A key side effect of the FGFR inhibitor erdafitinib is central serous retinopathy, presenting as blurred vision. Standard of care involves a baseline ophthalmologic exam before starting treatment. If blurred vision occurs, treatment should be held immediately, but the condition is typically reversible and manageable with dose reduction.
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Due to fedratinib's significant GI side effect profile and the logistical difficulty of measuring thiamine levels, clinicians should proactively provide patients with thiamine supplements, anti-emetics, and anti-diarrheal therapies. Instructing patients to take the drug with food can also help mitigate GI toxicity.
Patients report a temporary, fully reversible blue-gray tint to their vision. This occurs because the drug's target, GSK, is present in eye photoreceptors. Rather than a major concern, this manageable 'nuisance side effect' serves as a real-time biological marker that the drug is successfully engaging its target systemically.
Due to significant ocular toxicity affecting most patients, the approved starting dose for belantumab is likely not optimal long-term. Effective management requires clinicians to proactively hold, delay, and reduce doses at the first sign of side effects, meaning real-world application will differ from the initial protocol.
To determine if fatigue or cognitive dysfunction is caused by enzalutamide, a clinician suggests a practical approach called the "Stevens Maneuver." The patient stops the drug for two weeks. If symptoms don't improve, the cause is likely something else. If they do improve, the drug is the culprit, and it can often be resumed at a lower dose.
The ocular toxicity seen with the folate-targeted ADC mirvetuximab is not due to folate receptors in the eye. It is theorized to be caused by micropinocytosis, an alternative mechanism where the drug is non-specifically taken up by normal corneal cells, representing an off-target, off-tumor toxicity.
The development of new KIT inhibitors like bezuclastinib is largely fueled by the need for alternatives to high-dose avapritinib in advanced SM. Concerns about cognitive effects and rare intracranial hemorrhage with avapritinib create an opportunity for agents with less blood-brain barrier penetration.
The KVA grading scale for Bellemaf's ocular side effects can trigger a grade 2 event based on an ophthalmologist's exam, even if the patient's functional vision (e.g., ability to read or drive) is unaffected. This disconnect between clinical grading and patient experience is crucial for managing treatment holds and counseling.
Recurrent non-melanoma skin cancers in patients on ruxolitinib may be attributable to its JAK1 inhibition. In such cases, a viable strategy is to switch the patient to a more JAK2-selective inhibitor, such as pacritinib or fedratinib, to potentially mitigate this specific side effect while maintaining disease control.
Unlike neuropathy from vincristine which peaks during therapy, polatuzumab vedotin exhibits a "late cresting phenomenon." Patients can experience worsening neuropathy even after completing their sixth and final cycle, a crucial detail for patient counseling and proactive management.
The ADC Dato-DXD causes high rates of stomatitis and dry eye that are difficult to treat once they appear. Effective management requires aggressive, proactive prevention from the start of therapy using steroid mouthwash and lubricating eye drops, demanding significant patient engagement and vigilance.
