Management of Trastuzumab Deruxtecan-related nausea and vomiting in real-world practice.

Background

Nausea and vomiting are common side effects of Trastuzumab Deruxtecan (T-DXd), but guidelines for optimal management were not initially available. This retrospective single-center study aimed at evaluating the efficacy of two antiemetic regimens in patients receiving T-DXd.

Methods

Data from metastatic breast cancer patients receiving T-DXd were collected. Two groups were defined: patients treated with 5-HT3 receptor antagonists (RA) ± dexamethasone (5-HT3-group) and patients treated with a fixed oral combination of netupitant (NK1RA) and palonosetron ± dexamethasone (NK1 group). Physicians preferentially offered the NK1 regimen to patients at higher risk of nausea and vomiting based on internal recommendations. Only nausea and vomiting during cycles 1 and 2 were considered. Comparisons of nausea and vomiting by the antiemetic prophylaxis group were assessed using chi-square.

Results

A total of 53 patients were included in the analysis. At cycle 1, 72% and 28% of patients received the 5-HT3 and NK1 prophylaxis, respectively. Overall, 58% reported nausea, with no differences between groups (58% vs. 60%;

Conclusions

The NK1 regimen improved vomiting control at cycle 1 and, when introduced at cycle 2, significantly improved both nausea and vomiting. The biased NK1 selection for higher-risk patients may have dampened the differences between groups at cycle 1. These findings support enhanced control of T-DXd-related nausea and vomiting with NK1RA.

Informations de copyright

Copyright © 2024 Notini, Naldini, Sica, Viale, Rognone, Zambelli, Zucchinelli, Piras, Bosi, Mariani, Aldrighetti, Bianchini and Licata.

Déclaration de conflit d'intérêts

GV has served on the advisory boards for Gilead; has received honoraria for speakers’ bureaus from Novartis, Lilly; support for travel, accommodations, expenses from: Lilly and Pfizer. AR support for travel, accommodations, expenses from: Gilead, LeoPharma. SZ support for travel, accommodations, expenses from: Pfizer, D Sankyo. MP support for travel, accommodations, expenses from: Novartis, Gilead. GB has received consulting fee from Roche, AstraZeneca, Novartis, MSD, Sanofi, Daiichi Sankyo, and Exact Sciences; honoraria for speakers’ bureaus from Roche, Pfizer, Astra- Zeneca, Lilly, Novartis, Neopharm Israel, MSD, Chugai, Daiichi Sankyo, EISAI, and Exact Sciences; support for travel, accommodations, expenses from Roche, Pfizer, and AstraZeneca; is co-inventor of ‘European patent Application N. 12195182.6 and 12196177.5 titled “PDL-1 expression in anti-HER2 therapy” -Roche- Issued no compensation provided; has served on the advisory boards for Pfizer, Roche, Daiichi Sankyo, Lilly, MSD, Novartis, AstraZeneca, Genomic Health, EISAI, Gilead, Seagen. LL has served on the advisory boards for: Lilly, Exact Sciences, AstraZeneca, Italfarmaco, Daiichi Sankyo, Accord, Seagen; has received consulting fee from: Exact Sciences, Helsinn, EISAI, Daiichi Sankyo; honoraria for speakers’ bureaus from: Gilead, Exact Sciences, Helsinn, Lilly; support for travel, accommodations, expenses from: Lilly, Gilead, Accord. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.