Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Treatment regimen

Trastuzumab deruxtecan (T-DXd, Enhertu): dose and monitoring

5.4 mg/kg every 3 weeks in breast cancer; monitoring for interstitial lung disease

Updated: 28 October 20261 min read2 references

Summary for doctors

  • Metastatic HER2-positive breast cancer after anti-HER2 treatment, and HER2-low disease after chemotherapy [1].
  • Breast cancer: 5.4 mg/kg; gastric cancer: 6.4 mg/kg.
  • Interstitial lung disease (ILD) is the most important toxicity [1].

Dose and schedule

T-DXd

Metastatic HER2-positive or HER2-low breast cancerCycle length: Every 21 days

Metastatic HER2-positive or HER2-low breast cancer

DrugDoseRouteSchedule
Trastuzumab deruxtecan5.4 mg/kgIV (first dose over 90 minutes, then 30 minutes)Day 1
Cycle length
Every 21 days
Duration
Until progression or toxicity

Dose as in DESTINY-Breast03 [1]. Dose reduction: 4.4, then 3.2 mg/kg.

Dose source: [2].

Evidence: DESTINY-Breast03 (2022)

Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.

Premedication and supportive care

  • Nausea and vomiting are common [1]; strong prophylaxis (many centres use NK1, 5-HT3 and dexamethasone) and an antiemetic to take at home for the following days.
  • Patient education: report a new cough, fever or shortness of breath straight away.

Monitoring and dose adjustment

  • ILD: baseline CT and every 6 to 12 weeks; grade 1: hold until recovery and consider steroids; grade 2 or more: stop permanently and give steroids (prednisolone 1 mg/kg or more).
  • Blood counts before each dose; left ventricular ejection fraction (echo or MUGA) before starting and every 3 months during anti-HER2 treatment.

Main evidence

Show detailsHide

DESTINY-Breast03: vs T-DM1, 12-month progression-free survival was 75.8% vs 34.1%; drug-related interstitial lung disease in 10.5%, with no grade 4 or 5 cases [1].

Related cancer types

Breast cancerStomach cancerLung cancer

Treatment regimens (physicians)

FOLFOX (mFOLFOX6): dose, schedule and side effectsCAPOX (XELOX): dose, schedule and side effectsFOLFIRI regimen: dose, schedule and side effectsFLOT regimen: dose and schedule in gastric and oesophageal cancerNivolumab with CAPOX or FOLFOX in gastric cancer (CheckMate 649)AC followed by paclitaxel (dose-dense and weekly)TC regimen (docetaxel and cyclophosphamide): dose and scheduleTCHP regimen: dose and schedule in HER2-positive breast cancerWeekly paclitaxel with trastuzumab (APT regimen)KEYNOTE-522 regimen: pembrolizumab and chemotherapy in triple-negative breast cancerTrastuzumab emtansine (T-DM1, Kadcyla): dose and scheduleAdjuvant capecitabine after neoadjuvant treatment (CREATE-X)

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References

2 references
Show all references, 1 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    Trastuzumab Deruxtecan versus Trastuzumab Emtansine for Breast CancerCortés J, Kim SB, Chung WP, et al · N Engl J Med · 2022;386:1143-1154
    Study cardDOIPubMed Back to text: 1 2 3 4 5
  2. 2
    ENHERTU (FAM-TRASTUZUMAB DERUXTECAN-NXKI) — Prescribing InformationDaiichi Sankyo Inc · FDA label · 2026
    Source Back to text

This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/trastuzumab-deruxtecan-tdxd/

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