Adverse Event Management Strategies

Video content above is prompted by the following:

Adverse event profiles significantly influence treatment selection, particularly as multiple effective first-line options become available for clear cell renal cell carcinoma. The panel discusses a 54-year-old teacher with diabetes who is concerned about the treatment’s impact on their work and recreational activities. Toxicity considerations become paramount when efficacy differences between regimens are subtle, requiring detailed patient education about distinct adverse effect profiles and management strategies.

Immune checkpoint inhibitor combinations (eg, ipilimumab-nivolumab) present acute immune-related adverse events requiring prompt recognition and steroid management but offer treatment-free intervals after completing induction phases. Patients achieving durable responses may discontinue therapy entirely, providing superior long-term quality of life. Conversely, IO-TKI combinations require indefinite TKI therapy with chronic but manageable adverse effects, including hypertension, diarrhea, fatigue, and hand-foot syndrome. Diabetes management becomes complex with immunotherapy due to potential steroid requirements, requiring endocrinology coordination.

Patient-reported outcomes favor ipilimumab plus nivolumab long-term due to treatment discontinuation in responding patients, while IO-TKI combinations provide more predictable daily adverse effects. The experts emphasize extensive patient education about expected toxicities, management strategies, and support team resources. Age and performance status influence tolerance expectations, with older patients potentially benefiting from less intensive regimens. Treatment breaks and dose modifications represent important management tools, particularly for TKI components. Salvage therapy selection becomes heavily toxicity-driven as patients develop treatment experience and preferences based on prior adverse events.