Adverse Event Management Strategies
Panelists discuss how toxicity considerations significantly influence treatment selection given multiple effective options, requiring personalized discussions about patient goals, comorbidities, and tolerance for different adverse effect profiles between immune therapy doublets and immunotherapy-tyrosine kinase inhibitor (IO-TKI) combinations.
EP: 1.Overview of Clear Cell Renal Cell Carcinoma
EP: 2.Clinical Trial Review: CheckMate 214
EP: 3.Clinical Trial Review: KEYNOTE-426
EP: 4.Clinical Trial Review: CheckMate 9ER
EP: 5.Clinical Trial Review: CLEAR
EP: 6.First-Line Treatment Selection
EP: 7.Treatment Selection in Favorable Risk and Progression Considerations
EP: 8.Adverse Event Management Strategies
Video content above is prompted by the following:
Adverse event profiles significantly influence treatment selection, particularly as multiple effective first-line options become available for clear cell renal cell carcinoma. The panel discusses a 54-year-old teacher with diabetes who is concerned about the treatment’s impact on their work and recreational activities. Toxicity considerations become paramount when efficacy differences between regimens are subtle, requiring detailed patient education about distinct adverse effect profiles and management strategies.
Immune checkpoint inhibitor combinations (eg, ipilimumab-nivolumab) present acute immune-related adverse events requiring prompt recognition and steroid management but offer treatment-free intervals after completing induction phases. Patients achieving durable responses may discontinue therapy entirely, providing superior long-term quality of life. Conversely, IO-TKI combinations require indefinite TKI therapy with chronic but manageable adverse effects, including hypertension, diarrhea, fatigue, and hand-foot syndrome. Diabetes management becomes complex with immunotherapy due to potential steroid requirements, requiring endocrinology coordination.
Patient-reported outcomes favor ipilimumab plus nivolumab long-term due to treatment discontinuation in responding patients, while IO-TKI combinations provide more predictable daily adverse effects. The experts emphasize extensive patient education about expected toxicities, management strategies, and support team resources. Age and performance status influence tolerance expectations, with older patients potentially benefiting from less intensive regimens. Treatment breaks and dose modifications represent important management tools, particularly for TKI components. Salvage therapy selection becomes heavily toxicity-driven as patients develop treatment experience and preferences based on prior adverse events.
