A Promising Targeted Therapy For Advanced Lung Cancer
- Tratuzumab deruxtecan (brand name: Enhertu) represents a significant advance in precision oncology, providing new hope for patients with lung cancer who have something known as a HER2 mutation.
- This medication is a clear example of how understanding the specific molecular changes in cancer can lead to more effective and personalized treatments, opening a path toward improved outcomes and a better quality of life.
- Tratuzumab deruxtecan is an antibody-drug conjugate. “What this means is it has two heads,” Dr. Isabel Preeshagul, a medical oncologist at Memorial Sloan Kettering Cancer Center, tells SurvivorNet. “You have the part of the antibody that binds to the tumor cell, and then you have the other part that has the warhead or the chemotherapy agent.”
- This medication is approved for patients with metastatic non-small cell lung cancer (NSCLC) that tests positive for HER2 mutations and has progressed after being treated with chemotherapy.
“HER2, you’ve probably heard about in breast cancer, but we have also realized that HER2 alterations or HER2 mutations are also seen in patients with lung cancer,” Dr. Isabel Preeshagul, a medical oncologist at Memorial Sloan Kettering Cancer Center in New York City, tells SurvivorNet.
Read MoreWhat Is HER2 & Why Does It Matter?
HER2, or human epidermal growth factor receptor 2, is a protein naturally found on the surface of many cells. Commonly, it plays a crucial role in regulating normal cell growth. However, in certain cancers, including lung cancer, the HER2 gene can become altered (mutated or amplified), causing extreme HER2 protein production. This excess causes rapid cancer cell growth, leading to more aggressive tumor behavior. Testing for HER2 mutations is important, as HER2-positive lung cancers are typically less responsive to usual treatments. Identifying these mutations allows doctors to choose targeted medications, like trastuzumab, designed explicitly to block HER2-driven tumor growth.How Does Trastuzumab Deruxtecan Work?
Trastuzumab deruxtecan belongs to a group of antineoplastic drugs known as antibody-drug conjugates (ADCs).
This type of treatment combines two therapies into one:
- Trastuzumab: An antibody specifically designed to find and bind to the HER2 protein on cancer cells
- Deruxtecan: A powerful chemotherapy drug attached to trastuzumab
When this drug is infused into your bloodstream, the trastuzumab part of the molecule targets HER2-positive cancer cells, locking onto their surface like a perfect match. Once bound, it delivers deruxtecan directly into the cancer cells, dramatically increasing the effectiveness of the chemotherapy while reducing its impact on normal, healthy cells.
“Trastuzumab deruxtecan is an antibody-drug conjugate. What this means is it has two heads,” Dr. Preeshagul explains. “So, you have the part of the antibody that binds to the tumor cell, and then you have the other part that has the warhead or the chemotherapy agent.
“It’s almost like a Trojan horse. When I explain it to my patients, it’s like the horse looks very innocent and goes up to the tumor cell and binds to the tumor cell, and then unleashes this warhead and goes inside. And that’s how it kills the tumor.”
Trastuzumab is precise and powerful and aims specifically at cancer cells, thereby enhancing effectiveness and decreasing overall side effects.
Who Can Use Trastuzumab Deruxtecan?
This medication is specifically approved for patients with metastatic non-small cell lung cancer (NSCLC) that tests positive for HER2 mutations and whose cancer has progressed despite prior chemotherapy – essentially, it can be used as a second, or second-line, treatment. Your oncologist will typically order a genetic test on your tumor tissue to determine if it is suitable for your specific cancer type.
“If you have HER2 alteration and you’re diagnosed with non-small cell lung cancer stage 4, you have to receive standard of care treatment first, which means some kind of chemotherapy. And if your cancer grows on that or progresses on that or doesn’t respond, unfortunately, then you’re able to get trastuzumab deruxtecan,” Dr. Preeshagul explains.
It is important to note that it is given intravenously (IV), and the treatment continues as long as your tumor responds well, and you tolerate the side effects. Regular monitoring with imaging scans helps guide treatment length.
Potential Side Effects
Like all cancer therapies, Enhertu comes with potential side effects. However, its targeted nature means many patients experience fewer and milder effects compared to conventional chemotherapy.
Common side effects include:
- Fatigue (feeling unusually tired or weak)
- Nausea and/or vomiting (often manageable with supportive medications)
- Decreased appetite
- Hair loss
- Anemia and decreased blood counts (potentially causing infections or easy bruising)
- Diarrhea or constipation
- Eyes and mouth dryness and/or irritation
Some more serious side effects, though less common, are possible as well, including:
- Interstitial Lung Disease (ILD)/pneumonitis: This is inflammation of lung tissue, causing cough, difficulty breathing, fever, or worsening respiratory symptoms. Immediate medical evaluation and treatment with steroids may be necessary.
- Heart problems (mostly in patients with prior heart illness)
- Liver toxicity
Daily Life While on Enhertu
Most patients can maintain a reasonable quality of life while receiving Enhertu. Its targeted nature often means fewer side effects compared to traditional chemotherapy. However, regular visits for infusions, tests, and imaging scans will become part of your routine.
It’s crucial to have open conversations with your healthcare team, keep track of side effects, and report symptoms early. Staying well-nourished, hydrated, and gently active can significantly help manage treatment-related fatigue and maintain overall strength.
Questions To Ask Your Doctor
- Has my tumor been tested for HER2 mutations?
- What can I expect during and after Enhertu treatment?
- How quickly should I see results or improvement?
- What side effects should I watch for, and how can we manage them effectively?
- How often will I need blood tests, scans, and heart monitoring while on Enhertu?
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