The evolving landscape of treatment options for HER2-mutated non-small cell lung cancer (NSCLC) emphasizes the importance of patient involvement in therapeutic decisions. With rapid advancements in therapies and recent approvals occurring shortly after clinical discussions, there is an increasing need for comprehensive patient education and a shared decision-making process.
Empowering Patients Through Shared Decision-Making
Clinicians are encouraged to present various treatment alternatives side by side, facilitating informed discussions that take into account individual patient priorities, goals, and preferences. This approach is particularly vital given the unique characteristics and administration requirements associated with different HER2-targeted therapies. By actively engaging patients in the treatment selection process, healthcare providers can ensure that choices align with their specific circumstances and values.
Among the available options, T-DXd and zongertinib present distinct differences that significantly impact patient experience and quality of life. T-DXd, an antibody-drug conjugate, requires intravenous (IV) administration. This necessitates peripheral IV access and more frequent clinical visits for monitoring. The treatment is associated with chemotherapy-like toxicities, including nausea, vomiting, and an increased risk of neutropenia and interstitial lung disease. Close surveillance is critical, with repeat echocardiograms needed to monitor cardiac function and imaging typically occurring every 6 to 9 weeks during initial treatment phases.
These factors contribute to increased healthcare utilization and can affect patients’ daily functioning. In contrast, zongertinib, a targeted tyrosine kinase inhibitor, offers the convenience of once-daily oral administration. While it requires patient adherence, the monitoring protocols are less intensive. For the first 12 weeks, patients undergo liver function testing every two weeks, but subsequent visits are less frequent, with standard imaging intervals extending to approximately every three months.
Patient-Reported Outcomes Favor Targeted Therapy
Recent data indicates that patient-reported outcomes significantly favor zongertinib. Patients have reported greater improvements in functional status, respiratory symptoms such as cough and dyspnea, and a higher durability of symptomatic relief compared to traditional chemotherapy approaches. The cumulative toxicity profile of chemotherapy-based treatments versus the targeted nature of zongertinib is a critical consideration in treatment sequencing.
This evidence supports the preference for zongertinib, followed by trastuzumab deruxtecan, in clinical practice. Such sequencing optimizes both the efficacy of the treatment and the overall patient experience throughout the treatment continuum. As the field of oncology continues to advance, integrating patient preferences into treatment decisions will be paramount for enhancing outcomes in those battling HER2-mutated metastatic NSCLC.
