PMID- 37552439
OWN - NLM
STAT- MEDLINE
DCOM- 20231023
LR  - 20231023
IS  - 1179-1942 (Electronic)
IS  - 0114-5916 (Print)
IS  - 0114-5916 (Linking)
VI  - 46
IP  - 10
DP  - 2023 Oct
TI  - Clinical Guidance on the Monitoring and Management of Trastuzumab Deruxtecan 
      (T-DXd)-Related Adverse Events: Insights from an Asia-Pacific Multidisciplinary 
      Panel.
PG  - 927-949
LID - 10.1007/s40264-023-01328-x [doi]
AB  - Trastuzumab deruxtecan (T-DXd)-an antibody-drug conjugate targeting the human 
      epidermal growth factor receptor 2 (HER2)-improved outcomes of patients with 
      HER2-positive and HER2-low metastatic breast cancer. Guidance on monitoring and 
      managing T-DXd-related adverse events (AEs) is an emerging unmet need as 
      translating clinical trial experience into real-world practice may be difficult 
      due to practical and cultural considerations and differences in health care 
      infrastructure. Thus, 13 experts including oncologists, pulmonologists and a 
      radiologist from the Asia-Pacific region gathered to provide recommendations for 
      T-DXd-related AE monitoring and management by using the latest evidence from the 
      DESTINY-Breast trials, our own clinical trial experience and loco-regional health 
      care considerations. While subgroup analysis of Asian (excluding Japanese) versus 
      overall population in the DESTINY-Breast03 uncovered no major differences in the 
      AE profile, we concluded that proactive monitoring and management are essential 
      in maximising the benefits with T-DXd. As interstitial lung disease 
      (ILD)/pneumonitis is a serious AE, patients should undergo regular computed 
      tomography scans, but the frequency may have to account for the median time of 
      ILD/pneumonitis onset and access. Trastuzumab deruxtecan appears to be a highly 
      emetic regimen, and prophylaxis with serotonin receptor antagonists and 
      dexamethasone (with or without neurokinin-1 receptor antagonist) should be 
      considered. Health care professionals should be vigilant for treatable causes of 
      fatigue, and patients should be encouraged to use support groups and practice 
      low-intensity exercises. To increase treatment acceptance, patients should be 
      made aware of alopecia risk prior to starting T-DXd. Detailed monitoring and 
      management recommendations for T-DXd-related AEs are discussed further.
CI  - (c) 2023. The Author(s).
FAU - Chiu, Joanne Wing Yan
AU  - Chiu JWY
AUID- ORCID: 0000-0002-8320-3166
AD  - The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, 
      Hong Kong. jwychiu@hku.hk.
FAU - Lee, Soo Chin
AU  - Lee SC
AUID- ORCID: 0000-0002-5835-6419
AD  - National University Cancer Institute Singapore, National University Health 
      System, Singapore, Singapore.
FAU - Ho, James Chung-Man
AU  - Ho JC
AUID- ORCID: 0000-0003-4499-5284
AD  - The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, 
      Hong Kong.
FAU - Park, Yeon Hee
AU  - Park YH
AUID- ORCID: 0000-0003-4156-9212
AD  - Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South 
      Korea.
FAU - Chao, Ta-Chung
AU  - Chao TC
AUID- ORCID: 0000-0003-1451-1939
AD  - Division of Medical Oncology, Department of Oncology, Faculty of Medicine, Taipei 
      Veterans General Hospital, School of Medicine, National Yang Ming Chiao Tung 
      University, Taipei, Taiwan.
FAU - Kim, Sung-Bae
AU  - Kim SB
AUID- ORCID: 0000-0001-5588-8332
AD  - Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
FAU - Lim, Elgene
AU  - Lim E
AUID- ORCID: 0000-0001-8065-8838
AD  - Faculty of Medicine and Health, Garvan Institute of Medical Research and St 
      Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
FAU - Lin, Ching-Hung
AU  - Lin CH
AUID- ORCID: 0000-0003-2403-4056
AD  - Cancer Center Branch, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Loi, Sherene
AU  - Loi S
AUID- ORCID: 0000-0001-6137-9171
AD  - Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
AD  - Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, 
      Melbourne, Australia.
FAU - Low, Su Ying
AU  - Low SY
AD  - Department of Respiratory and Critical Care Medicine, Singapore General Hospital, 
      Singapore, Singapore.
FAU - Teo, Lynette Li San
AU  - Teo LLS
AUID- ORCID: 0000-0002-2817-9458
AD  - National University Hospital, Singapore, Singapore.
FAU - Yeo, Winnie
AU  - Yeo W
AUID- ORCID: 0000-0002-0863-8469
AD  - The Chinese University of Hong Kong, Sha Tin, Hong Kong Special Administrative 
      Region, Hong Kong.
FAU - Dent, Rebecca
AU  - Dent R
AUID- ORCID: 0000-0001-6421-7602
AD  - National Cancer Centre Singapore, Singapore, Singapore. 
      rebecca.dent@duke-nus.edu.sg.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20230808
PL  - New Zealand
TA  - Drug Saf
JT  - Drug safety
JID - 9002928
RN  - 5384HK7574 (trastuzumab deruxtecan)
RN  - 0 (Immunoconjugates)
SB  - IM
MH  - Humans
MH  - Asia
MH  - *Immunoconjugates
MH  - *Lung Diseases, Interstitial
MH  - *Pneumonia
PMC - PMC10584766
COIS- Joanne Wing Yan Chiu received honorarium from AstraZeneca for consulting services 
      and lectures related to the drug of interest; Soo Chin Lee received grants from 
      Pfizer, Eisai, Taiho, ACT Genomics, Bayer, Karyopharm; consulting fees or 
      honorarium from Pfizer, Novartis, AstraZeneca, ACT Genomics, Eli Lilly, MSD, 
      Roche, Eisai; payments for lectures from Pfizer, Novartis, Astra Zeneca, ACT 
      Genomics, MSD, Roche and Eisai; James Chung-man Ho received consulting fees or 
      honorarium and lectures from AstraZeneca; Yeon Hee Park received grants 
      AstraZeneca, Pfizer; consulting fees or honorarium from AstraZeneca, Pfizer, 
      Lilly, MSD, Eisai, Roche, Daiichi Sankyo, MENARINI, Bixink, Everest and Novartis 
      Pharmaceuticals; Payment for writing or review or reviewing manuscript for Lancet 
      Oncology; and payment for lectures from AstraZeneca, Pfizer, Lilly, MSD, Eisai, 
      Roche and Novartis Pharmaceuticals; Ta-Chung Chao has no conflicts of interest to 
      disclose; Sung-Bae Kim received grants to their institution from Novartis, 
      Sanofi-Aventis and DongKook Pharm Co; consulting fees or honorarium from 
      Novartis, AstraZeneca, Lilly, Dae Hwa Pharmaceutical Co Ltd, ISU Abxis, OBI 
      Pharma, Beigene and Daiichi Sankyo; and holds stock/stock options from Genopeaks 
      and NeogeneTC; Elgene Lim received consulting fees or honorarium for advisory 
      boards from AstraZeneca; provision of writing assistance (manuscript) by Medical 
      Pharma Services; and payment for lectures by AstraZeneca; Ching-Hung Lin has no 
      conflicts of interest to disclose; Sherene Loi receives research funding to her 
      institution from Novartis, Bristol Myers Squibb, Merck, Puma Biotechnology, Eli 
      Lilly, Nektar Therapeutics, AstraZeneca and Seattle Genetics. She has acted as 
      consultant (not compensated) to Seattle Genetics, Novartis, Bristol Myers Squibb, 
      Merck, AstraZeneca, Eli Lilly, Pfizer, Gilead Therapeutics and Roche-Genentech. 
      She has acted as consultant (paid to her institution) to Aduro Biotech, Novartis, 
      GlaxoSmithKline, Roche-Genentech, AstraZeneca, Silverback Therapeutics, G1 
      Therapeutics, PUMA Biotechnologies, Pfizer, Gilead Therapeutics, Seattle 
      Genetics, Daiichi Sankyo, Merck, Amunix, Tallac Therapeutics, Eli Lilly and 
      Bristol Myers Squibb; Sherene Loi is supported by the National Breast Cancer 
      Foundation of Australia Endowed Chair and the Breast Cancer Research Foundation, 
      New York; Su Ying Low received grants received from Boehringer Ingelheim; 
      consulting fees or honorarium from Roche and Boehringer Ingelheim; payment for 
      writing or reviewing manuscript from AstraZeneca; Lynette Teo consulting fees or 
      honorarium and provision of writing assistance from AstraZeneca; Winnie Yeo 
      consulting fees or honorarium from AstraZeneca and Daiichi Sankyo; payment for 
      lectures from AstraZeneca and Daiichi Sankyo; Rebecca Dent has no conflicts of 
      interest to disclose.
EDAT- 2023/08/08 12:42
MHDA- 2023/10/23 12:42
PMCR- 2023/08/08
CRDT- 2023/08/08 11:18
PHST- 2023/06/16 00:00 [accepted]
PHST- 2023/10/23 12:42 [medline]
PHST- 2023/08/08 12:42 [pubmed]
PHST- 2023/08/08 11:18 [entrez]
PHST- 2023/08/08 00:00 [pmc-release]
AID - 10.1007/s40264-023-01328-x [pii]
AID - 1328 [pii]
AID - 10.1007/s40264-023-01328-x [doi]
PST - ppublish
SO  - Drug Saf. 2023 Oct;46(10):927-949. doi: 10.1007/s40264-023-01328-x. Epub 2023 Aug 
      8.