Julie Williamson, Kristen Kelley, Mary Beth Scholand, Christine Crossno, Shelly Hummert, Patricia Jeppson, Holly Jacobson, Saundra Buys
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引用次数: 0
Abstract
Purpose: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
目的：间质性肺疾病（ILD）是曲妥珠单抗-德鲁德康（T-DXd）治疗的一种已知的潜在致命并发症。目前尚不清楚特异性监测是否有助于这些患者早期发现ILD。我们描述了一种新的ILD监测方案在我们机构接受T-DXd治疗的乳腺癌患者中的有效性和可行性。方法：我们机构制定的ILD监测方案包括基线和持续监测，肺功能测试（PFTs）和高分辨率胸部计算机断层扫描（HRCT）在预先规定的间隔进行监测。纳入在2020年至2023年期间接受≥1个周期T-DXd治疗的亨斯迈癌症研究所（Huntsman cancer Institute）转移性HER2+或HER2低乳腺癌患者（n = 68）。回顾性评估患者预后和提供者对方案的依从性。如果提供者没有选择参与推荐方案的任何要素，则将其分类为“无依从性”；如果提供者至少对每个方案进行了一些监测，则将其分类为“一些依从性”。结果：发现10例ILD，无依从组发生率为12%(3/25)，有依从组发生率为16%（7/43）。无依从组的ILD病例包括1例2级和2例5级。部分依从组包括3例1级和4例2级。结论：由基线PFTs和持续监测PFTs和HRCT组成的ILD监测方案是一种可行的方法，大多数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病例和识别可能允许治疗再次挑战的1级事件。
期刊介绍：
Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.
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