de Weger Vincent A, Schutte Tim, Konings Inge R H M, Menke-van der Houven van Oordt Catharina Willemien
Department of Medical Oncology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.
J Breast Cancer. 2023 Oct;26(5):519-523. doi: 10.4048/jbc.2023.26.e38.
Trastuzumab deruxtecan (T-DXd) is used to treat human epidermal growth factor receptor 2-positive advanced breast cancer. Interstitial lung disease (ILD) is a severe adverse event associated with T-DXd. Current guidelines recommend permanent discontinuation of T-DXd after Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 2 ILD. Here, we describe a case of successful rechallenge with T-DXd after CTCAE grade 2 treatment-induced ILD. After discontinuation of T-DXd, ILD was treated with steroids until complete resolution. Given the initial beneficial antitumor response, retreatment was discussed during disease progression. In a shared decision with the patient, T-DXd was restarted at the lowest registered dose, along with low-dose steroids. ILD did not reoccur. Importantly, both clinical and radiological responses to the treatment were observed, with an improvement in the patient's quality of life. This case demonstrates that retreatment with T-DXd after a grade 2 ILD event is feasible and yields clinical benefit.
曲妥珠单抗德鲁昔单抗（T-DXd）用于治疗人表皮生长因子受体2阳性晚期乳腺癌。间质性肺疾病（ILD）是与T-DXd相关的严重不良事件。当前指南建议在不良事件通用术语标准（CTCAE）≥2级ILD后永久停用T-DXd。在此，我们描述了1例CTCAE 2级治疗引起的ILD后成功再次使用T-DXd治疗的病例。停用T-DXd后，ILD用类固醇治疗直至完全缓解。鉴于最初的抗肿瘤有益反应，在疾病进展期间讨论了再次治疗。在与患者共同决策后，以最低注册剂量重新开始使用T-DXd，并联合低剂量类固醇。ILD未复发。重要的是，观察到了对治疗的临床和影像学反应，患者生活质量得到改善。该病例表明，2级ILD事件后再次使用T-DXd治疗是可行的，并产生临床益处。
