Clinical Summary

• Experts outlined role-specific strategies for oncology nurses and advanced practice providers managing trastuzumab deruxtecan-related interstitial lung disease.
• Recommendations emphasized proactive monitoring, early steroid initiation, patient education, and multidisciplinary communication.
• Findings support structured implementation of the Five “S” Strategy during routine oncology care encounters.

Trastuzumab deruxtecan (T-DXd), a HER2-directed antibody-drug conjugate used across multiple malignancies, carries a risk of interstitial lung disease (ILD)/pneumonitis, a potentially serious adverse event requiring early recognition and intervention. A practice-focused project presented at the 2026 Oncology Nursing Society (ONS) Congress gathered expert insights from an oncology nurse and an advanced practice provider (APP) to identify practical strategies for ILD monitoring and management in clinical settings.

The initiative aimed to translate existing prescribing information and best-practice guidance—including the Five “S” Strategy—into actionable recommendations tailored to frontline oncology clinicians. Structured interviews were conducted with a practicing oncology nurse and an oncology nurse practitioner from academic and community oncology settings. Discussions focused on patient education, monitoring workflows, treatment suspension, steroid management, and care team communication.

Insights generated role-specific recommendations aligned with the Five “S” framework. For screening and scanning, the oncology nurse emphasized coordinating baseline and follow-up imaging with other required assessments, such as echocardiograms, to improve efficiency and streamline patient care. The nurse practitioner highlighted the importance of assessing patient-specific ILD risk factors at baseline and ensuring explicit radiology reporting.

Both clinicians identified communication and knowledge gaps across oncology and non-oncology disciplines. To address these issues, they recommended broader use of the T-DXd medication guide and expanded educational initiatives for multidisciplinary teams.

Approaches to treatment suspension and steroid management also differed by role. The oncology nurse stressed the importance of clear patient instructions regarding steroid adherence and symptom reporting. The nurse practitioner advocated for greater autonomy to hold T-DXd treatment based on clinical suspicion and supported early, liberal steroid initiation when ILD is suspected.

The findings reinforce the complementary roles of oncology nurses and APPs in managing T-DXd-related ILD. Nurses were identified as central to care coordination, patient education, and symptom monitoring, while APPs were described as key clinical decision-makers responsible for assessment and intervention.

Clinically, the project highlights the importance of standardized monitoring pathways and proactive communication to reduce morbidity associated with ILD/pneumonitis. The researchers noted that “effective ILD monitoring and management requires role-specific training and robust multidisciplinary communication.” They added that these real-world perspectives demonstrate “practical application of guidelines and prescribing information” while offering “actionable pearls to empower the care team.”

Overall, the project provides practical recommendations to support oncology clinicians managing T-DXd-related ILD and underscores the need for coordinated, team-based approaches to toxicity monitoring in modern oncology care.

Source:

Hollinghurst E, LaRose L, Racadio M, Lam C, Tesic-Schnell M. Expert Insights for T-DXD-Related ILD Management: Empowering Oncology Nurses and Advanced Practice Providers in Clinical Practice. Presented at the Oncology Nursing Society Annual Congress; May 13-17, 2026. San Antonio, TX.