Почему это важно
В recent webinar, Dr. Matthew Gubens and Dr. Estelamari Rodriguez discussed key questions about the management of HER2-altered advanced non-small cell lung cancer (NSCLC). They reviewed the rationale for targeting HER2 in NSCLC, optimal testing strategies for HER2, data on HER2-directed antibody-drug conjugates (ADCs) in NSCLC, and the practical applications of HER2-targeted therapy and emerging HER2-directed approaches in NSCLC.
Как управлять HER2-измененными прогрессирующими НСЛК
Dr. Gubens noted that T-DXd, zongertinib, and sevabertinib are currently FDA-approved for patients with HER2-altered advanced NSCLC. T-DXd is the only HER2-directed agent with approval for use in patients with HER2-overexpressing (IHC 3+) advanced NSCLC. Zongertinib and sevabertinib are TKIs with approval for patients with HER2 mutation-positive NSCLC only.
For patients with HER2-overexpressing unresectable or metastatic NSCLC who have received prior systemic treatment, the clear-cut second-line treatment option is T-DXd, especially if the patient has no known or suspected cardiac dysfunction or interstitial lung disease (ILD)/pneumonitis.
Как управлять пациентами с прогрессирующими НСЛК, которые развивают ILD/пневмонит при лечении T-DXd
Dr. Rodriguez emphasized the importance of monitoring patients for ILD/pneumonitis, which can be fatal if not appropriately managed. Any-grade ILD/pneumonitis was reported in approximately 15% of patients with NSCLC in the DESTINY-Lung02 trial with the use of T-DXd at the FDA-approved dose of 5.4 mg/kg (mostly grade 1/2). Grade ≥3 ILD/pneumonitis was reported in only 2% (2/101) of the patients.
For asymptomatic ILD/pneumonitis (grade 1), T-DXd should be interrupted until resolution to grade 0. If symptoms resolve ≤28 days from onset, T-DXd can be resumed at the same dose. However, if symptoms resolve >28 days from the time of onset, T-DXd dose should be reduced by 1 dose level as stated in the prescribing information.