Safety profile of trastuzumab-emtansine (T-DM1) with concurrent radiation therapy: A systematic review and meta-analysis

Viola Salvestrini, Kyubo Kim, Saverio Caini, Sara Alkner, Maria Ekholm, Tanja Skyttä, Carlotta Becherini, Charlotte E. Coles, Orit Kaidar-Person, Birgitte Offersen, Evandro de Azambuja, Luca Visani, Javier Cortes, Nadia Harbeck, Hope S. Rugo, Clare M. Isacke, Elisabetta Marangoni, Andrea Morandi, Matteo Lambertini, Philip PoortmansLorenzo Livi, Icro Meattini

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Background and Purpose: In recent years, the treatment landscape for breast cancer has undergone significant advancements, with the introduction of several new anticancer agents. One such agent is trastuzumab emtansine (T-DM1), an antibody drug conjugate that has shown improved outcomes in both early and advanced breast cancer. However, there is currently a lack of comprehensive evidence regarding the safety profile of combining T-DM1 with radiation therapy (RT). In this study, we aim to provide a summary of the available data on the safety of combining RT with T-DM1 in both early and metastatic breast cancer settings. Materials and Methods: This systematic review and meta-analysis project is part of the consensus recommendations by the European Society for Radiotherapy and Oncology (ESTRO) Guidelines Committee on integrating RT with targeted treatments for breast cancer. A thorough literature search was conducted using the PUBMED/MedLine, Embase, and Cochrane databases to identify original studies focusing on the safety profile of combining T-DM1 with RT. Results: After applying eligibility criteria, nine articles were included in the meta-analysis. Pooled data from these studies revealed a high incidence of grade 3 + radionecrosis (17%), while the rates of grade 3 + radiation-related pneumonitis (<1%) and skin toxicity (1%) were found to be very low. Conclusion: Although there is some concern regarding a slight increase in pneumonitis when combining T-DM1 with postoperative RT, the safety profile of this combination was deemed acceptable for locoregional treatment in non-metastatic breast cancer. However, caution is advised when irradiating intracranial sites concurrently with T-DM1. There is a pressing need for international consensus guidelines regarding the safety considerations of combining T-DM1 and RT for breast cancer.

Original languageEnglish
Article number109805
JournalRadiotherapy and Oncology
StatePublished - Sep 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s)


  • Breast cancer
  • Meta-analysis
  • Radiotherapy
  • Systematic review
  • T-DM1
  • Trastuzumab emtansine


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