Toxicity Management and Quality of Life

Dr. Park addresses management of low-grade immune-related adverse events (irAEs), the most common toxicities encountered with checkpoint inhibitors, including dermatitis, pruritus, and GI symptoms. She prioritizes supportive care for grade 1 to 2 toxicities when safe to do so, enabling most patients to remain on treatment. Key to success is early symptom reporting, proactive management, and setting expectations upfront. She notes that older patients often value functional independence over maximal treatment intensity, and that treatment breaks or discontinuation do not necessarily compromise outcomes, as responses in cSCC tend to be durable.

Dr. Sondak builds on this by addressing how disease-related symptoms, including painful or bleeding lesions, neuropathic pain from perineural invasion, can themselves be meaningfully improved by effective treatment. He encourages providers to use both radiation and systemic immunotherapy early when nerve involvement is causing pain. He reassures patients that treating irAEs with corticosteroids does not impair antitumor response, and that even patients who discontinue due to severe toxicity have sometimes had the best outcomes. He stresses the importance of the full care team (nurses, NPs, Pas) in monitoring patients and catching side effects early.