The landscape of treatment for HER2-mutated non-small cell lung cancer (NSCLC) is evolving rapidly. Recent therapeutic developments, including the swift approval of new therapies, underscore the importance of integrating patient preferences and shared decision-making into treatment plans. Clinicians are now tasked with presenting various treatment options alongside each other, facilitating discussions that prioritize patient goals and preferences.
Understanding Treatment Options
Two notable therapies in this context are T-DXd, an antibody-drug conjugate, and zongertinib, a targeted tyrosine kinase inhibitor. Both have distinct characteristics that significantly influence patient experiences and quality of life. T-DXd requires intravenous (IV) administration, which involves peripheral IV access and more frequent clinical visits for monitoring due to its chemotherapy-like toxicities. Patients undergoing this treatment may face side effects such as nausea, vomiting, neutropenia, and a risk of interstitial lung disease. The monitoring process is intensive, often necessitating repeat echocardiograms to assess cardiac function and frequent imaging every six to nine weeks initially.
In contrast, zongertinib offers a more convenient option with its once-daily oral administration. This route, while requiring patient adherence, allows for fewer clinical visits after an initial monitoring period that includes liver function testing every two weeks for the first 12 weeks. Following this, patients typically return for standard imaging every three months, thus reducing the burden of frequent medical visits.
Patient-Centered Decision-Making
Research suggests that patient-reported outcomes for zongertinib are favorable. Patients report significant improvements in functional status and respiratory symptoms, including cough and dyspnea. This treatment also demonstrates greater durability of symptomatic improvements.
The contrasting toxicity profiles of these therapies play a crucial role in treatment sequencing. The cumulative risks associated with chemotherapy-based approaches, such as T-DXd, compared to the targeted nature of zongertinib, support the preference for the latter among clinicians. Evidence indicates that initiating treatment with zongertinib, followed by trastuzumab deruxtecan, may optimize both efficacy and patient experience throughout the treatment continuum.
Incorporating shared decision-making in this manner allows patients to engage actively in their treatment choices based on their individual circumstances and preferences. As treatment landscapes continue to develop, this patient-centered approach is essential for enhancing the quality of care in HER2-mutated NSCLC.