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Key Clinical Updates in Toxicity & Dose Modification of Chemotherapeutic Agents

The main toxicities of immune checkpoint inhibitors involve immune-related adverse events which occur via the same mechanisms as their antitumor effects (ie, self-reactive T-cells escaping central tolerance). The combination of PD-1 or PD-L1 inhibitors with CTLA-4 inhibitors results in higher rates of grade 3 or higher and all grades of immune-related adverse events.

Brahmer JR et al. J Immunother Cancer. [PMID: 34172516]

Use of chemotherapy to treat cancer is generally guided by results from clinical trials in individual tumor types. The complexity of treating cancer has increased over the last decade as more drugs, including those with targeted mechanisms of action, have been approved by the US FDA and introduced into general practice. Drug side effects and toxicities must be anticipated and carefully monitored. The short- and long-term toxicities of individual drugs are listed in Tables 39–3 and 39–10. Decisions on dose modifications for toxicities should be guided by the intent of therapy. In the palliative setting where the aim of therapy is to improve symptoms and quality of life, lowering doses to minimize toxicity is commonly done. However, when the goal of treatment is cure, dosing frequency and intensity should be maintained whenever possible.

Table 39–10.Commonly used supportive care agents.1

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