The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

+90 850 321 50 00

Trastuzumab Deruxtecan in HER2-Positive and HER2-Low Breast Cancer

Antibody-drug conjugate revolutionizing treatment of HER2-expressing breast cancer

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is Trastuzumab Deruxtecan in HER2-Positive and HER2-Low Breast Cancer?

Trastuzumab deruxtecan combines anti-HER2 antibody with deruxtecan payload (DXd), a topoisomerase I inhibitor with high drug-antibody ratio of 8:1.

Bystander effect from cleavable linker allows drug release affecting neighboring cells with lower HER2 expression.

Approved indications include HER2-positive metastatic breast cancer after prior anti-HER2 therapy, HER2-low metastatic breast cancer, HER2-positive gastric cancer and HER2-mutated NSCLC.

Standard dosing administered intravenously every 3 weeks until disease progression or unacceptable toxicity.

DESTINY-Breast trial series demonstrated transformative efficacy expanding HER2-directed therapy to HER2-low disease.

Symptoms

Common adverse events include nausea, vomiting, fatigue, alopecia, anemia, neutropenia and decreased appetite.
Interstitial lung disease/pneumonitis is a class effect requiring vigilant monitoring with chest imaging and respiratory assessment.
Cardiotoxicity with decreased left ventricular ejection fraction less common than with trastuzumab-emtansine.
Less common but serious effects include neutropenic complications, severe diarrhea and infusion reactions.
Long-term effects include cumulative bone marrow suppression and possible delayed pneumonitis.

Risk Factors

Pre-existing pulmonary disease including interstitial lung disease, COPD or pulmonary fibrosis increases pneumonitis risk.
Prior radiation therapy to chest area may increase pulmonary toxicity risk.
Concomitant medications that may exacerbate pulmonary toxicity require careful evaluation.
Cardiac comorbidity though cardiotoxicity less common than other anti-HER2 therapies.
Prior cumulative anthracycline exposure may compound cardiac toxicity risk.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • New or worsening dyspnea, cough or other respiratory symptoms require immediate evaluation for pneumonitis with chest CT.
  • Severe nausea or vomiting requires symptomatic management and possibly dose modification.
  • Symptoms of cardiac dysfunction warrant cardiac evaluation with echocardiography.
  • Severe cytopenias with infections, bleeding or fatigue require dose modification and supportive care.
  • Pneumonitis is potentially life-threatening requiring immediate treatment interruption, corticosteroids and pulmonology consultation.

Treatment Methods

01
Comprehensive baseline evaluation including HER2 status (immunohistochemistry, fluorescence in situ hybridization), echocardiogram and pulmonary function assessment.
02
Routine monitoring including chest imaging, cardiac function and complete blood count throughout treatment.
03
Patient education emphasizing pneumonitis symptoms recognition and prompt reporting.
04
Aggressive antiemetic prophylaxis with dexamethasone, 5-HT3 antagonist and NK1 receptor antagonist.
05
Dose modifications, treatment interruption and supportive care guided by toxicity grade with multidisciplinary care including oncology, pulmonology, cardiology and nursing optimizes outcomes with this transformative antibody-drug conjugate.

Which Department to Visit?

You can visit our Onkoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Onkoloji Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Book AppointmentContact Us

Related Health Topics

Other articles from the same department you may want to explore.

Anaemia

Dahiliye (İç Hastalıkları)

Anaemia is a low haemoglobin level that reduces oxygen delivery, causing fatigue, pallor, and shortness of breath. It is not a disease itself but a sign of many underlying conditions. Most cases are correctable with appropriate diagnosis and treatment.

Iron Deficiency Anaemia

Dahiliye (İç Hastalıkları)

Iron deficiency anaemia develops when dietary intake, absorption, or losses create an iron shortfall, most often affecting women and children. Identifying the underlying cause is the core of management, alongside iron replacement.

Vitamin B12 Deficiency

Dahiliye (İç Hastalıkları)

Vitamin B12 deficiency can cause megaloblastic anaemia, neurological symptoms, and cognitive impairment. Early treatment with intramuscular or oral B12 largely prevents irreversible complications.

Hypertension (High Blood Pressure) Management

Dahiliye (İç Hastalıkları)

Hypertension is often called the silent killer because it progresses symptom-free for years and can damage the heart, brain, kidneys, and eyes. Regular monitoring, lifestyle change, and evidence-based drug therapy dramatically reduce cardiovascular risk.

Chronic Kidney Disease

Dahiliye (İç Hastalıkları)

Chronic kidney disease is one of the most common complications of chronic conditions such as diabetes and hypertension, and can be silent in its early stages.

Hepatitis B (HBV)

Dahiliye (İç Hastalıkları)

Hepatitis B is a DNA virus infection causing acute and chronic hepatitis with risk of cirrhosis and hepatocellular carcinoma; diagnosis integrates HBsAg, HBeAg, anti-HBc, and HBV DNA with management based on disease phase using nucleos(t)ide analogues (entecavir, tenofovir) and universal infant vaccination.

Hepatitis C (HCV)

Dahiliye (İç Hastalıkları)

Hepatitis C is an RNA virus causing chronic hepatitis that may progress to cirrhosis and hepatocellular carcinoma; modern direct-acting antiviral (DAA) pangenotypic regimens (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) achieve sustained virologic response over 95% in 8–12 weeks with universal adult screening and cure for nearly all patients.

Fatty Liver Disease

Dahiliye (İç Hastalıkları)

Non-alcoholic fatty liver disease (NAFLD) is closely related to obesity and metabolic syndrome and is largely reversible with early treatment.

Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.