How do you monitor for pulmonary toxicity for patients on trastuzumab deruxtecan?

Eligibility criteria for T-DXd trials were based on clinical history and not on objective findings such as PFTs or radiographic criteria. Therefore, risk for factors for T-DXd-related ILD or other pulmonary toxicity are not at all clear, although they may emerge with larger pooled safety analyses an...

ILD is certainly a concern for the new generation of ADC affecting the HER family member receptors especially for a new drug such as trastuzumab deruxtecan, where the drug is quite effective but can cause up to 15% ILD and up to 15-16% of them being fatal; the monitoring of ILD is quite critical.

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The best way to monitor for pulmonary toxicity consists on, first of all, advising the patient to talk to the physician if any symptom appears (dyspnea, cough, etc.). In addition, it is very important to look at the follow-up CT scans carefully to detect any signs of grade 1ILD/pneumonitis. To the b...

So far, the limited data shows a higher risk for the heavily pretreated patient population, for patients with prior history of interstitial lung disease, and for patients of Japanese origin. Proposed mechanisms of trastuzumab deruxtecan-related lung injury are: target-dependent uptake, target-indepe...

I am not aware of any published data or recommendations regarding PFTs prior to or during treatment with T-DXd. In my practice, I monitor closely for new pulmonary symptoms while on therapy and instruct patients to as well. Unfortunately, I have encountered ILD in patients treated with T-DXd. These ...