xichun |
| author_sort | ZHANG Jian, HAN Qian, XU Fei, GAN Lu, CHEN Zhanhong, MA Li, WANG Hao, LIU Jieqiong, WU Xiaohong, CAI Li, ZHAO Bing, LÜ Zheng, LI Li, NI Sujie, HU Xichun |
| collection | DOAJ |
| description | Trastuzumab deruxtecan (T-DXd) has demonstrated significant efficacy in clinical trials for human epidermal growth factor receptor 2 (HER2)-expressing breast cancer, gastric cancer, lung cancer and other solid tumors. Its overall safety profile is manageable and tolerable, including the clinically concerning interstitial lung disease (ILD). The etiology of ILD is varied, among which drug-induced ILD is an exclusionary diagnosis. The incidence of ILD caused by different antitumor drugs varies with different symptoms, and the pathogenesis remains unclear. T-DXd-induced ILD is mostly Grades 1-2, and implementing a standardized clinical management protocol can reduce the incidence of severe ILD events, improve patient prognosis, and help maximize the clinical benefits of T-DXd. This article summarized the epidemiology, etiology, risk factors, and potential mechanisms of drug-induced ILD, with a focus on the incidence, time to onset, and outcomes of T-DXd-induced ILD after standardized clinical management. It aimed to help readers understand the importance of standardized clinical management before and during T-DXd treatment. Regarding specific clinical management strategies, the article reviewed comprehensive management approaches for T-DXd-induced ILD based on clinical trial protocols and real-world experiences from both domestic and international perspectives, covering patient screening, patient education, ILD monitoring, diagnosis, and treatment. Before initiating T-DXd treatment, patient screening helps identify those at high risk for ILD, and T-DXd should be used cautiously in these high-risk patients. Effective patient education can enhance patient initiative, encouraging them to promptly report suspected symptoms, which contributes to early identification of ILD. During T-DXd treatment, it is important to regularly monitor symptoms and signs related to ILD, implement regular imaging monitoring and leverage multidisciplinary team collaboration to diagnose ILD as early as possible, thereby minimizing the risk of severe ILD. If symptoms or imaging suggest ILD, T-DXd treatment must be immediately interrupted, and relevant examinations should be completed to rule out other possible causes while considering corticosteroid treatment. Upon ILD diagnosis, subsequent T-DXd dose adjustments, corticosteroid therapy, and supportive treatments should be guided by severity. The article also explored whether patients with T-DXd-induced ILD can be re-treated, concluding that Grade 1 ILD patients might be eligible for re-treatment under specific conditions. In conclusion, the article reviewed the epidemiology, characteristics, clinical trial-recommended management strategies, and real-world management measures of T-DXd-induced ILD, integrating clinical expert experiences to summarize and discuss comprehensive management strategies for it. This aimed to enhance clinicians' understanding of T-DXd-induced ILD and provide valuable insights for early identification, timely diagnosis, and proper management of it. |
| format | Article |
| id | doaj-art-fe7f302db58143d58c02159540a8a34a |
| institution | DOAJ |
| issn | 1007-3639 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Editorial Office of China Oncology |
| record_format | Article |
| series | Zhongguo aizheng zazhi |
| spelling | doaj-art-fe7f302db58143d58c02159540a8a34a2025-08-20T02:53:54ZengEditorial Office of China OncologyZhongguo aizheng zazhi1007-36392024-12-0134121067107910.19401/j.cnki.1007-3639.2024.12.001Comprehensive management strategy of interstitial lung disease induced by trastuzumab deruxtecanZHANG Jian, HAN Qian, XU Fei, GAN Lu, CHEN Zhanhong, MA Li, WANG Hao, LIU Jieqiong, WU Xiaohong, CAI Li, ZHAO Bing, LÜ Zheng, LI Li, NI Sujie, HU Xichun01. Department of Oncology, Fudan University Shanghai Cancer Center, Department of Medical Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China;2. Society of Oncology Drug Clinical Research, Shanghai Anticancer Association, Shanghai 200032, China;3. Department of Respiratory, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease, Guangzhou 510120, Guangdong Province, China;4. Department of Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510000, Guangdong Province, China;5. Department of Oncology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China;6. Department of Breast Internal Medicine, Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang Province, China;7. Breast Disease Center, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China;8. Department of Breast Surgery, Sichuan Cancer Hospital, Chengdu 610041, Sichuan Province, China;9. Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China;10. Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi 214122, Jiangsu Province, China;11. Department of Oncology, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China;12. Department of Breast Internal Medicine, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China;13. Department of Oncology, the First Bethune Hospital of Jilin University, Changchun 130021, Jilin Province, China;14. Department of Oncology, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China;15. Department of Oncology Chemotherapy, Affiliated Hospital of Nantong University, Nantong 226006, Jiangsu Province, ChinaTrastuzumab deruxtecan (T-DXd) has demonstrated significant efficacy in clinical trials for human epidermal growth factor receptor 2 (HER2)-expressing breast cancer, gastric cancer, lung cancer and other solid tumors. Its overall safety profile is manageable and tolerable, including the clinically concerning interstitial lung disease (ILD). The etiology of ILD is varied, among which drug-induced ILD is an exclusionary diagnosis. The incidence of ILD caused by different antitumor drugs varies with different symptoms, and the pathogenesis remains unclear. T-DXd-induced ILD is mostly Grades 1-2, and implementing a standardized clinical management protocol can reduce the incidence of severe ILD events, improve patient prognosis, and help maximize the clinical benefits of T-DXd. This article summarized the epidemiology, etiology, risk factors, and potential mechanisms of drug-induced ILD, with a focus on the incidence, time to onset, and outcomes of T-DXd-induced ILD after standardized clinical management. It aimed to help readers understand the importance of standardized clinical management before and during T-DXd treatment. Regarding specific clinical management strategies, the article reviewed comprehensive management approaches for T-DXd-induced ILD based on clinical trial protocols and real-world experiences from both domestic and international perspectives, covering patient screening, patient education, ILD monitoring, diagnosis, and treatment. Before initiating T-DXd treatment, patient screening helps identify those at high risk for ILD, and T-DXd should be used cautiously in these high-risk patients. Effective patient education can enhance patient initiative, encouraging them to promptly report suspected symptoms, which contributes to early identification of ILD. During T-DXd treatment, it is important to regularly monitor symptoms and signs related to ILD, implement regular imaging monitoring and leverage multidisciplinary team collaboration to diagnose ILD as early as possible, thereby minimizing the risk of severe ILD. If symptoms or imaging suggest ILD, T-DXd treatment must be immediately interrupted, and relevant examinations should be completed to rule out other possible causes while considering corticosteroid treatment. Upon ILD diagnosis, subsequent T-DXd dose adjustments, corticosteroid therapy, and supportive treatments should be guided by severity. The article also explored whether patients with T-DXd-induced ILD can be re-treated, concluding that Grade 1 ILD patients might be eligible for re-treatment under specific conditions. In conclusion, the article reviewed the epidemiology, characteristics, clinical trial-recommended management strategies, and real-world management measures of T-DXd-induced ILD, integrating clinical expert experiences to summarize and discuss comprehensive management strategies for it. This aimed to enhance clinicians' understanding of T-DXd-induced ILD and provide valuable insights for early identification, timely diagnosis, and proper management of it.http://www.china-oncology.com/fileup/1007-3639/PDF/1737446449820-1755203622.pdf|interstitial lung disease|trastuzumab deruxtecan|management |
| spellingShingle | ZHANG Jian, HAN Qian, XU Fei, GAN Lu, CHEN Zhanhong, MA Li, WANG Hao, LIU Jieqiong, WU Xiaohong, CAI Li, ZHAO Bing, LÜ Zheng, LI Li, NI Sujie, HU Xichun Comprehensive management strategy of interstitial lung disease induced by trastuzumab deruxtecan Zhongguo aizheng zazhi |interstitial lung disease|trastuzumab deruxtecan|management |
| title | Comprehensive management strategy of interstitial lung disease induced by trastuzumab deruxtecan |
| title_full | Comprehensive management strategy of interstitial lung disease induced by trastuzumab deruxtecan |
| title_fullStr | Comprehensive management strategy of interstitial lung disease induced by trastuzumab deruxtecan |
| title_full_unstemmed | Comprehensive management strategy of interstitial lung disease induced by trastuzumab deruxtecan |
| title_short | Comprehensive management strategy of interstitial lung disease induced by trastuzumab deruxtecan |
| title_sort | comprehensive management strategy of interstitial lung disease induced by trastuzumab deruxtecan |
| topic | |interstitial lung disease|trastuzumab deruxtecan|management |
| url | http://www.china-oncology.com/fileup/1007-3639/PDF/1737446449820-1755203622.pdf |
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