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Safety of ADCs in MBC: Module

CME

Optimizing Outcomes and Quality of Life for Patients With Advanced Breast Cancer Through Effective Management of ADC-Associated Toxicities

Physicians: Maximum of 0.75 AMA PRA Category 1 Credit™

Released: February 07, 2024

Expiration: February 06, 2025

Komal Jhaveri
Komal Jhaveri, MD, FACP
CME/CE Information

Activity

Progress
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Course Completed

Overall Conclusions

In summary, it is very important to be aware of the unique and distinct AEs associated with the different ADCs—especially the 2 currently FDA-approved ADCs for patients with HER2-negative and/or HER2-low advanced breast cancer. Patients need to be well educated about the unique AEs associated with these agents and able to recognize the signs and symptoms that require immediate intervention. Of note, it is necessary to involve a multidisciplinary team when indicated. The involvement of the multidisciplinary team optimizes AE management and provides maximum supportive care for our patients.

ILD/pneumonitis is the most common reason for the discontinuation of T-DXd, and because it can be fatal, it is important to carefully monitor patients throughout the treatment course. If ILD is suspected, symptoms should be promptly and appropriately managed. In my practice, our pulmonologists are involved as soon as ILD/pneumonitis is suspected. Cardiotoxicity, nausea, and vomiting are other T-DXd‒related AEs of which we need to be aware. So, proactive management of these AEs is of importance. Depending on whether a patient has moderate or high emetic risk, a 3-drug or 4-drug antiemetic combination is recommended on Day 1 of T-DXd treatment.

With regard to SG, the most common serious AEs associated with treatment are diarrhea, febrile neutropenia, neutropenia, and neutropenic colitis. In my practice, if neutropenic colitis is suspected, we involve our gastrointestinal colleagues immediately. With both T-DXd and SG, it is important to prepare patients for the possibility of complete alopecia and proactively take appropriate measures.

As we recommend treatment with these novel and effective ADCs that have drastically shifted the treatment paradigm for patients with metastatic breast cancer, it is critical that we remain cognizant of the unique safety profiles of these agents and that we are able to manage the associated AEs as soon as they occur. Proactive intervention and prompt recognition and mitigation of these AEs will optimize treatment outcomes and significantly improve the quality of life of patients who are receiving these ADCs. Finally, a patient‒physician shared treatment decision‑making approach is important, including discussions about the benefit‒risk ratio of each of these agents with our patients.

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