Tom Baker Cancer Centre, 1331-29th Street, Calgary, AB T2N 4N2, Canada.
Mount Sinai Hospital, 1284-600 University Avenue, Toronto, ON M5G 1X5, Canada.
Curr Oncol. 2023 Aug 30;30(9):8019-8038. doi: 10.3390/curroncol30090582.
Ongoing advances in precision cancer therapy have increased the number of molecularly targeted and immuno-oncology agents for a variety of cancers, many of which have been associated with a risk of pulmonary complications, among the most concerning being drug-induced interstitial lung disease/pneumonitis (DI-ILD). As the number of patients undergoing treatment with novel anticancer agents continues to grow, DI-ILD is expected to become an increasingly significant clinical challenge. Trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate targeting human epidermal growth factor receptor 2 that is gaining widespread use in the metastatic breast cancer setting and is undergoing exploration for other oncologic indications. ILD/pneumonitis is an adverse event of special interest associated with T-DXd, which has potentially fatal consequences if left untreated and allowed to progress. When identified in the asymptomatic stage (grade 1), T-DXd-related ILD can be monitored and treated effectively with the possibility of treatment continuation. Delayed diagnosis and/or treatment, however, results in progression to grade 2 or higher toxicity and necessitates immediate and permanent discontinuation of this active agent. Strategies are, therefore, needed to optimize careful monitoring during treatment to ensure patient safety and optimize outcomes. Several guidance documents have been developed regarding strategies for the early identification and management of T-DXd-related ILD, although none have been within the context of the Canadian health care environment. A Canadian multidisciplinary steering committee was, therefore, convened to evaluate existing recommendations and adapt them for application in Canada. A multidisciplinary approach involving collaboration among medical oncologists, radiologists, respirologists, and allied health care professionals is needed to ensure the proactive identification and management of T-DXd-related ILD and DI-ILD associated with other agents with a similar toxicity profile.
精准癌症治疗的不断进展，增加了针对多种癌症的分子靶向和免疫肿瘤学药物的数量，其中许多都与肺部并发症风险相关，最令人担忧的是药物性间质性肺病/肺炎（DI-ILD）。随着接受新型抗癌药物治疗的患者数量不断增加，DI-ILD 预计将成为一个日益严峻的临床挑战。曲妥珠单抗 deruxtecan（T-DXd）是一种针对人表皮生长因子受体 2 的抗体药物偶联物，在转移性乳腺癌治疗中得到广泛应用，并正在探索用于其他肿瘤学适应证。ILD/肺炎是与 T-DXd 相关的特别关注的不良事件，如果不治疗和任由其进展，可能会产生致命后果。当在无症状阶段（1 级）发现时，T-DXd 相关的 ILD 可以通过监测并进行有效治疗，有继续治疗的可能。然而，如果诊断和/或治疗延迟，可能会进展为 2 级或更高毒性，需要立即永久停用该有效药物。因此，需要制定策略，以优化治疗期间的谨慎监测，确保患者安全并优化结果。已经制定了一些关于早期识别和管理 T-DXd 相关 ILD 的指南文件，尽管这些指南都不是针对加拿大医疗保健环境制定的。因此，成立了一个加拿大多学科指导委员会，以评估现有的建议并对其进行调整，以适用于加拿大。需要采取多学科方法，让肿瘤内科医生、放射科医生、呼吸科医生和其他医疗保健专业人员协作，以确保主动识别和管理 T-DXd 相关 ILD 以及与其他具有类似毒性特征的药物相关的 DI-ILD。
