“… 13 Increased knowledge of ILD/pneumonitis and implementation of ILD/pneumonitis monitoring, diagnosis, and management guidelines may explain why there were no grade 4 or 5 events since ILD/pneumonitis events may have been identified and treated early before they progressed. 23 DESTINY-Breast03 investigated T-DXd as an earlier line of therapy than the trials included in this pooled analysis [median prior lines of therapy, 4 (range, 1-27)], which implies that perhaps there is a lower rate of ILD/pneumonitis in patients who are less heavily pretreated, although line of therapy was not identified as a potential factor of interest in the multivariate analysis reported here. The present analysis reflects a heavily pretreated population overall, including data from multiple tumor types, which may also partially explain differences in the rates of ILD/pneumonitis observed between the pooled analysis and DESTINY-Breast03.…”
“… 13 Increased knowledge of ILD/pneumonitis and implementation of ILD/pneumonitis monitoring, diagnosis, and management guidelines may explain why there were no grade 4 or 5 events since ILD/pneumonitis events may have been identified and treated early before they progressed. 23 DESTINY-Breast03 investigated T-DXd as an earlier line of therapy than the trials included in this pooled analysis [median prior lines of therapy, 4 (range, 1-27)], which implies that perhaps there is a lower rate of ILD/pneumonitis in patients who are less heavily pretreated, although line of therapy was not identified as a potential factor of interest in the multivariate analysis reported here. The present analysis reflects a heavily pretreated population overall, including data from multiple tumor types, which may also partially explain differences in the rates of ILD/pneumonitis observed between the pooled analysis and DESTINY-Breast03.…”
“… Figure 2 Management of ILD/pneumonitis. 20 , 59 , 61 , 62 The ‘Manage ILD/P’ portion of this figure is from Figure 3 of Swain SM, Nishino M, Lancaster LH, et al. Multidisciplinary clinical guidance on trastuzumab deruxtecan (T-DXd)-related interstitial lung disease/pneumonitis-Focus on proactive monitoring, diagnosis, and management.…”
Section: Management Of T-dxd-related Aes Of Interestmentioning
confidence: 99%
“…8,16,20 It is of the utmost importance to monitor and assess patients for ILD/pneumonitis to reduce the risk of fatal outcomes (Figure 2). 59,61 In 2019, guidelines for the management and monitoring of T-DXd-related ILD/pneumonitis were published and incorporated into clinical trials of T-DXd 6 ; these were updated in 2021. 20 These guidelines stress the importance of proactive management and monitoring to help identify and treat ILD/pneumonitis as effectively as possible; the guidelines provide more details around steroid dosing, duration, and timing of taper for better management (Figure 2).…”
“…According to the latest expert opinion, this case was diagnosed as a grade 4 (very severe) ICI‐ILD. 24 It was recommended to use mechanical ventilation, steroid therapy (2 mg/kg/day intravenous prednisolone or equivalent) and even intravenous immunoglobulins. We have implemented these treatments in compliance with the expert opinion.…”
The safety of neoadjuvant chemoimmunotherapy before surgery in patients with non–small cell lung cancer (NSCLC) remains unclear in the perioperative stage. We describe a case of a 63‐year‐old man with IIIC stage NSCLC who received neoadjuvant chemoimmunotherapy and radical lobectomy. After the second cycle of pembrolizumab and chemotherapy (paclitaxel + carboplatin), the patient was diagnosed with immunologic enterocolitis and relieved by glucocorticoid therapy. Radical lobectomy of the right upper lobe was then performed. On postoperative day 4 (POD 4), the patient suddenly suffered suffocated wheezing during sleep. Interstitial lung disease was, therefore, identified by chest computed tomography scan. Glucocorticoids and mechanical ventilation were applied and the symptoms were relieved. On POD 10, the patient developed a bronchial fistula and underwent emergent repair surgery. This is the first case of multi‐organs, multi‐time point immune‐related adverse events (irAE) in perioperative NSCLC patients who received neoadjuvant chemoimmunotherapy. Clinicians should be on high alert for signs of irAEs in neoadjuvant chemoimmunotherapy patients, promptly requiring multidisciplinary management.
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