Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Welcome to the Quick Consult podcast, brought to you by Metall. Before starting this podcast, please review the faculty information, disclosure statements, and learning objectives using the link in the episode description. To claim your CME credit, complete the evaluation using the link in the episode description. This podcast is a continuing education activity managed and accredited by Current Concepts Institute in collaboration with Metal. This activity is supported by an independent medical education grant from Pfizer. Welcome back to First Line Focused perspectives. In our second episode, Managing What Matters, we turn our attention to the critical task of proactively managing adverse events associated with BRRAF targeted therapies. This is crucial for maintaining dose intensity and ensuring the best outcomes. We are again honored to be joined by Doctor Zev Weinberg. Doctor Weinberg, adverse event management is a major concern for healthcare professionals. In the first line test. What are the most common and important toxicities that colleagues should anticipate and actively monitor for when administering a BRAAF targeted combination, such as encarafenib plus cetuximab with or without chemotherapy in metastatic colorectal cancer? So thanks, Phil. I mean there's a number of unique toxicities associated with the combination of BRAF inhibitor therapy. First, if we're talking about colorectal cancer, we're obviously dealing with in frontline, FOLFOX and carafe. Stuximab, so that has both the FOLFOX toxicities and the engrafenibintuximab toxicities. So from a targeted therapy perspective, it's primarily rash. Some people can get some blood count changes like anemia and thrombocytopenia, which we monitor pretty carefully, and sometimes, of course, the typical EGFR inhibitor toxicities, hypomagnesaemia, things to look for in the urine studies. Ultimately, and carafenib and tuximab actually has not too worse of a Rash and tuximab alone, and when you combine with chemotherapy, you're not making the rash necessarily that much worse. I think that one of the things that we've learned over the years is probably prophylactic management of the rash is probably a good idea. So if patients are on cetuximab combination, it's very appropriate to consider baseline doxycycline, things of that nature. If you kind of look at overall, you're going to have some. Very obscure side effects as well. Uh, so to keep in mind, including some of the, you know, rare ocular toxicities and rare, uh, you know, rare toxicities that are They've been around for a long time. You've touched on this already, but pyrexia and rash can be unique challenges in these BRAFMC inhibitor regimens. Can you offer any other practical tips on when an adverse event like pyrexia should prompt a dose modification versus supportive care and what preventative skin strategies work the best? So I think for p pyrexia, which is really an unusual side effect. But common in the Braek combinations, prophylactic management, sometimes with Tylenol in advance of when the fever pattern starts to occur, has been shown to help. Other people use a very low dose of steroids because the fever is felt to be an inflammatory response to the agents. So managing that prophylactically, gain a sense of the pattern has been how we've often approached it, beginning with antipyretic therapies such as Tylenol. and ibuprofen, followed by a low dose of dexamethasone to keep this fever suppressed. With respect to the rash, I think there is pretty good standards that we should be treating these people with prophylactic doxycycline, for example, to minimize the rash induced by the EGFR inhibitor toxicities. Treatment interruptions and dose reductions compromise the effectiveness of these therapies. What strategies or Key practice-based protocols can community oncology teams adopt to ensure they are intervening early and maintaining treatment continuity as much as possible. So I mean, I think most of the oncologists are quite familiar with how to manage FOLFOX chemotherapy combinations, one of the most common regimens used. There isn't really any significant management strategies distinct from FOLFOX plus, let's. EGFR that you would now make when you add in FOLFOX EGFR plus the BRAF. The only one, of course, is the rash to keep in mind for. So I think that early interventions are of course appropriate. Those include prophylactic management of nausea with the typical anti-emetic profiles, prophylactic management of the rash with the typical antibiotic, and creams that are often steroid-based, and as we mentioned, Um, you know, perhaps if, if things are, are getting a little worse, considering a dermatology referral in an appropriate patient population. This is a point where the patient's perspective is invaluable, and we have the opportunity to hear from Laura, who is a lung cancer patient advocate. Laura, what can a clinical team, the doctor, nurse, or pharmacist do to make you feel comfortable calling about a new or worsening side effect rather than just toughing it out at home? Yeah. Um, in my particular situation, um, I did develop a nasty rash from the medication, and the medical staff communicated that I should stop the medication for a week and see if the rash was better. Um, the skin on my face looked really bad and I was, uh, very self-conscious and embarrassed to be seen. Um, it did resolve, so I was able to resume medication after 10 days with dose reduction. Um, I think at this point, the best thing that the team can do is make sure that they have someone who is very responsible, I'm sorry, responsive and reassuring communication, um, with the patient. Thank you, Laura, for that essential insight. Doctor Weinberg, how can healthcare professionals better empower patients to be active partners in adverse event monitoring and management in the community setting? So, I mean, I think obviously, Talking to the patients on a pretty regular basis is critical. I mean, Most of us, hopefully by the time we are senior attendings, have some clinical support staff who can communicate with patients directly, whether it's physician assistants, nurse practitioners, or even educational nurses that are sort of familiar with the expected toxicity profiles of these individual agents. So maintaining Close lines of communication is always the key. It's excellent advice. Thank you so much again, Doctor Weinberg. Join us for our next episode where we'll dive into providing guidance on ordering, interpreting, and applying biomarker results to inform first line treatment decisions. You can access more accredited CME resources on this topic and others by visiting metalEducation.com. Thanks for listening. To claim your CME credit, complete the evaluation using the link in the episode description. See you next time on the Quick Consult podcast.