Does Cutting the Dose Help?

A clinician asks whether reducing the dose of T-DXd meaningfully eases nausea or fatigue. The “stubborn oncologist” confesses she rules out secondary causes such as B12 deficiency or de-conditioning before surrendering milligrams, but admits a first-step reduction generally salvages quality of life without gutting efficacy. She states that she scans the lungs every 12 weeks for ILD; becoming more laid back and shortening intervals during year one, spacing them once the two-year plateau passes. She finishes by stating that she won’t relax imaging until stability rides past the 24-month mark.