Williamson Julie, Kelley Kristen, Scholand Mary Beth, Crossno Christine, Hummert Shelly, Jeppson Patricia, Jacobson Holly, Buys Saundra
Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA.
Pulmonary Medicine Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
Breast Cancer Res Treat. 2025 Apr;210(2):487-491. doi: 10.1007/s10549-024-07586-2. Epub 2025 Jan 22.
Interstitial lung disease (ILD) is a well described and potentially fatal complication of trastuzumab-deruxtecan (T-DXd). It is currently unknown if specific monitoring is beneficial in the early detection of ILD in these patients. We describe the efficacy and feasibility of a novel ILD monitoring protocol in breast cancer patients treated with T-DXd at our institution.
An ILD monitoring protocol developed at our institution included baseline and ongoing monitoring with pulmonary function testing (PFTs) and high-resolution chest computed tomography (HRCT) at pre-specified intervals. Patients with metastatic HER2+ or HER2-low breast cancer treated at Huntsman Cancer Institute who received ≥ 1 cycle of T-DXd between 2020 and 2023 were included (n = 68). Patient outcomes and provider adherence to the protocol were retrospectively evaluated. Providers were classified as "no adherence" if they did not elect to participate in any elements of the recommended protocol or as "some adherence" if they had at least some monitoring per protocol.
10 cases of ILD were identified with an incidence of 12% (3/25) in the no adherence group and 16% (7/43) in the some adherence group. ILD cases in the no adherence group included one grade 2 and two grade 5 cases. The some adherence group included three grade 1 and four grade 2 cases.
An ILD monitoring protocol consisting of baseline PFTs and ongoing monitoring with PFTs and HRCT is a feasible approach as evidenced by a majority provider adherence rate. This type of protocol may be effective in preventing severe cases of ILD and identifying grade 1 events that may permit treatment re-challenge.
间质性肺疾病（ILD）是曲妥珠单抗德瓦鲁单抗（T-DXd）一种已被充分描述且可能致命的并发症。目前尚不清楚特定监测对这些患者ILD的早期检测是否有益。我们描述了在我们机构接受T-DXd治疗的乳腺癌患者中一种新型ILD监测方案的疗效和可行性。
我们机构制定的ILD监测方案包括基线监测以及按预先指定的间隔进行肺功能测试（PFT）和高分辨率胸部计算机断层扫描（HRCT）的持续监测。纳入2020年至2023年期间在亨茨曼癌症研究所接受≥1个周期T-DXd治疗的转移性HER2+或HER2低表达乳腺癌患者（n = 68）。对患者的结局和医疗服务提供者对该方案的依从性进行回顾性评估。如果医疗服务提供者未选择参与推荐方案的任何要素，则分类为“不依从”；如果他们至少按照方案进行了一些监测，则分类为“部分依从”。
共识别出10例ILD病例，不依从组的发生率为12%（3/25），部分依从组为16%（7/43）。不依从组的ILD病例包括1例2级和2例5级病例。部分依从组包括3例1级和4例2级病例。
由基线PFT以及PFT和HRCT的持续监测组成的ILD监测方案是一种可行的方法，大多数医疗服务提供者的依从率证明了这一点。这种类型的方案可能有效地预防严重的ILD病例，并识别可能允许重新挑战治疗的1级事件。
