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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 LU ; Ekholm, Maria LU ; Skyttä, Tanja ; Becherini, Carlotta ; Coles, Charlotte E. ; Kaidar-Person, Orit and Offersen, Birgitte , et al. (2023) In Radiotherapy and Oncology 186.
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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Breast cancer, Meta-analysis, Radiotherapy, Systematic review, T-DM1, Trastuzumab emtansine
in
Radiotherapy and Oncology
volume
186
article number
109805
publisher
Elsevier
external identifiers
  • pmid:37437610
  • scopus:85166661686
ISSN
0167-8140
DOI
10.1016/j.radonc.2023.109805
language
English
LU publication?
yes
id
32fbcc12-d4ac-4ca4-8e13-6b7afd811d26
date added to LUP
2023-10-26 08:56:12
date last changed
2024-04-19 02:53:43
@article{32fbcc12-d4ac-4ca4-8e13-6b7afd811d26,
  abstract     = {{<p>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 (&lt;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.</p>}},
  author       = {{Salvestrini, Viola and Kim, Kyubo and Caini, Saverio and Alkner, Sara and Ekholm, Maria and Skyttä, Tanja and Becherini, Carlotta and Coles, Charlotte E. and Kaidar-Person, Orit and Offersen, Birgitte and de Azambuja, Evandro and Visani, Luca and Cortes, Javier and Harbeck, Nadia and Rugo, Hope S. and Isacke, Clare M. and Marangoni, Elisabetta and Morandi, Andrea and Lambertini, Matteo and Poortmans, Philip and Livi, Lorenzo and Meattini, Icro}},
  issn         = {{0167-8140}},
  keywords     = {{Breast cancer; Meta-analysis; Radiotherapy; Systematic review; T-DM1; Trastuzumab emtansine}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Radiotherapy and Oncology}},
  title        = {{Safety profile of trastuzumab-emtansine (T-DM1) with concurrent radiation therapy : A systematic review and meta-analysis}},
  url          = {{http://dx.doi.org/10.1016/j.radonc.2023.109805}},
  doi          = {{10.1016/j.radonc.2023.109805}},
  volume       = {{186}},
  year         = {{2023}},
}