Importance of Managing Nausea Related to T-DXd in HR+ Breast Cancer

Managing nausea related to treatment with trastuzumab deruxtecan (T-DXd; Enhertu) for patients with hormone receptor–positive breast cancer is important to reducing fatigue and improve quality of life, according to Sarah Donahue, MPH, NP.

Donahue, a nurse practitioner at University of California, San Francisco, and part of the Oncology Nursing Society, spoke with CancerNetwork® about her strategies for mitigating the effects of nausea among patients at her practice. According to Donahue, she uses pre-medications such as doxorubicin and cyclophosphamide as well as other agents including olanzapine to the limit the amount of nausea that may follow treatment with T-DXd.

Transcript:

With T-DXd, many of my patients with hormone receptor–positive, HER2-negative or HER2-low metastatic breast cancer would qualify for this, and many of them have never had a medication, like T-DXd before. T-DXd can cause cardiovascular effects.

The other main [adverse] effect of that medication is mostly nausea. It’s pretty common. You’re giving a lot of pre-medications. You’re giving doxorubicin and cyclophosphamide; you’re giving them the works. And then you’re making sure that at home they have the antiemetics to use as needed. Sometimes, in the first cycle, I’ll help patients schedule it because it’s harder to catch up with the pain. I don’t want to create a situation where every time they’re coming in, they’re thinking about the nausea that they had last time, [feeling] worried, and having that anticipatory nausea, as well. I give them a lot of these medications to take at home with a little bit of scheduling.

What I found is that some of these patients will have a nausea that occurs for longer than you would expect with a medication. What I find is adding on olanzapine at bedtime for the first 3 to 5 nights starting the night of treatment really helps. Sometimes I have patients who just continue with that even longer or take it as needed, and they are needing it later on. When we’re talking about the patient’s quality of life, if they’re not eating well and they’re nauseated, they’re going to have some level of fatigue, low blood sugar, and lack of hydration because they’re not feeling well enough to drink. A lot of my goals to make them feel as normal as possible and having the least amount of fatigue so that they can do what they want to be doing—which makes them feel better emotionally, too—are really targeting that nausea and making sure that it is very well controlled.