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Treatment began at a reduced dose due to frailty, then escalated to standard dosing after good tolerability, with extended dosing intervals because of financial constraints. Near-complete pleural effusion resolution, nodal shrinkage, symptom improvement, and durable disease control were achieved with mild myelosuppression and gastrointestinal discomfort, without interstitial lung disease.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/trastuzumab-deruxtecan-in-an-elderly-patient-with-hrher2-low-breast-cancer-complicated-by-pleural-effusion-a-case-report-and-literature-review/409889/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/trastuzumab-deruxtecan-in-an-elderly-patient-with-hrher2-low-breast-cancer-complicated-by-pleural-effusion-a-case-report-and-literature-review/409889.png","ImageObject",300,407,{"name":92,"@type":93},"Miles","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was the trastuzumab deruxtecan dose reduced at the start?","Question",{"text":112,"@type":113},"The case started at 4.4 mg/kg due to frailty, then escalated to the standard 5.4 mg/kg after good tolerability.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What outcomes did T-DXd produce for the pleural effusion and nodal disease?",{"text":117,"@type":113},"T-DXd resulted in near-complete resolution of the pleural effusion and marked shrinkage of lymph node metastases, alongside improved respiratory symptoms and upper limb edema.",{"name":119,"@type":110,"acceptedAnswer":120},"What treatment-related adverse events were reported?",{"text":121,"@type":113},"Adverse events were limited to mild myelosuppression and gastrointestinal discomfort, with no interstitial lung disease reported.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},409889,1790794108,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},13056703019404,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","TYPE Case Report  \nPUBLISHED 18 December 2025 DOI 10.3389/fonc.2025.1728983  \nOPEN ACCESS  \nEDITED BY  \nRyan Varghese,  \nSaint Joseph ’s University, United States  \nREVIEWED BY  \nMohsina Patwekar,  \nLuqman College of Pharmacy, India Praneetha Pulyala,  \nLehigh University, United States  \n*CORRESPONDENCE  \nMaojian Chen  \n [chenmj78@mail.sysu.edu.cn](chenmj78@mail.sysu.edu.cn)[ ](chenmj78@mail.sysu.edu.cn)Hongna Lai  \n [laihn5@mail.sysu.edu.cn](laihn5@mail.sysu.edu.cn)  \n†These authors have contributed equally to this work  \nRECEIVED 24 October 2025  \nREVISED 24 November 2025  \nACCEPTED 03 December 2025  \nPUBLISHED 18 December 2025  \nCITATION  \nHuang S, Law S, Chen M and Lai H (2025) Trastuzumab deruxtecan in an elderly patient with HR+/HER2-low breast cancer complicated by pleural effusion: a case report and literature review.  \nFront. Oncol. 15:1728983 .  \ndoi: 10.3389/fonc.2025.1728983  \nCOPYRIGHT  \n© 2025 Huang, Law, Chen and Lai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.  \nTrastuzumab deruxtecan in an elderly patient with HR+/HER2-low breast cancer complicated by pleural effusion: a case report and literature review  \nShiyu Huang 1†, Saikam Law 2†, Maojian Chen 1* and Hongna Lai 1*  \n1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for Ribonucleic Acid (RNA) Medicine, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China, 2 Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China  \nTrastuzumab deruxtecan (T-DXd or DS-8201) is a novel antibody–drug conjugate (ADC) targeting HER2 that has shown significant efficacy in advanced breast cancer. However, data on its use in elderly patients with hormone receptor–positive (HR+)/HER2-low disease complicated by malignant pleural effusion are scarce. We report the case of a 75-year-old woman with HR+/HER2-low (HER2 2+/FISH– at diagnosis, HER2–0 at recurrence) advanced breast cancer who developed multiple lymph node metastases and a large pleural effusion after progression on endocrine therapy plus a CDK4/6 inhibitor. She received trastuzumab deruxtecan as salvage therapy, initially at a reduced dose of 4.4 mg/kg because of frailty, followed by escalation to the standard 5 .4 mg/kg dose after good tolerability. Several cycles were administered at extended intervals due to financial constraints. T-DXd therapy resulted in near-complete resolution of the pleural effusion, marked shrinkage of nodal disease, improvement of upper limb edema and respiratory symptoms, and sustained declines in serum tumor markers. Progression-free survival on T-DXd reached 16 months, while overall survival from T-DXd initiation was 18 months . Treatment-related adverse events were limited to mild myelosuppression and gastrointestinal discomfort, without interstitial lung disease. This case suggests that dose-adjusted T-DXd can achieve durable disease control with acceptable safety in a frail elderly patient with HR+/HER2-low breast cancer and pleural effusion, adding to the growing real-world evidence supporting the use of HER2-directed ADCs beyond traditional HER2-positive populations.  \nKEYWORDS  \ntrastuzumab deruxtecan, HR+/HER2-low, breast cancer, elderly, pleural effusion  \nFrontiers in Oncology 01 [frontiersin.org](frontiersin.org)  \nIntroduction  \nBreast cancer is the most common malignancy and the second leading cause of cancer-related death among women worldwide, posing a major threat to women’s health and longevity (1) . To improve dis","cbCaibcUvOOsJDEJ","https://ap.wps.com/l/cbCaibcUvOOsJDEJ","pdf",2364064,"English","# Introduction\n# Case presentation\n## Basic information and initial diagnosis","[{\"question\":\"Why was the trastuzumab deruxtecan dose reduced at the start?\",\"answer\":\"The case started at 4.4 mg/kg due to frailty, then escalated to the standard 5.4 mg/kg after good tolerability.\"},{\"question\":\"What outcomes did T-DXd produce for the pleural effusion and nodal disease?\",\"answer\":\"T-DXd resulted in near-complete resolution of the pleural effusion and marked shrinkage of lymph node metastases, alongside improved respiratory symptoms and upper limb edema.\"},{\"question\":\"What treatment-related adverse events were reported?\",\"answer\":\"Adverse events were limited to mild myelosuppression and gastrointestinal discomfort, with no interstitial lung disease reported.\"}]","Trastuzumab deruxtecan in an elderly patient with HR+/HER2-low breast cancer complicated by pleural effusion - a case report and literature review | PDF",1790583608]