Best Practices for Discussing and Managing Ocular Surface Toxicities When Using ADCs for Solid Tumors

In this segment, the expert faculty discusses how they introduce and manage ocular surface toxicities when initiating antibody–drug conjugate (ADC) therapy. They explain that ocular toxicity counseling is integrated into the broader treatment-start conversation, presented alongside other safety considerations such as pneumonitis and neutropenia. When an ADC has specific ocular requirements—such as baseline eye exams, prophylactic preservative-free tears, or activity restrictions—these elements are emphasized during consent to ensure patients understand expectations and monitoring needs.

The panel notes that oncologists may feel less comfortable addressing eye-related events, but ophthalmologists often remind them that they already manage far more dangerous toxicities. As such, ocular effects should be framed as typically low-grade, manageable, and rarely treatment-limiting, especially with coordinated ophthalmology support.

The panel then outlines how REMS-related considerations vary across ADCs. While some agents carry boxed warnings, very few require REMS programs; however, all demand clear documentation and patient education to ensure proactive mitigation and continuity of care.