Prevention and Monitoring of Ocular and Hepatic Toxicities in HR Positive Breast Cancer

Panelists recommend baseline ophthalmologic assessment and liver function evaluation before initiating agents with known ocular or hepatic risk to establish reference status and detect issues. For ocular risk, obtain baseline visual acuity and slit lamp or optometry exam, educate patients on new visual symptoms such as flashing lights or vision changes, and set referral pathways to ophthalmology for assessment. For hepatic risk, measure baseline ALT, AST, bilirubin and alkaline phosphatase with scheduled early monitoring during the first 1 to 3 months and at routine intervals thereafter, with lower thresholds for action in symptomatic patients. Incorporate EKG monitoring when agents pose QTc risk and perform periodic CBC and metabolic panels to detect toxicities. Use prophylactic measures such as dexamethasone mouthwash for therapies associated with stomatitis, counsel about sun protection, and plan dose modifications early. Document monitoring plans, engage multidisciplinary colleagues, and use decision making to balance surveillance burden with clinical benefit.