Dr. Kruse addresses the balance between efficacy and quality of life when using T-DXd in earlier treatment lines and prolonged therapy contexts. Proactive nausea management becomes crucial given extended treatment durations, requiring multi-agent antiemetic regimens rather than single-drug approaches. She emphasizes olanzapine's utility at bedtime for managing nausea while addressing concurrent symptoms including sleep disruption, anxiety, and poor appetite common in metastatic breast cancer.