Interstitial Lung Disease (ILD) and Pneumonitis

ILD and pneumonitis, including Grade 5 cases, have been reported with ENHERTU; monitor patients and initiate management at first sign of ILD1,a,b

  • ILD and pneumonitis, including fatal cases, have been reported with ENHERTU

In DESTINY-Gastric01

  • 10% of patients (n=12/125) in the ENHERTU arm experienced ILD/pneumonitis of any grade1,c
  • The majority of ILD/pneumonitis cases in previously treated patients with HER2+ aGC who received ENHERTU were Grade 1 or 22
    • 2.4% of patients (n=3/125) experienced Grade 1 events
    • 4.8% of patients (n=6/125) experienced Grade 2 events
    • 1.6% of patients (n=2/125) experienced Grade 3 events
    • 0.8% of patients (n=1/125) experienced a Grade 4 event
  • Median time to first onset was 2.8 months (range: 1.2-21.0)1

aILD includes events that were adjudicated as ILD: pneumonitis, interstitial lung disease, respiratory failure, organizing pneumonia, acute respiratory failure, lung infiltration, lymphangitis, alveolitis.1

bGrade 5=fatal cases.

cPercentages of ILD/pneumonitis events by grade may not add up to 10% due to rounding.

ENHERTU Prescribing Information management recommendations for ILD/pneumonitis, including corticosteroid recommendations, were based on experience in the clinical trials and developed in collaboration with an external ILD expert panel comprised of oncologists, pulmonologists, and radiologists

It could be more than a cough

Identification of the signs and symptoms of ILD, including cough, dyspnea, fever,
and worsening respiratory symptoms, can help inform patient management.1

Promptly investigate evidence of ILD/pneumonitis1

  • Evaluate patients with suspected ILD/pneumonitis by radiographic imaging1
  • Consider consultation with a pulmonologist1
  • Investigation may be prompted by incidental findings on routine scans when checking for progression or symptomatic findings
    • Diagnosis of ILD/pneumonitis requires exclusion of other causes

For asymptomatic ILD/pneumonitis (Grade 1)1

  • Consider corticosteroid treatment (eg, ≥0.5 mg/kg per day prednisolone or equivalent)
  • Interrupt ENHERTU until resolved to Grade 0, then:

For symptomatic ILD/pneumonitis (Grade 2 or greater)1

  • Promptly initiate systemic corticosteroid treatment (eg, ≥1 mg/kg per day prednisolone or equivalent)
    • Continue for at least 14 days followed by gradual taper for at least 4 weeks
  • Permanently discontinue ENHERTU in patients who are diagnosed with any symptomatic ILD/pneumonitis

ILD identification1,3

Severity Description (NCI-CTCAEd grading)
Grade 1 Asymptomatic, clinical or diagnostic observations only
Grade 2 Symptomatic, limiting instrumental activities of daily living
Grade 3 Severe symptoms, limiting self-care activities of daily living; oxygen indicated
Grade 4 Life-threatening respiratory compromise
Grade 5 Death
dToxicity grades are in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.03 (NCI-CTCAE v.4.03).3

Symptom identification is key to ILD/pneumonitis diagnosis

Monitor patients for and promptly investigate the signs and symptoms of ILD/pneumonitis,
which may include1:

  • Cough
  • Dyspnea
  • Fever
  • New or worsening respiratory symptoms

Talk to your patients to raise awareness and help identify symptoms1

  • Advise patients to contact their healthcare provider immediately for any of the symptoms shown above
  • Inform patients of the risks of severe, life-threatening, or fatal ILD
  • Advise patients to read the FDA-approved patient labeling: Download the Medication Guide

Potential questions to ask your patients to help with identification of ILD4,5

  • Have you been coughing recently? Is it a dry cough?
  • Have you had any shortness of breath, especially during or after physical activity?
  • Have you experienced any new breathing or respiratory problems?
  • If you already have respiratory problems, have they gotten worse?
  • Have you had a fever?
  • Have you been feeling tired?
  • Have you lost weight?
Ready to learn more about ENHERTU?

aGC, advanced gastric cancer; HER2, human epidermal growth factor receptor 2.