ILD/Pneumonitis Assessment Questions for Enhertu® (Fam-trastuzumab deruxtecan-nxki)

Home Toolkit for Practice Enhancement Solutions ILD/Pneumonitis Assessment Questions for Enhertu® (Fam-trastuzumab deruxtecan-nxki)

This tool is for the purpose of facilitating detection of interstitial lung disease (ILD) and pneumonitis. Please utilize the assessment questions during patient discussion and suggested intervention instructions to help manage your patients.

 

  • In clinical studies, of the 234 patients with HER2+ unresectable or metastatic breast cancer treated, ILD occurred in 9% of patients (n=22/234)
    • Majority of ILD events were Grade 2 (n=12/22)
    • Fatal outcomes due to ILD and/or pneumonitis occurred in 2.6% of patients
  • Median time to first onset was 4.1 months (range: 1.2-8.3)

 

Click Here when Beginning a Patient Discussion


Has the patient experienced any of the following since start of treatment?
  • Pneumonitis
  • Interstitial lung disease
  • Respiratory failure
  • Organizing pneumonia
  • Acute respiratory failure
  • Lung infiltration
  • Lymphangitis
  • Alveolitis
Yes No

Has the patient shown inflammatory changes to the lung(s) on chest radiography?
Yes No

Has the patient experienced dry cough recently?
Yes No

Has the patient experienced shortness of breath, especially during or after physical activity?
Yes No

Has the patient experienced any new breathing or respiratory problems?
Yes No

Have the patient’s current respiratory problems gotten worse?
Yes No

Has the patient experienced a fever?
Yes No

Has the patient experienced worsening fatigue?
Yes No

Has the patient lost weight?
Yes No

Based on these factor(s):

Please click on the dropdown menu to select the grade best matching the patient's degree of adverse event

Based on the responses, possible grade is suggested

  • More information required.
  • Consider consulting Radiographer and/or Pulmonologist.
  • Evaluate patient with radiographic imaging.
  • If pneumonitis is confirmed:
  • Interrupt dose until resolved to Grade 0, then:
    • If resolved in ≤28 days from date of onset, maintain dose.
    • If resolved in >28 days from date of onset, reduce dose one level.
      • Consider corticosteroid treatment as soon as ILD/pneumonitis is suspected (e.g., ≥0.5 mg/kg prednisolone or equivalent).
    • Dose Modifications:
      • *Do not re-escalate the Enhertu® dose after a dose reduction is made*
        • Dose reduction schedule (starting dose is 5.4 mg/kg)
        • First dose reduction 4.4 mg/kg
        • Second dose reduction 3.2 mg/kg
        • Requirement for further dose reduction: Discontinue treatment.
    • If a planned dose is delayed or missed.
      • Administer as soon as possible; do not wait until the next planned cycle.
      • Adjust the schedule of administration to maintain a 3-week interval between doses.
      • Administer the infusion at the dose and rate the patient tolerated in the most recent infusion.
  • Consider holding drug, and verify grade with radiographic imaging and obtain pulmonary consult before proceeding.
  • If confirmed:
  • Permanently discontinue.
  • Promptly initiate corticosteroid treatment as soon as ILD/pneumonitis is suspected (e.g., ≥1 mg/kg prednisolone or equivalent) and continue for at least 14 days followed by gradual taper for at least 4 weeks.
    1. Hold drug
    2. Obtain imaging
    3. Consult with Radiographer and/or Pulmonologist

Please fill-in reason for change in suggested grade if applicable


For additional information: visit https://www.enhertuhcp.com/en/nurse/

  • Download helpful resources to guide use of Enhertu® created by Oncology Nurse Educators
  • Download resources for your patients and their caregivers include adverse event management brochures

Report summary:

1. Enhertu® (fam-trastuzumab deruxtecan-nxki) [prescribing information]. Daiichi Sankyo, Inc., Basking Ridge, NJ and AstraZeneca Pharmaceuticals LP, Wilmington, DE, 2021.
2. Ripley BA, Kelil T, Gill RR. Deciphering drug-induced interstitial lung disease: a mechanistic approach. Appl Radiol. 2016;45(4):9-18.
3. Kubo K, Azuma A, Kanazawa M, et al; Japanese Respiratory Society Committee. Consensus statement for the diagnosis and treatment of drug-induced lung injuries. Respir Invest. 2013;51(4):260-277.

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