Background and purpose: In recent years, the treatment landscape for breast cancer has undergone significant advancements, with the introduction of several new anticancer agents. One such agent is trastuzumab emtansine (T-DM1), an antibody drug conjugate that has shown improved outcomes in both early and advanced breast cancer. However, there is currently a lack of comprehensive evidence regarding the safety profile of combining T-DM1 with radiation therapy (RT). In this study, we aim to provide a summary of the available data on the safety of combining RT with T-DM1 in both early and metastatic breast cancer settings. Materials and methods: This systematic review and meta-analysis project is part of the consensus recommendations by the European Society for Radiotherapy and Oncology (ESTRO) Guidelines Committee on integrating RT with targeted treatments for breast cancer. A thorough literature search was conducted using the PUBMED/MedLine, Embase, and Cochrane databases to identify original studies focusing on the safety profile of combining T-DM1 with RT. Results: After applying eligibility criteria, nine articles were included in the meta-analysis. Pooled data from these studies revealed a high incidence of grade 3+ radionecrosis (17%), while the rates of grade 3+ radiation-related pneumonitis (<1%) and skin toxicity (1%) were found to be very low. Conclusion: Although there is some concern regarding a slight increase in pneumonitis when combining T-DM1 with postoperative RT, the safety profile of this combination was deemed acceptable for locoregional treatment in non-metastatic breast cancer. However, caution is advised when irradiating intracranial sites concurrently with T-DM1. There is a pressing need for international consensus guidelines regarding the safety considerations of combining T-DM1 and RT for breast cancer.

Safety profile of trastuzumab-emtansine (T-DM1) with concurrent radiation therapy: a systematic review and meta-analysis / Salvestrini, Viola; Kim, Kyubo; Caini, Saverio; Alkner, Sara; Ekholm, Maria; Skyttä, Tanja; Becherini, Carlotta; Coles, Charlotte E; Kaidar-Person, Orit; Offersen, Birgitte; de Azambuja, Evandro; Visani, Luca; Cortes, Javier; Harbeck, Nadia; Rugo, Hope S; Isacke, Clare M; Marangoni, Elisabetta; Morandi, Andrea; Lambertini, Matteo; Poortmans, Philip; Livi, Lorenzo; Meattini, Icro. - In: RADIOTHERAPY AND ONCOLOGY. - ISSN 0167-8140. - ELETTRONICO. - 186:(2023), pp. 0-0. [10.1016/j.radonc.2023.109805]

Safety profile of trastuzumab-emtansine (T-DM1) with concurrent radiation therapy: a systematic review and meta-analysis

Salvestrini, Viola;Kim, Kyubo;Caini, Saverio;Becherini, Carlotta;Visani, Luca;Morandi, Andrea;Livi, Lorenzo;Meattini, Icro
2023

Abstract

Background and purpose: In recent years, the treatment landscape for breast cancer has undergone significant advancements, with the introduction of several new anticancer agents. One such agent is trastuzumab emtansine (T-DM1), an antibody drug conjugate that has shown improved outcomes in both early and advanced breast cancer. However, there is currently a lack of comprehensive evidence regarding the safety profile of combining T-DM1 with radiation therapy (RT). In this study, we aim to provide a summary of the available data on the safety of combining RT with T-DM1 in both early and metastatic breast cancer settings. Materials and methods: This systematic review and meta-analysis project is part of the consensus recommendations by the European Society for Radiotherapy and Oncology (ESTRO) Guidelines Committee on integrating RT with targeted treatments for breast cancer. A thorough literature search was conducted using the PUBMED/MedLine, Embase, and Cochrane databases to identify original studies focusing on the safety profile of combining T-DM1 with RT. Results: After applying eligibility criteria, nine articles were included in the meta-analysis. Pooled data from these studies revealed a high incidence of grade 3+ radionecrosis (17%), while the rates of grade 3+ radiation-related pneumonitis (<1%) and skin toxicity (1%) were found to be very low. Conclusion: Although there is some concern regarding a slight increase in pneumonitis when combining T-DM1 with postoperative RT, the safety profile of this combination was deemed acceptable for locoregional treatment in non-metastatic breast cancer. However, caution is advised when irradiating intracranial sites concurrently with T-DM1. There is a pressing need for international consensus guidelines regarding the safety considerations of combining T-DM1 and RT for breast cancer.
2023
186
0
0
Salvestrini, Viola; Kim, Kyubo; Caini, Saverio; Alkner, Sara; Ekholm, Maria; Skyttä, Tanja; Becherini, Carlotta; Coles, Charlotte E; Kaidar-Person, Orit; Offersen, Birgitte; de Azambuja, Evandro; Visani, Luca; Cortes, Javier; Harbeck, Nadia; Rugo, Hope S; Isacke, Clare M; Marangoni, Elisabetta; Morandi, Andrea; Lambertini, Matteo; Poortmans, Philip; Livi, Lorenzo; Meattini, Icro
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1320755
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