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What is your main challenge in supporting patients with BC undergoing treatment with HER2-directed ADCs?

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Knowledge gaps
   
Not enough time
   
Inadequate patient resources
   
Lack of confidence
   

Tutorial

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How involved are you in side effect monitoring/management for patients with BC treated with HER2-directed ADCs?

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Not involved
   
A little involved
   
Somewhat involved
   
Extremely involved
   

Tutorial

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How confident are you in explaining the expected outcomes of treatment with HER2-directed ADCs to patients with BC?

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Moderately
   
Extremely
   
 
Individualizing treatment strategies: HER2-directed ADCs in breast cancer
What to look out for: Side effects associated with HER2-directed ADCs in breast cancer
Optimal strategies for managing patients with breast cancer treated with HER2-directed ADCs
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Breast Cancer CE/CME accredited

touchIN CONVERSATION
A relaxed discussion between two faculty focussed on real world clinical issues. Useful tips below will show how to navigate the activity. Join the conversation. Close

Knowledge for nurses: ADC updates in breast cancer

  • Select in the video player controls bar to choose subtitle language. Subtitles available in English, French, German, Italian, Spanish.
  • A practice aid is available for this activity in the Toolkit
  • Downloads including slides are available for this activity in the Toolkit
Learning Objectives

After watching this activity, participants should be better able to:

  • Explain the rationale and latest evidence for current and upcoming HER2-directed ADCs for the treatment of breast cancer
  • Identify, mitigate and manage side effects related to HER2-directed ADCs in breast cancer
  • Discuss best practices for nurses and nurse practitioners caring for patients with breast cancer receiving HER2-directed ADCs in real-world clinical practice
Overview

In this activity, two experts in breast cancer, an oncology nurse and a medical oncologist, respond to questions from the oncology community. The questions cover the rationale and latest evidence for HER2-directed antibody–drug conjugates (ADCs) for the treatment of breast cancer; identifying, mitigating and managing side effects; and best practices for nurses and nurse practitioners caring for patients receiving HER2-directed ADCs.

This activity is provided by touchIME. touchIME is an EBAC® accredited provider.

Target Audience

Oncology nurses, including breast cancer nurse specialists involved in the management of breast cancer.

Disclosures

Faculty

Ms Nikolina Dodlek has no financial interests/relationships or affiliations in relation to this activity.

Prof. Sherko Kümmel discloses: All support since the initial planning of this work including advisory role and study material from Amgen, AstraZeneca, Daiichi Sankyo, Gilead Sciences and Novartis. Support to his institution from Agendia, AstraZeneca, Eli Lilly and Company, Hologic, MSD, Pfizer, PINK!, Roche and Stemline Therapeutics. Disclosures in the past 36 months including consulting fees from Eli Lilly and Company, MSD, Stryker. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Agendia, Amgen, AstraZeneca, Daiichi Sankyo, Eli Lilly and Company, Exact Sciences Corp., Gilead Sciences, Hologic, MSD, Novartis, Pfizer, pfm medical, Pinkpharma, Roche, Seagen, SOMATEX® Medical Technologies. Support for attending meetings and/or travel from Daiichi Sankyo, Eli Lilly and Company, MSD, Roche, Stemline Therapeutics. Participation on Data Safety Monitoring Board or Advisory Board from Agendia, Amgen, AstraZeneca, Daiichi Sankyo, Eli Lilly and Company, Exact Sciences Corp., Gilead Sciences, MSD, Novartis, Pfizer, pfm medical, Roche, Seagen, SonoScape.

Touch Medical Contributor

Katrina Lester has no financial interests/relationships or affiliations in relation to this activity.

EBAC® Accreditation

touchIME is an EBAC® accredited provider since 2023.

This programme is accredited by the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) for up to 1.0 hour(s) of CE credit(s). Each participant should claim only time that has been spent in the educational activity.

The Accreditation Council for Continuing Medical Education (ACCME®), and the Royal College of Physicians and Surgeons of Canada hold an agreement on substantial equivalency of accreditation systems with EBAC®.

Through an agreement between the European Board for Accreditation of Continuing Education for Health Professionals and the American Medical Association (AMA), physicians may convert EBAC® CE credits to AMA PRA Category 1 CreditsTM. Information on the process to convert EBAC® credit to AMA credit can be found on the AMA website. Other healthcare professionals may obtain from the AMA a certificate of having participated in an activity eligible for conversion of credit to AMA PRA Category 1 CreditTM.

Faculty Disclosure Statement / Conflict of Interest Policy

In compliance with EBAC® guidelines, all speakers/ chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event are declared to the audience prior to the CME activities.

Requirements for Successful Completion

Certificates of Completion may be awarded upon successful completion of the post-test and evaluation form. If you have completed one hour or more of effective education through EBAC® accredited CE activities, please contact us at accreditation@touchime.org to receive your EBAC® CE credit certificate. EBAC® grants 1 CE credit for every hour of education completed.

Date of original release: 31 July 2024. Date credits expire: 31 July 2025.

Time to complete: 45 minutes.

If you have any questions regarding the EBAC® credits, please contact accreditation@touchime.org

This activity is CE/CME accredited

To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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  • Select in the video player controls bar to choose subtitle language. Subtitles available in English, French, German, Italian, Spanish.
  • A practice aid is available for this activity in the Toolkit
  • Downloads including slides are available for this activity in the Toolkit

Topics covered in this activity

Breast Cancer
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touchIN CONVERSATION
Knowledge for nurses: ADC updates in breast cancer
1.0 CE/CME credit

Question 1/5
HER2-directed antibody-based therapies have been developed for patients with BC with HER2 overexpression, with more in clinical development. In approximately what percentage of BC cases is the HER2 protein overexpressed?

BC, breast cancer; HER2, human epidermal growth factor receptor 2.

The HER2 protein is overexpressed in 20–30% of BC cases and is historically associated with higher cancer recurrence rates and shorter disease-free and overall survival vs patients with HER2-negative BC.

Abbreviations 

BC, breast cancer; HER2, human epidermal growth factor receptor 2.

Reference

Zimmerman BS, Esteva FJ. Cancers (Basel). 2024;16:800.

Question 2/5
The DESTINY-Breast03 clinical trial is comparing the efficacy and safety of T-DXd vs T-DM1 in patients with HER2+ metastatic BC. Based on interim trial data, how would you describe the difference in median PFS observed with T-DXd vs T-DM1?

BC, breast cancer; HER2, human epidermal growth factor receptor 2; PFS, progression-free survival; T-DM1, trastuzumab emtansine; T-DXd, trastuzumab deruxtecan.

In the phase III DESTINY-Breast03 clinical trial (NCT03529110), median PFS (primary endpoint) at data cutoff, 20 November 2023, was 29.0 months (95% CI, 23.7–40.0) with T-DXd and 7.2 months (95% CI, 6.8–8.3) with T-DM1 (hazard ratio 0.30; 95% CI, 0.24–0.38).1 A hazard ratio of 0.30 means that the study drug provides 70% risk reduction compared with control treatment.2

Abbreviations

CI, confidence interval; PFS, progression-free survival; T-DM1, trastuzumab emtansine; T-DXd, trastuzumab deruxtecan.

References

  1. Cortés J, et al. Nat Med. 2024. doi: 10.1038/s41591-024-03021-7.
  2. Brody T. In: Brody T. Clinical Trials. Academic Press, 2012;165–90.
Question 3/5
According to clinical trial data, what proportion of patients with BC treated with T-DM1 develop thrombocytopenia?

BC, breast cancer; T-DM1, trastuzumab emtansine.

Across multiple clinical trials, thrombocytopenia or decreased platelet counts have been commonly reported with T-DM1 and are the most common adverse reaction leading to treatment discontinuation. Thrombocytopenia or reduced platelet counts were reported in 24.9% of patients with metastatic BC and 28.5% of patients with early BC. Patients should have their platelet counts monitored prior to each T-DM1 dose.

Abbreviations

BC, breast cancer; T-DM1, trastuzumab emtansine.

Reference

EMA. Trastuzumab emtansine SPC. 2023. Available at: https://bit.ly/4avhuvl (accessed 10 July 2024).

Question 4/5
How would you advise patients treated with a HER2-directed ADC to facilitate early identification and effective management of ILD/pneumonitis?

ADC, antibody–drug conjugate; HER2, human epidermal growth factor receptor 2; HRCT, high-resolution computed tomography; ILD, interstitial lung disease.

Patients with BC treated with HER2-directed ADCs should be educated about potential signs of ILD/pneumonitis to encourage self-monitoring and reporting of potential symptoms.1–3 Symptoms indicative of ILD/pneumonitis should be described, such as a cough, dyspnea and fever. Patients should be encouraged to immediately report new or worsening respiratory symptom(s) suggestive of ILD/pneumonitis.3 HRCT or radiographic changes potentially consistent with ILD/pneumonitis warrant immediate treatment interruption and further evaluation to confirm the diagnosis.3 T-DXd should be permanently discontinued for grade ≥2 ILD/pneumonitis; T-DM1 should be permanently discontinued for all confirmed cases of ILD/pneumonitis.4,5 

Abbreviations

ADC, antibody–drug conjugate; BC, breast cancer; HER2, human epidermal growth factor receptor 2; HRCT, high-resolution computed tomography; ILD, interstitial lung disease; T-DM1, trastuzumab emtansine; T-DXd, trastuzumab deruxtecan.

References

  1. Chai M, et al. Crit Rev Oncol Hematol. 2024;195:104274.
  2. Swain SM, et al. Cancer Treat Rev. 2022;106:102378.
  3. Rugo HS, et al. JCO Oncol Pract. 2023;19:539–46.
  4. EMA. Trastuzumab deruxtecan SPC. 2024. Available at: https://bit.ly/3URZ2rd (accessed 10 July 2024).
  5. EMA. Trastuzumab emtansine SPC. 2023. Available at: https://bit.ly/4avhuvl (accessed 10 July 2024).
Question 5/5
Your patient with metastatic HER2-low BC is taking granisetron and dexamethasone emesis prophylaxis alongside T-DXd, but they inform you that they have recently started to experience some nausea. What would you do next to help reduce their symptoms?

BC, breast cancer; HER2, human epidermal growth factor receptor 2; T-DXd, trastuzumab deruxtecan.

Eating frequent small meals will ensure the body receives enough calories, protein and nutrients to tolerate treatment. Small meals may help reduce treatment-related side effects, such as nausea.1 Eating five to eight small meals about every 3 hours is recommended.1,2 Eating food cold or at room temperature may reduce its smell and taste.2

References

  1. Sarah Cannon Cancer Network. Breast Cancer Nutrition. Available at: https://bit.ly/3wFrlRu (accessed 10 July 2024).
  2. BreastCancer.org. Eating When You Have Nausea and Vomiting. Available at: https://bit.ly/3UNkwFq (accessed 10 July 2024).
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