We scan new podcasts and send you the top 5 insights daily.
Abruptly stopping JAK inhibitors can trigger a potentially fatal SIRS-like syndrome from a cytokine storm. Clinicians must taper the dose. If an abrupt stop is necessary (e.g., for a procedure), bridging the patient with prednisone is a critical and effective strategy to prevent this severe withdrawal reaction.
When CLL patients temporarily stop their BTK inhibitor for a procedure, they can experience a "disease flare" mimicking relapse. It is critical for clinicians to recognize this phenomenon and not misinterpret it as true disease progression, as symptoms typically resolve upon restarting the medication.
Despite subsequent data not confirming an increased bleeding risk compared to other therapies, the initial studies on pacritinib showed a signal for increased bleeding. Consequently, it is still advised that the drug be stopped for several days prior to any major surgical procedure as a safety precaution.
The standard of care for CRS has evolved. Instead of waiting for CRS to escalate, institutions now immediately administer dexamethasone and tocilizumab at the first sign of a fever (grade 1), finding it doesn't harm CAR T-cell expansion and improves safety.
Pulsed dexamethasone provides no overall response rate benefit compared to a standard prednisone taper in first-line ITP treatment. It may offer a slightly faster response (by about one day) but carries a higher risk of acute steroid complications, particularly psychosis in older adults.
The discovery of low-grade, asymptomatic interstitial lung disease (ILD) on scans for patients on certain ADCs does not mandate permanent discontinuation. By holding the drug, initiating steroids, and involving pulmonology, the inflammation can resolve, often allowing the patient to safely resume a highly effective therapy.
To improve long-term tolerability of amivantamab, some experts advocate for a "marathon, not a sprint" approach. This involves aggressive dose holds or reductions at the earliest signs of toxicity, even low-grade, to prevent side effects from escalating and ensure patients can remain on effective therapy longer.
To prevent rebound weight gain and associated inflammation—which is particularly detrimental for cancer survivors—patients should not stop GLP-1s abruptly. Instead, a slow, methodical 20-week taper is recommended, with close monitoring to ensure weight stability before full discontinuation.
Unlike some immunotherapy guidelines, experts recommend immediate steroid treatment for even Grade 1 (asymptomatic) ADC-induced pneumonitis or interstitial lung disease (ILD) found on scans. This aggressive, proactive approach is considered necessary due to the risk of rapid clinical deterioration, prioritizing safety and the ability to resume cancer therapy.
Clinicians should interpret anemia in myelofibrosis patients on JAK inhibitors based on its timing. Anemia in the first 16 weeks is an expected on-target effect. In contrast, new anemia in a patient on a stable dose is a warning sign that may indicate disease progression, warranting further investigation.
Data shows that patients who permanently stopped ipilimumab due to immune-related side effects still had exceptionally good outcomes. This gives clinicians confidence to manage toxicity by discontinuing the CTLA-4 inhibitor portion of the regimen while continuing nivolumab, without fearing a loss of efficacy.