Abstract P4-05-08: Impact of antiemetic prophylaxis on maintaining dose intensity of trastuzumab deruxtecan in HER2-positive advanced breast cancer
Abstract
Introduction: Maintaining dose intensity is crucial for optimizing outcomes in patients with HER2-positive advanced breast cancer (ABC) treated with trastuzumab deruxtecan (T-DXd). Nausea and vomiting are among the most frequent adverse events associated with T-DXd and often lead to dose reductions, potentially compromising efficacy. While T-DXd is classified as moderately to highly emetogenic, clinician education on appropriate antiemetic prophylaxis is crucial, especially given the extended treatment duration due to its remarkable efficacy. This analysis investigated the impact of guideline-recommended antiemetic prophylaxis in the first cycle on maintaining T-DXd dosing over time. Methods: Data from patients with HER2-positive ABC treated with at least two cycles of T-DXd were extracted and analyzed from the clinical data warehouse of Samsung Medical Center. Patients were grouped based on the use of a guideline-recommended triple antiemetic regimen (TAR) in the first cycle of T-DXd. The TAR consisted of either the fixed combination of netupitant/palonosetron (NEPA) or the combination of an NK1 receptor antagonist (RA) and a 5-HT3 RA plus dexamethasone. The proportions of patients requiring a reduction from the 5.4 mg/kg starting dose of T-DXd to 4.4 mg/kg and 3.2 mg/kg were calculated for both TAR and non-TAR groups. Results: Between June 29, 2022 and May 5, 2024, 59 patients with HER2-positive ABC received a median of 7 cycles (range, 2–30) of T-DXd. The median age at…
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