Recommendations for mitigating and managing common treatment-related adverse events associated with loncastuximab tesirine based on safety data from LOTIS-2 and variables that may impact patient candidacy.
Tycel Jovelle Phillips, MD: Neutropenias and cytopenias are things that we deal with quite a bit as hematologists. Thus, your standard practice for managing those…factor transfusions are what would be recommended for this situation. When it comes to the management of some of the other issues, like the cutaneous rash, counseling the patient to be cognizant of not having significant sun exposure while also making sure they’re using sunscreen to protect themselves is important. Notifying a physician early, when you do have a rash, is also important so that appropriate strategies can be implemented to make sure the rash does not become more advanced.
As far as the fluid and the capillary leak, keeping careful management of the patient’s weight, and early implementation of use of a diuretic, of Aldactone in this situation, would be important to ensure that the patient does not have any significant edematous issues, whether it be fluid retention in the lungs or in the extremities. Concurrent use of steroids during the first couple of days should also be beneficial to preventing some of the additional side effects noted. Steroids themselves, usually Decadron in this situation, is good for mitigating any anorexia, nausea or vomiting that may occur with treatment, and helping prevent some of the issues with edema that may occur with the treatment. Thus, it is believed that this treatment should help overcome some of these side effects and should allow for this treatment to be manageable in most patients.
Based on the side effect profile, there aren’t too many patients that I would be worried about giving this treatment to. Now, if you have a patient who has poor circulatory function and cardiovascular disease, that is a patient you may worry about, given that a lot of these patients will have weight shifts just based on their heart dysfunction. Other than that, this treatment should be well tolerated in most of the patients, and you should not have any significant problems managing some of these adverse events [AEs].
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