曲妥珠单抗 deruxtecan (T-DXd) 是一种人表皮生长因子受体 2 (HER2) 导向的抗体药物偶联物 (ADC)，它改变了乳腺癌 (BC) 的治疗前景，无论 HR 受体状态如何。尽管发现接触 T-DXd 会增加间质性肺病 (ILD) 的风险，尤其是 BC 患者，但该药物的使用仍在增加。尽管 T-DXd 相关 ILD 可能很严重并危及生命，但大多数低级别病例可以使用多学科方法安全治疗，包括早期准确诊断、有效管理、密切监测和及时服用类固醇。此外，加强患者对 ILD 症状的教育可确保密切关注并能够及时报告，从而改善患者的治疗效果。建议对存在 ILD 危险因素的患者进行预测性生物标志物评估。目前，诊断标准包括新发现的肺部混浊、症状发作与开始用药的关系以及排除 ILD 的其他原因。在 ILD 治疗期间（BC 进展和皮质类固醇治疗），患者的一般状况会减弱。因此，BC 化疗可能会减弱。这凸显了预防（高级）间质性肺病的重要性，特别是在其使用范围不断扩大的情况下。然而，识别高风险患者、诊断和定制治疗具有挑战性，并且有关患者选择的附加信息通常不完全明确。在本文中，我们为 HER2 阳性 BC 患者中 T-DXd 诱发的 ILD 患者选择、主动监测、早期诊断和有效管理提供最新的多学科临床指导。我们描述了发生 ILD 的危险因素、ILD 患者的特征以及 ILD 的组织病理学和放射学特征，包括真实世界的临床实践报告。这些建议提供了一种结构化的分步方法来管理每个可疑的 BC 相关 ILD 等级。版权所有 © 2023 作者。由爱思唯尔有限公司出版。保留所有权利。

Trastuzumab deruxtecan (T-DXd), a human epidermal growth factor receptor 2 (HER2)-directed antibody-drug conjugate (ADC), has altered the treatment landscape in breast cancer (BC), irrespective of the HR-receptor status. The use of the agent is increasing, despite the finding that exposure to T-DXd increases the risk of interstitial lung disease (ILD), particularly in BC patients. Although T-DXd-related ILD can be potentially severe and life-threatening, most low-grade cases can be treated safely using a multidisciplinary approach comprising early and accurate diagnosis, effective management, close monitoring, and the prompt administration of steroids. Additionally, increasing patients' education on ILD symptoms ensures close attention and enables prompt reporting, enhancing patient outcomes. It is recommended that predictive biomarkers are assessed in patients with risk factors for developing ILD. Currently, diagnostic criteria comprise newly identified pulmonary opacities, the relation of symptom onset to medication initiation, and the exclusion of other causes of ILD. The general condition of patients is weakened during the management of ILD (BC progression and corticosteroid treatment). Consequently, BC chemotherapy might be attenuated. This highlights the importance of preventing (high-grade) ILD, especially since its use is expanded. Identifying high-risk patients, diagnosing, and customizing treatment is, however, challenging and additional information on patient selection is often not fully clarified. In this paper, we provide updated multidisciplinary clinical guidance for patient selection, proactive monitoring, early diagnosis, and effectively management of T-DXd-induced ILD in HER2-positive BC patients. We describe the risk factors for developing ILD, patients' characteristics of ILD, and the histopathological and radiographic characteristics of ILD, including real-world clinical practice reports. These recommendations provide a structured step-by-step approach for managing each suspected BC-related ILD grade.Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.