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The Chemo Mouthpiece had favorable outcomes when used during and after treatment with chemotherapy among a range of patients with various types of cancer. 

Cryotherapy Device Improves Oral Mucositis Outcomes After Chemotherapy Treatment

A survey found that patients believed dermatologic AEs were more prevalent with anti-cancer therapies than what has been reported. 

Perceptions of Dermatologic AEs Could Impact Treatment Adherence 

The intravenous formulation of tocilizumab-anoh for CRS is expected to launch in the US on August 31, 2025.

FDA OKs Intravenous Tocilizumab Biosimilar in Cytokine Release Syndrome

ATR04-484 showed inhibition of both methicillin-sensitive and methicillin-resistant Staphylococcus aureus bacteria strains, which are associated with rash.

Advancing Treatment for EGFR Inhibitor–Associated Dermal Toxicities

BMI, serum albumin, and G8 screening tool scores were all factors correlated with the likelihood of experiencing a grade 3 or higher AE. 

Frailty Assessments Indicate Severe AE Probability in Prostate Cancer

Addressing Systemic Barriers to Dermatologic Consultation in Oncology Care

As oncologic therapies become increasingly effective, the focus of comprehensive cancer care must broaden to include the aggressive management of therapy-related adverse effects (AEs). Dermatologic AEs, ranging from radiation dermatitis to permanent hair loss, significantly affect a patient’s quality of life and adherence to treatment. A key finding from a recent study, "

Perceptions and Knowledge of Dermatologic Side Effects of Anti-Cancer Therapies: A Pilot Survey

," coauthored by Adam Friedman, MD, FAAD, confirmed that many patients previously treated for cancer had not been referred to or visited a dermatologist during their treatment course. These data suggested a potential systemic failure in ensuring timely, specialized care for cutaneous toxicities.

Friedman, professor and chair of dermatology, director of the Residency Program, and director of translational research at George Washington Medical Faculty Associates in Washington, DC, addressed the key systemic and logistical barriers preventing optimal dermatologic consultation for patients with cancer. Friedman emphasized how these access issues are exacerbated in “dermatology deserts,” citing the geographic and socioeconomic disparities in his own study conducted in Ward 7 and Ward 8 of Washington, DC.

I wasn't surprised by that, and there are a couple of reasons why access to dermatology may not be happening when it absolutely should be, especially in this setting. It also depends on the community and the availability of dermatologists. There is, certainly, a bucket of referrals. Colleagues in support of the dermatology world have published on this before. One of my colleagues, Beth N. McLellan, MD, who’s chief of dermatology at Montefiore Einstein School of Medicine in the Bronx, published a study looking at the referral rates from radiation oncology to dermatology in the setting of radiation dermatitis, and the numbers were quite low. This was many years ago, so hopefully, that’s better [now]…. There’s so much going on in oncology that we have to focus on a bigger picture, and that’s getting rid of the cancer and, hopefully, saving the patient. Sometimes, dermatologic consequences fall by the wayside.

[It is important to] be mindful of the opportunity to refer. Then, on their side, [they must] have somewhere to refer. Access to dermatology is a huge challenge in the US. There are plenty of papers and a lot of evidence supporting that unsettling statement. Knowing even where to send someone and send someone quickly probably fits into that as well.

There are also different socioeconomic and demographic features. Our study specifically took place in Wards 7 and 8 of Washington, DC, which is a dermatology desert. There’s not a single dermatologist in that area, which is why we have created a free dermatology clinic that happens monthly there at a local church in Wards 7 and 8. Cost has to be considered as well.

Menta N, Vidal SI, Whiting C, Azim SA, Desai S, Friedman A. Perceptions and knowledge of dermatologic side effects of anti-cancer therapies: a pilot survey. 

Adam Friedman, MD, FAAD, discusses systemic barriers to timely dermatologic consultation for patients with cancer.

Crucial Communication Strategies for Dermatologic AEs of Cancer Therapies

The landscape of modern oncology, while rapidly advancing, often comes with a challenging set of dermatologic adverse effects (AEs) tied to various anti-cancer therapies. For the oncology clinician, managing these AEs extends beyond clinical management, as it is tied to patient adherence and quality of life.

 looking at patient perceptions of dermatologic AEs from anti-cancer therapies. Study results indicated that 52% of patients believed anti-cancer therapy caused their hair loss.

Overall, the study showed that a significant portion of respondents, including those who have previously undergone cancer treatment, indicated they would potentially decline life-saving anti-cancer therapies specifically due to the fear of dermatologic AEs such as permanent hair loss. Friedman, professor and chair of Dermatology, director of the Residency Program, and director of Translational Research at George Washington Medical Faculty Associates, discussed how clinicians can approach these conversations so patients can make informed decisions.

It starts with setting expectations—realistic expectations—on both sides of the fence. I like to say, name the fear first, then right-size it. Often, I have patients come into our supportive onco-dermatology clinic never being aware [of], for example, the hair loss associated with chemotherapy. I’m [going to] highlight chemotherapy, which is different from targeted therapies, whether it be small molecule inhibitors, biologics, or immunotherapies. They were never told that that was a possibility, that either hair loss would be permanent, or that when their hair grew back, it might grow back differently. It starts with setting the stage for success by letting people know what could potentially happen. It goes to having those early conversations before therapy starts. I know a lot of cancer centers, for example, have these boot camps where they introduce the patient to all those expectations. They get a handbook, and I’ve often seen the dermatologic [adverse] effect piece is like this big, and the book is this big. It’s important to prepare the patient for what could happen to the point of the [adverse] effects that most likely would push someone away from even pursuing treatment.

An impetus for this study was based on an earlier study finding that about 8% of [individuals] who were surveyed in an earlier survey study [stated] that they would not get treated for breast cancer due to the risk of hair loss. We wanted to put our finger on the pulse of where people are feeling now but also look at whether someone has had treatment before vs has never had treatment. Is there a difference in that perception? While both were certainly concerned, those who had gone through the experience before were more likely to do it again, knowing full well what those [adverse] effects look like.

Adam Friedman, MD, FAAD, discusses essential communication strategies for oncologists to address patient fears about dermatologic adverse effects.

Revolutionizing Onco-Dermatology Techniques and Managing Adverse Effects

The field of oncodermatology has witnessed significant advancements that have impacted clinical practice and enhanced the supportive care provided to patients with cancer.

Jonathan Leventhal, MD, emphasized that the landscape of clinical trials and studies is continuously refining strategies to optimize outcomes for patients experiencing dermatologic adverse effects. A notable breakthrough pertains to targeted cancer therapies, particularly EGFR inhibitors. Research has demonstrated that preemptive treatment with topical agents and oral antibiotics can effectively reduce the severity of associated rashes, offering a proactive measure to improve patient comfort and treatment adherence.

Beyond targeted therapies, a major achievement in recent years has been the widespread adoption of scalp cooling for hair loss associated with chemotherapy, especially for women with breast cancer. Scalp cooling can improve the quality of life by preserving hair during treatment. Ongoing studies  continue to uncover novel treatments and approaches for managing the diverse cutaneous toxicities of cancer treatment.

Leventhal highlighted that he needed to stay abreast of these rapid developments, as these advances directly inform daily practice, allowing for more effective prevention and management of dermatologic complications and ultimately contributing to better patient care.

Leventhal is director of the Onco-Dermatology Clinic at Smilow Cancer Hospital, and director of the residency program and associate professor term at Yale School of Medicine in New Haven, Connecticut.

The field is moving rapidly. There are [many] clinical trials and studies looking to optimize outcomes. A lot depends on the type of cancer therapy. For instance, with targeted cancer therapy, studies have shown that if we preemptively treat patients with topical agents and oral antibiotics before starting targeted treatments such as EGFR inhibitors, we can reduce the severity of the rash. One of the major breakthroughs in recent years has been in preserving hair on the scalp in patients, especially women, with breast cancer undergoing chemotherapy. Scalp cooling has been a major breakthrough in helping women preserve their hair during treatment, and it improves quality of life dramatically. There are a lot of new studies that are showing us novel treatments and approaches for managing the toxicities of cancer treatment. All of this impacts my clinic on a day-to-day basis, while staying on top of all the new studies. We’re also conducting various studies at Yale as well investigating the best approaches for treating and preventing the cutaneous toxicities that we see.

Scalp cooling may enhance patients’ quality of life when managing hair loss associated with cancer treatment. 

Revolutionizing Oncodermatology Techniques and Managing Adverse Effects

Managing Dermatologic Complications in Oncology

Patients with cancer frequently experience a wide spectrum of dermatologic, hair, and nail changes, along with mucosal surface issues, as a direct consequence of their treatments. These adverse effects (AEs) observed are dependent upon the treatment administered and require qualified clinicians to understand and determine specific treatment options.

Jonathan Leventhal, MD, director of the residency program, director of the Onco-Dermatology Clinic, and associate professor term at Yale School of Medicine, spoke with CancerNetwork® about observed AEs and how he and his team go about diagnosing and treating them. Some observed effects include those on the hair, nails, and skin and can occur from received treatment such as targeted therapies or immunotherapies.

The advent of targeted therapies has introduced a new profile of dermatologic toxicities, including acneiform and hand-foot skin reaction. Furthermore, these agents can contribute to a predisposition for nail infections, a common and often painful complication. With the increasing use of immune checkpoint inhibitors, clinicians are encountering a unique set of dermatologic AEs. Additionally, radiation therapy, a cornerstone of cancer treatment, is well-known for inducing localized skin reactions such as radiation dermatitis.

Patients who are undergoing cancer treatment frequently have many issues that impact their skin, hair, nails, and mucosal surfaces. A lot depends on the type of treatment that they’re on. For instance, chemotherapy often results in hair loss; nail changes; multiple types of skin rashes, such as toxic erythema of chemotherapy; and mucositis. Patients who are on targeted therapies often have acne-type rashes or a hand-foot skin reaction and other issues that can impact their hair and nails. We see [many] nail infections. Patients on immune checkpoint inhibitor therapy can have a variety of rashes. These are often autoimmune in nature. They [experience] a lot of itching as well. Radiation can cause a lot of skin reactions, such as radiation dermatitis, among others. All types of cancer therapy can result in dermatologic complications.

Diverse dermatologic AEs, such as hair and nail toxicities, can be associated with various cancer treatments.

When pembrolizumab is combined with immunotherapies, the incidence of grade 3 to 5 toxicities increases, especially with anti–CTLA-4 combinations. 

Pembrolizumab (Keytruda) is currently approved in around 40 different indications covering a wide range of disease types. Omid Hamid, MD, was part of a team that assessed the safety profile of pembrolizumab, and he spoke with CancerNetwork® about how when it is combined with immunotherapies, the incidence of adverse effects (AEs) increases.

More specifically, the incidence of grade 3 to 5 toxicities rises, particularly in anti–CTLA-4 combinations, as opposed to anti–LAG3 combinations that experience a significant rise.

Hamid, chief of Translational Research and Immunotherapy and director of the Melanoma Center and Phase I Immuno-Oncology Program at The Angeles Clinic and Research Institute, an affiliate of the Cedars Sinai Medical Center, also highlighted that when communicating with patients, it’s important to emphasize that the majority of these AEs will resolve, whether it’s through care, steroids, or tapering of treatment.

He also mentioned that it’s possible for the AEs to resolve themselves after treatment is discontinued.

[When combining pembrolizumab] with immunotherapies, the incidence [of AEs] increases, and not just the incidence of all toxicities, but the incidence of grade 3 to 5 toxicities. That’s been our experience with the anti–CTLA-4 combinations, specifically with higher doses in malignant, advanced melanoma. We now have anti-LAG3 combinations, and more interestingly, that rate is not as high, and the majority of grade 3 to 5 AEs that are increased have to do with the endocrinological pathways. We talked to patients about that. We talked to patients mostly about [how] when there’s an endocrinological toxicity, there’s risk for adrenal crisis with chemotherapy. What we have been seeing are changes in the incidence of toxicities, but also overlapping toxicities, where at some points, the risk of cytopenias, or long-duration cytopenias, can increase.

All of this is an important discussion to have. More importantly, when you look at the data presented here, it was based on trials, and there is no long-term post-discontinuation evaluation of the resolution of toxicities or late toxicities. These trials only looked [over] 30 days, so it’s important when someone has a toxicity to say, “Look, the majority [of toxicities] we take care of, and they resolve.” The majority can improve with steroids and tapering, so if you are on this type of therapy, and you do well when we discontinue [treatment], some of these AEs that you have [can] resolve on their own.

Selected indications for KEYTRUDA® (pembrolizumab). Keytruda. Accessed February 14, 2025. https://tinyurl.com/mtpnwhrr

Brahmer JR, Long GV, Hamid O, et al. Safety profile of pembrolizumab monotherapy based on an aggregate safety evaluation of 8937 patients. 

. 2024;199:113530. doi:10.1016/j.ejca.2024.113530

Identifying and Managing Toxicities From Pembrolizumab Combinations

Multidisciplinary Approach for AE Management After Pembrolizumab/ICI 

Caring for patients who experience adverse effects (AEs) while receiving treatment with pembrolizumab (Keytruda) is often reliant on various multidisciplinary professionals, according to Omid Hamid, MD.


Hamid, chief of Translational Research and Immunotherapy and director of the Melanoma Center and Phase I Immuno-Oncology Program at The Angeles Clinic and Research Institute, an affiliate of the Cedars Sinai Medical Center, stated that even though only 0.2% of patients included in the pembrolizumab safety profile assessment he conducted died of immune-mediated disease, the simple fact that occurrence is a possibility requires awareness from every individual involved.

As compared with 10 years ago when checkpoint inhibitors were starting to be used, pembrolizumab has been approved in around 40 indications encompassing various types of disease.

 Though that means more people need to be aware of how to address different situations, many are now aware of who they need to call or what they need to do when certain AEs arise.

He also concluded by saying that, as we’ve already seen with ipilimumab (Yervoy) in the anti–CTLA-4 experience, this process will need time to be fully addressed, but ultimately, care staff will get better at identifying and managing these AEs.

This is an 8937-patient cohort, and when you say something like 0.2% [of patients died from immune-mediated AEs], that’s small, but it’s still individually important. [For] these risks, [we have] the same discussion; it is the fact that [because] this is a multidisciplinary team, if you have an AE, we may have to send you into the hospital, we may have to send you to a consultant, or we may have to bring you in [for care] in between. Even though it’s rare, we do state that, now, we have a greater sensitivity for these AEs, what we’re going to do [if they arise], and how we’re going to take care of them.

Remember, this is a different discussion than we had 10 years ago. Ten years ago, immune checkpoint inhibitors were beginning to come into the [forefront]; multiple physicians in the community had never used them. Now, pembrolizumab is approved for 40 different indications in first-line and second-line refractory [disease], [disease with] high tumor mutational burden, renal [cancer], multiple skin [cancers], lung cancer, etc. In one way or another, the majority of oncological nurses, the majority of oncologists, and the majority of support staff have been exposed to this and are aware. More importantly, our consultants who exist in gastrointestinal, cardiology, rheumatology, endocrinology, and more importantly, emergency room physicians who see these patients have become aware, not of how to manage these, but that there is specific management required, who [they need] to call and what [they need] to do so we are better able to take care of patients in this way.

Remember, these trials span a huge amount of time, and multiple experiences [of this] have now come forward. Pembrolizumab is not the only anti–PD-1/PD-L1 [inhibitor] that’s approved. There are checkpoint inhibitors in other ways, whether it’s LAG3 or CTLA-4, which have made us more in tune with these toxicities. That data has been borne out; we’ve seen with the initial anti–CTLA-4 ipilimumab experience that, as time went by, we were better at identifying and managing toxicities.

“We’ve seen with the initial anti-CTLA-4 ipilimumab experience that, as time went by, we were better at identifying and managing toxicities,” stated Omid Hamad, MD.

The Intricacies of Discontinuation Rates With Pembrolizumab Across Cancer Types

Omid Hamid, MD, chief of Translational Research and Immunotherapy and director of the Melanoma Center and Phase I Immuno-Oncology Program at The Angeles Clinic and Research Institute, an affiliate of the Cedars Sinai Medical Center, stated that discontinuation of pembrolizumab (Keytruda) generally comes from higher-grade toxicities.

During a conversation with CancerNetwork®, Hamid spoke about a safety profile evaluation of pembrolizumab that he conducted.

 When it comes to discontinuations, adverse effects (AEs) like colitis, type 1 diabetes, myositis, myocarditis, or the neurological type are generally responsible.

As he noted, the discontinuation rate of pembrolizumab due to AEs is 12.7%, and at times, the rate can approach that of targeted agents or chemotherapeutics. One of the things he highlighted as important is communicating with the patient regarding what types of AEs they might deal with and the frequency of discontinuation.

You need to begin to talk to them about the fact that these toxicities are different than what we are used to with targeted [therapy] or chemotherapy. You begin by saying that these are inflammatory, you describe the most common ones, and you set a baseline: “What’s your baseline? How is your skin normally? How are your bowel movements?” [These] are difficult discussions because they’re different. Then you begin to discuss the fact that these are novel toxicities that can happen anytime and usually don’t happen with the first one. The majority resolve, and they can happen anytime, not just the day after or the week after. At times, you’re sending people away for 6 weeks, and you create a network for them to call back, whether it’s a nurse, your team, or yourself. You also note that these can happen after discontinuation. Every visit should begin with a discussion about any changes [regarding AEs] and a review of what these toxicities are.

The majority of the discontinuations, in my experience, have to do with the higher-grade toxicities, whether they’re colitis or pneumonitis; the neurological ones, diabetes type 1, myositis, myocarditis, et cetera. They have to do with the fact that these toxicities, at times, don’t go back to baseline. It is, that’s not the most important thing.

Those are immune-related AEs. The majority of discontinuations do come from AEs that are not immune-related; they can be related to the drug or related to disease progression. What we see are discontinuation rates to AEs that are, at times, similar or higher [than] targeted agents and chemotherapeutics. When I talk to patients, I state that there are discontinuations; I relay that each patient is an individual case and that we will work to get them the most benefit, and that comes from the communication of AEs.

A pooled analysis found pembrolizumab has a discontinuation rate of 12.7%, and a major key to handling it is maintaining good communication between the doctor and the patient. 

Adverse Effects

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