TDXD is highly emetogenic. Adding low-dose olanzapine to the standard three-drug antiemetic prophylaxis regimen is a transformative strategy that significantly reduces both acute and delayed nausea, making the potent therapy much more tolerable for patients.

After observing deep, MRD-negative responses at their starting dose, Colonia Therapeutics unconventionally tested a lower dose level. This counter-intuitive strategy aims to identify the minimum effective dose, which is crucial for maximizing the safety profile (the therapeutic window) and improving commercial viability through lower manufacturing costs.

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.

Dr. Smith highlights a critical flaw in pharmacology: while a single drug undergoes rigorous FDA testing, there is zero data on the interactive effects when a patient takes two or more drugs concurrently. This 'polypharmacy' creates unpredictable and potentially harmful side effects.

Clinicians are finding that forgoing the standard 800mg loading dose of zolbituximab and starting directly with the 600mg maintenance dose appears to mitigate acute gastrointestinal toxicity, particularly gastritis. This practical adjustment is being formally studied but is already used in practice to improve patient experience.

Despite showing massive weight loss, new obesity drugs from Eli Lilly and others have high discontinuation rates due to side effects. This suggests the industry's singular focus on efficacy may be hitting diminishing returns, opening a new competitive front based on better patient tolerance and adherence.

When a toxicity like rash occurs with EV+pembrolizumab—which could be caused by either drug—the recommended strategy is to stop both. After the rash improves, reintroduce the drug least suspected of causing it first. If the rash does not recur, it helps confirm the other agent was the culprit.

Ron Cooper highlights a key disconnect: Wall Street values the highest efficacy ("more is better"), but community physicians, who treat most patients, weigh three factors equally: efficacy, tolerability, and ease of administration. A drug that seamlessly integrates into their practice flow can win significant market share without best-in-class efficacy.