What Toxicities Are Common for ADCs Approved in Breast Cancer?
Melissa Rikal, MSN, FNP-BC, AOCNP, explained that adverse effects are common among the available antibody-drug conjugates in breast cancer.
As antibody-drug conjugates (ADCs) become more common in the treatment of patients with breast cancers, familiarity with each agent’s respective adverse effect [AE] profiles is crucial. Among these are gastrointestinal issues as well as cytopenias and ocular toxicities, as Melissa Rikal, MSN, FNP-BC, AOCNP, explained in an interview with Oncology Nursing News following a Case-Based Roundtable discussion with peer oncology advanced practice providers (APPs).
The discussion centered around the treatment of patients with hormone receptor (HR)–positive, HER2-negative metastatic breast cancer beyond the first line. This included the discussion of the ADCs currently approved in breast cancer: fam-trastuzumab deruxtecan-nxki (Enhertu; T-DXd), datopotamab deruxtecan (Datroway; dato-DXd), and sacituzumab govitecan (Trodelvy).
Rikal, a nurse practitioner at Sarah Cannon Research Institute in Nashville, Tennessee, emphasized that interstitial lung disease (ILD) is associated with many ADCs currently available. However, T-DXd is a more frequent cause of ILD, Rikal explained.
Gastrointestinal AEs, Rikal said, are frequent across ADCs, but they are more likely to cause quality of life issues with sacituzumab deruxtecan. Stomatitis and ocular toxicities may be more likely in patients treated with dato-DXd. Lastly, Rikal noted that cytopenias occur largely in sacituzumab govitecan and T-DXd.
Transcript
With the majority of the ADCs on the market, there is a slight risk of interstitial lung disease. We see this a little bit more with [T-DXd] than we do something like dato-DXd or sacituzumab [govitecan], but we certainly know there’s potential. We’re always educating on how each ADC has a bit of a different AE profile. We can see nausea with just about all of them and as well as gastrointestinal AEs.
Some can have a bit more stomatitis than others, like dato-DXd. This is something we worry about. [Dato-DXd] has a more of a unique AE of potentially some keratitis or even dry eye. We’re monitoring for any blurred vision or eye discomfort with trastuzumab deruxtecan. Nausea and other gastrointestinal AEs are the more predominant symptoms. Of course, we educate about interstitial lung disease. Then with sacituzumab govitecan, we can see diarrhea as a quality-of-life issue, so we’re teaching them at the beginning how to manage that with multiple different antidiarrheal agents.
We also can see cytopenias with sacituzumab govitecan as well as trastuzumab deruxtecan. Monitor patients’ blood counts closely, and sometimes you may need to add GCSF [granulocyte colony-stimulating factor] or dose reduce because of some neutropenia or other cytopenias, as we can see as well.
This transcript has been edited for clarity and conciseness.
