Ep. 2: Managing Ocular Toxicity, Mucositis, and ILD With Datopotamab Deruxtecan in EGFR-Mutated NSCLC
Key Points
-
Ocular toxicities with datopotamab deruxtecan (Dato-DXd) occur in 35% to 40% of patients and are usually low grade.
-
Prophylactic strategies for mucositis, including early steroid mouth rinses and patient education, can reduce severity and allow continued therapy without loss of efficacy.
-
Interstitial lung disease (ILD) remains an uncommon but serious risk.
In this continuation of the Clinical Insights discussion on Dato-DXd, the panel shifted focus to practical toxicity management strategies for this antibody–drug conjugate in routine practice. Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, were joined by Blanca A. Ledezma, NP, of UCLA Health; Aaron Lisberg, MD, of UCLA Health; and Sarah B. Sunshine, MD, of the University of Maryland School of Medicine, to highlight the value of multidisciplinary collaboration when introducing new agents into non–small cell lung cancer (NSCLC) care.
Ocular Toxicity: Recognition, Prevention, and Collaboration
Dr. Sunshine addressed ocular adverse events, particularly dry eye and keratitis, which occur in 35% to 40% of patients treated with Dato-DXd. Importantly, most cases are low grade, presenting as irritation, blurry vision, or mild exam findings rather than severe vision-threatening complications.
A key clinical pearl involved the value of baseline ophthalmologic assessment early in treatment. Many patients already have underlying dry eye or other ocular conditions related to age or prior chemotherapy, and understanding baseline status allows clinicians to differentiate treatment-related changes from preexisting disease. Preventive strategies include routine use of preservative-free artificial tears, avoidance of contact lenses, and regular ophthalmologic follow-up during treatment.
Proactive Management of Mucositis and Interstitial Lung Disease
Dr. Lisberg expanded on strategies for mucositis and ILD. For mucositis, he described a proactive approach beginning before the first dose of therapy. Patients routinely receive a steroid-containing prophylactic mouth rinse along with a symptomatic rinse at treatment initiation, paired with counseling on oral hygiene.
When grade 2 mucositis develops, short treatment delays of 1 to 2 weeks often allow recovery without compromising disease control. Dose reductions are reserved for recurrent or higher-grade toxicity. Notably, dose delays and reductions have not been associated with loss of antitumor efficacy.
The panel underscored that while ILD is uncommon, this toxicity warrants vigilance, particularly in lung cancer patients with baseline respiratory symptoms. Aggressive monitoring, prompt imaging review, early pulmonary consultation, and rapid initiation of corticosteroids when indicated are central to safe management.