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Check with your doctor or nurse immediately if any of the following side effects occur: More common Black, tarry stools bleeding gums chest pain chills cough fever loss of coordination lower back or side pain painful or difficult urination pains in the chest, groin, or legs, especially calves of the legs pale skin pinpoint red spots on the skin severe headaches of sudden onset sore throat sudden onset of slurred speech sudden vision changes swollen glands trouble breathing ulcers, sores, or white spots in the mouth unusual bleeding or bruising unusual tiredness or weakness Less common Bloody urine or bloody stools chest tightness decreased frequency or amount of urine fainting or loss of consciousness fast or irregular breathing increased blood pressure increased thirst itching, skin rash loss of appetite nausea swelling of the eyes, eyelids, face, fingers, or lower legs vomiting weight gain Incidence not known Blistering, peeling, or loosening of the skin joint or muscle pain pain and redness of the skin in the area of earlier radiation treatment red skin lesions, often with a purple center red, irritated eyes stomach cramps, tenderness, or pain watery diarrhea Some side effects may occur that usually do not need medical attention

T-DXd has become the prevalent treatment in different clinical settings because of its improved efficacy as compared to state-of-the-art treatment and/or other ADCs

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Viegi et al., 2020)

Manganese and zinc are involved in the formation and degradation of carbohydrates, lipids, proteins, and nucleic acids

53 The integration of CTC assessment into routine clinical practice could enhance treatment personalization, improve early detection of therapeutic resistance, and optimize GBM management strategies