Hedgehog inhibitors for basal cell carcinoma cause significant side effects like dysgeusia and muscle cramps. To improve tolerability and long-term adherence, clinicians use practical strategies like scheduled treatment interruptions (e.g., weeks on, weeks off) rather than continuous daily dosing.

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.

A critical reason patients stop ADC treatments is the burden of side effects like skin toxicity or GI issues, not just disease progression. This underscores the urgent need to develop ADCs with better safety profiles, enabling patients to stay on effective therapy longer.

For new treatments like antibody-drug conjugates (ADCs) with unfamiliar side effects, dedicated thoracic pharmacists are critical. They provide follow-up education after the initial overwhelming oncologist visit and help the care team, who may be less experienced with the new drug, to identify and intervene early on adverse events.

Though ADCs like Sacituzumab Govitekan cause notable side effects like diarrhea and neutropenia, patient-reported outcome data shows they provide a meaningful and sustained improvement in quality of life compared to standard chemotherapy. This was observed even with longer treatment durations and lower discontinuation rates.

Despite proven benefits, side effects from adjuvant CDK4/6 inhibitors like abemaciclib create significant adherence challenges. The speaker notes that in practice, almost no patient completes the full multi-year course at the starting dose. Even in a supportive study, 20% of patients discontinued therapy within six months, highlighting a critical gap between trial efficacy and real-world tolerability.

Managing side effects of antibody-drug conjugates is not one-size-fits-all. Sazetuzumab-govatecan requires managing GI issues, while Datopotamab-deruxtecan has unique risks like ophthalmologic problems and ILD, necessitating pre-treatment specialist evaluation. Proactive patient education and tailored mitigation are key to maintaining treatment continuity and efficacy.

The LIDERA trial showed that while jiridestrant and standard therapies had similar adverse event profiles, patients on jiridestrant had significantly lower discontinuation rates. This highlights that a patient's subjective experience of tolerability is a more critical factor for long-term adherence than a simple list of side effects.

The perception that pills are less intense than infusions is a misconception. Patients on oral PARP inhibitors require constant monitoring for side effects like fatigue, nausea, and hematologic toxicities, especially in the first three months.