ESMO 2025 | Management of interstitial lung disease in the DESTINY-Breast05 trial
Charles Geyer, MD, University of Pittsburgh Medical Center, Pittsburgh, PA, describes the significance of the Phase III DESTINY-Breast05 trial (NCT04622319), highlighting its activity and the measures taken to monitor and mitigate the risk of serious lung toxicity, including regular CT scans to catch interstitial lung disease (ILD) early. The majority of ILD cases were reversible, although two patients unfortunately died from the condition. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
Well, I think the results clearly established what an active drug it is in the early setting as well as the advanced setting. We knew it was active. I mean, there was kind of a sense that this study should be positive. We don’t know how positive, but the other critical aspect of the study was what would be the risk of this serious lung toxicity that happens to a subset of patients who get tx-related interstitial lung disease or ILD for short...
Well, I think the results clearly established what an active drug it is in the early setting as well as the advanced setting. We knew it was active. I mean, there was kind of a sense that this study should be positive. We don’t know how positive, but the other critical aspect of the study was what would be the risk of this serious lung toxicity that happens to a subset of patients who get tx-related interstitial lung disease or ILD for short. In the metastatic trials, we have seen that there’s a very thankfully low, but it’s a percentage of patients who died from the disease. So if we were bringing this into the early setting, we wanted to do extra things to try to catch it early, because it was already evident that when you catch it early, stop the drug, use supportive care, that recoverability seems to be the norm. If it gets too far, it reaches a point of no return. So in Catherine, we had built in regular CT scans of the chest using lower doses of radiation, not doing contrast, because our pulmonology experts said, “No, that will tell us if you’re getting ILD.” So that was built into the study. And we feel like we were successful in catching it early when it happened. The number was about 10% of patients. 9.6 was the precise number, but 10% of patients developed ILD, but 8% of those were grade one or grade two, which is reversible. We unfortunately still had two patients die from the ILD, and that’s out of 1600, so it’s a low number, but it’s obviously something you’d like to avoid for everybody, for sure.
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