Oncology nurses are critical in preparing patients for trastuzumab deruxtecan (T-DXd; Enhertu) treatment by discussing potential adverse events, including nausea, hair loss, and interstitial lung disease, according to Nancy U. Lin, MD, a medical oncologist at the Dana-Farber Cancer Institute.
DESTINY-Breast12 Trial Highlights
The phase 3b/4 DESTINY-Breast12 trial, presented at the 2024 ESMO Congress, demonstrated promising response rates and progression-free survival with trastuzumab deruxtecan in patients with HER2-positive metastatic breast cancer, even in those with brain metastases. These findings underscore the drug's potential in challenging-to-treat patient populations.
Managing Adverse Events
Despite its efficacy, trastuzumab deruxtecan is associated with several adverse events that require careful management. "Before starting a patient on [trastuzumab deruxtecan], I think some of the highlights for counseling include teaching about antiemetic regimens and antiemetic use, making sure that patients are properly pre-medicated and that they understand what to do if they have nausea following the infusion," Dr. Lin explained.
Hair loss is another common side effect, affecting approximately 25% to 30% of patients. Nurses should proactively discuss this possibility to prevent patient surprise and distress.
Interstitial Lung Disease: A Critical Concern
One of the most serious potential adverse events associated with trastuzumab deruxtecan is interstitial lung disease (ILD). Symptoms include shortness of breath and cough. Dr. Lin emphasized the importance of patient education regarding ILD: "It's very important that patients are counseled about this. If they're on vacation, if they're traveling, or they're going to an emergency room that doesn't know them or doesn't know about [trastuzumab deruxtecan] they really need to be sensitized to this, because it's so important to treat [interstitial lung disease] and manage it properly from the get go to prevent bad outcomes."
Prompt recognition and management of ILD are essential to prevent severe outcomes. Oncology nurses play a vital role in ensuring patients and their families are aware of the signs and know to seek immediate medical attention if they occur.
