Ocular Toxicity Management and Multidisciplinary Coordination

Dr. Sunshine provides ophthalmologic perspective on Dato-DXd's unique ocular surface events, representing a new toxicity profile for breast oncology practitioners. The management approach begins with baseline patient education and ophthalmologic examination, establishing foundation for both patient awareness and professional monitoring.

Baseline ophthalmologic evaluation involves comprehensive eye examination including dilation, even though most toxicities affect the ocular surface. Updated labeling now recommends ophthalmologic assessments every 3 cycles throughout treatment, with final examination at treatment completion.

Regular monitoring visits include basic eye examinations with vision testing, intraocular pressure measurement, and slit lamp examination to evaluate ocular surface from eyelids through the lens. This allows detection of surface toxicity before symptomatic presentation.

Dr. Sunshine differentiates Dato-DXd's relatively mild ocular surface toxicity from more severe ADC-related complications. The drug causes dry eye findings with epithelial breakdown and associated symptoms, manageable with artificial tears and supportive care.

Other ADCs can cause more severe toxicities including pseudo-microcysts with refractive changes affecting vision and eyeglass prescriptions, or uveitis with intraocular inflammation potentially causing long-term complications. Dato-DXd's toxicity profile remains generally reversible with appropriate early detection and management.

Ms. Davidson emphasizes robust patient education encouraging prophylactic artificial tear use before symptom onset to maintain ocular surface health. Patients receive instruction to report symptoms promptly, with nursing teams providing responsive escalation based on symptom severity.