Managing Adverse Events With Capivasertib Plus Fulvestrant

Erica L. Mayer, MD, MPH, of Dana-Farber Cancer Institute, reviews final safety data from CAPItello-291, the phase 3 trial of capivasertib plus fulvestrant in hormone receptor positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer, reporting no new signals: diarrhea in nearly 80% of patients with about 10% grade 3 and no prophylactic antidiarrheal in the protocol, rash in about 40%, and all-grade hyperglycemia of 17% despite allowing hemoglobin A1c up to 8%. Seth A. Wander, MD, PhD, of Massachusetts General Hospital, stresses comprehensive team-based education and early intervention at grade 1 or 2 toxicity. Sarah L. Sammons, MD, of the University of Maryland Greenebaum Comprehensive Cancer Center, schedules dosing Monday through Thursday with a 3-day weekend off, prescribes loperamide at the first sign of diarrhea, adds prophylactic cetirizine starting the day before treatment based on antihistamine data, and counsels close glucose monitoring with reduced carbohydrate intake.