Would you hold off using fam-trastuzumab deruxtecan-nxki in malignant pleural effusion?
Malignant pleural effusion is itself a risk factor for developing T-DXd-induced pneumonitis (OR 2.50) and is associated with higher-grade pneumonitis events. Yang et al., JCO 2026
Is there a specific threshold of comfort level to initiate Enhertu in the setting of malignant pleural effusion?
How would you monitor, or what is your approach in decision-making?
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Would you hold off using fam-trastuzumab deruxtecan-nxki (Enhertu) in malignant pleural effusion?
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2 Answers
Mednet MemberInvited Expert
Medical Oncology · University of Colorado Cancer Center
Answered on
No. While there may be a higher risk of higher-grade pulmonary adverse events in patients with pleural effusions, some of this is related to the impaired pulmonary function (e.g., loss of volume, lower flexibility of the lung tissue) and also the possible/probable involvement of intrapulmonary lymph...
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Mednet MemberInvited Expert
Medical Oncology · Ohio State University
Answered on
My decision on whether or not to use T-DXd in this situation would heavily depend on the patient's comorbidities, symptoms, and other radiographic findings. If the patient's dyspnea related to malignant pleural effusion is relieved with thoracentesis, she has no prior history of pulmonary disorders,...
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