Chinese expert consensus on the management of adverse reactions to HER2-targeted antibody-drug conjugates in digestive system cancers (2025 edition)

Digestive system cancers represent the most prevalent malignant tumor in China and globally. Among these, gastric cancer, colorectal cancer, and cholangiocarcinoma are human epidermal growth factor receptor 2 (HER2)-positive tumors that require particular attention. HER2-targeted antibody-drug conjugates (ADC) deliver cytotoxic drugs specifically to tumor cells via HER2 monoclonal antibodies, representing a breakthrough in the precision treatment of HER2-positive tumors and a milestone in oncology therapeutics. Currently, trastuzumab deruxtecan and disitamab vedotin have been approved by the National Medical Products Administration for the treatment of advanced gastric cancer. However, with the expanding clinical use of ADC, drug-related adverse reactions have been increasingly observed, impacting patient prognosis and quality of life. Based on clinical trial evidence from China and abroad, and integrating multidisciplinary expertise, this consensus emphasizes a physician-led and patient-engaged education model, defines key aspects of clinical management and patient education for HER2-targeted ADC-related adverse reactions, and provides evidence-based support for standardized management in primary healthcare settings.