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

Giulia Notini; Matteo Maria Naldini; Lorenzo Sica; Giulia Viale; Alessia Rognone; Stefania Zambelli; Patrizia Zucchinelli; Marta Piras; Carlo Bosi; Marco Mariani; Daniela Aldrighetti; Giampaolo Bianchini; Luca Licata

doi:10.3389/fonc.2024.1374547

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

Front Oncol. 2024 Mar 11:14:1374547. doi: 10.3389/fonc.2024.1374547. eCollection 2024.

Authors

Giulia Notini^{1

2}, Matteo Maria Naldini^{1

2}, Lorenzo Sica^{1

2}, Giulia Viale^{1

2}, Alessia Rognone^{1

2}, Stefania Zambelli^{1

2}, Patrizia Zucchinelli^{1

2}, Marta Piras^{1

2}, Carlo Bosi^{1

2}, Marco Mariani^{1

2}, Daniela Aldrighetti^{1

2}, Giampaolo Bianchini^#^{1

2}, Luca Licata^#^{1

2}

Affiliations

¹ Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
² School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.

^# Contributed equally.

Abstract

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%; p = 0.832), but with a trend for lower grade in the NK1 group (33.3% G1; 26.7% G2) compared to the 5-HT3 group (23.7% G1; 31.6% G2; 2.6% G3). Vomiting was reported by 21% and 0% of patients in the 5-HT3 and the NK1 group, respectively (p = 0.054). Among the 15 patients in the 5-HT3 group with nausea at cycle 1 who escalated to NK1 at cycle 2, nausea decreased from 100% to 53% (p = 0.022) and vomiting decreased from 47% to 13% (p = 0.046).

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.

Keywords: Trastuzumab Deruxtecan; antiemetic prophylaxis; breast cancer; nausea; vomiting.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work has been supported in part by Fondazione AIRC per la Ricerca sul Cancro (IG2018 - ID21787, P.I. GB).