Dr. Jan-Willem Henning (University of Calgary) and Dr. Nadia Califaretti (Grand River Regional Cancer Centre) discuss Management of Interstitial lung disease (ILD) and Pneumonitis. Watch their discussion in the video below as they delve into the topic in greater detail.
Can you summarize what we have learned on special AE of interest- ILD and pneumonitis?
- In the DESTINY Breast03, incidence of ILD was 10.5% (all grades), and there were no deaths
- This is lower than previously reported in other trials (which ranged from 11-15%) and could reflect better understanding and management of patients on this new molecule.
Can you comment on diagnosis and management of ILD and pneumonitis?
- It is really grade 1 and 2 that we need to focus on. ILD is still a differential diagnosis of other conditions so we need to be vigilant with identifying this early, especially in the COVID era.
- Once it is confirmed that ILD is related to T-DXd treatment, patients require prompt treatment (typically steroids)
What were the outcomes overall in terms of grading in DESTINY Breast03?
- Majority is grade 1 or 2
- Onset of ILD is typically seen between 6-9 months.
- Onset is gradual and does not happen overnight.
Can we identify patients who are at a greater risk for ILD?
- A pooled analysis by Powell et al. suggests that ethnicity, breast cancer, and renal insufficiency are potential risk factors.
- Pulmonary comorbidities (i.e. COPD and asthma) did not contribute statistically but requires caution
What advice do you have moving forward for engaging a multidisciplinary team? What are the requirements in that team?
- It is important that you educate yourself, your team (what to expect) and your patients (make sure they understand when to report adverse events)