OnCo
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Caution: DXd ADC + agents with pneumonitis risk

Enhertu and its DXd cousins can inflame the lungs; combining them with immunotherapy, radiation, or mTOR inhibitors stacks that risk.

ILD ~10-15% with T-DXd; checkpoint inhibitors add 3-5%. Combination trials (DESTINY-Breast07/08, TROPION-Breast05) use careful monitoring. Thoracic radiation timing matters.

Rationale
Distinct but overlapping mechanisms of pneumonitis; additive toxicity with limited ability to attribute cause.
Evidence
Toxicity data from combination trials.

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