Management of nausea and vomiting induced by antibody-drug conjugates

Abstract

Antibody-drug conjugates (ADCs) are an emerging class of anticancer therapy that combines the specificity and long circulation half-life of monoclonal antibodies with the cytotoxic potency of the payload connected through a chemical linker. The optimal management of toxicities is crucial for improving quality of life in patients undergoing ADCs and for avoiding improper dose reductions or discontinuations. This article focuses on the characteristics and management of nausea and vomiting (NV) induced by three ADCs: trastuzumab deruxtecan (T-DXd), sacituzumab govitecan (SG), and datopotamab deruxtecan (Dato-DXd). We summarize the proposed mechanism of NV, clinical study data on NV, and recommendations from clinical guidelines. We also discuss three prospective studies evaluating prophylactic antiemetic therapy in patients receiving T-DXd, along with future perspectives.

Keywords: Antibody–drug conjugate; Datopotamab deruxtecan; Nausea and vomiting; Sacituzumab govitecan; Trastuzumab deruxtecan.

Fig. 1

Central and peripheral mechanisms of CINV. The pathways by which antineoplastic agents, including antibody–drug conjugates, may produce an emetic response are shown. VC vomiting center, CTZ chemoreceptor trigger zone, EC cells enterochromaffin cells, NK1R neurokinin 1 receptor, D2R dopamine D2 receptor, 5-HT3 R serotonin type 3 receptor