Mark Kris, MD, discusses the implications of long-term toxicities with TKI therapy.
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Well, what about 1+ rash? I must say I was a little shocked when I read the data on 1+ plus acneiform rash from the. It's papules or pustules covering less than 10% of the body surface area, which may or may not be associated with symptoms of pruritus and tenderness. Think about it: If you have 1+ toxicity from a TKI, that could mean constant rash with pruritus and tenderness for years.
From the oncologist's standpoint, what to do? Number one, ask the patient more than just how many times; ask how it affects their life. If you find out that people aren't living the life they want, you really need to think about what to do. The other thing that you need to do is think about lowering the dose of these drugs. Generally, the doses are too high.. They compared a dose of 40, the standard dose, to 20.
Pay attention to it. Try to deal with it by ameliorating the side effects with whatever local measures we can. When we can't, think about dose reductions. I think the literature shows that most patients have dose reductions anyway, and the literature that's out there comparing lower doses shows very little change in overall outcomes.
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