Transcript
Announcer:
This is Project Oncology on ReachMD. Today, Dr. Petros Grivas will be discussing key considerations for assessing treatment-related toxicities in patients with urothelial carcinoma. Dr. Grivas is a board-certified medical oncologist and researcher at Fred Hutch Cancer Center. He’s also a Professor and the Medical Director of Local Regional Outreach and the International Program at the University of Washington. Let’s hear from him now.
Dr. Grivas:
It's always important to think about multiple parameters when we consider interpretation of toxicity. For example, we want to know the severity. And there are some guides out there, like the CTCAE grading system, for adverse events. We use that commonly when we have clinical trials, and of course, we can also use that outside the context of clinical trial standard-of-care scenarios, because we can attempt an accurate grading assessment of severity of the side effect.
Of course, attribution's important. Is the adverse event related, possibly related, or not related to a particular treatment, A or B? We will have a combination—a treatment that may be sometimes difficult to discern or to tease apart which agent is causing the toxicity—and sometimes maybe overlapping toxicity profiles.
We recently had a publication with Dr. Michel Оbеid—spelled as O-B-E-I-D—and I'm one of the co-authors with other esteemed colleagues. And we talk about that situation: when you have antibody-drug conjugates and checkpoint inhibitor combinations, how can you get some cues and characteristic considerations to try to attribute the side effect?
And there are multiple parameters: the timing when the side effect happens, the type of the side effect, which organ is involved, what characteristics… morphology's appearance may be relevant in that case. And of course, it's also relevant what other medications the patients may be taking. We always work with our pharmacy to think about drug-drug interactions that can be relevant in specific treatments. Of course, we have an available oral therapy, an FGFR3 inhibitor, erdafitinib, for selected patients with an FGFR3-activating mutation or fusion that may be used in some patients. So we think about also drug-drug interactions in that context.
Of course, organ function is very important—liver function, kidney function—because this may be relevant to the metabolism, the kinetics, and what I call the breakdown of some of those drugs. So it's also important to think about the organ function and the metabolism of particular agents.
Overall, I think it's important to get as much information as possible. Sometimes patients may get other medications or supplements—sometimes not proven supplements—that may actually confound the picture. And we recently had a relevant article with the American Cancer Society discussing why patients should ideally avoid taking unproven supplements like febantel or ivermectin, because that can confound the picture and cause side effects that sometimes makes it hard to interpret if it is caused by the standard-of-care treatment or those unproven supplements. And of course, those unproven supplements may not have known efficacy.
So it's important to have this dialogue with the patient in a very compassionate and thoughtful manner and with, as I say, a thoughtful curiosity and respect. Ask them if they take any other supplements and have a thoughtful discussion about pros and cons, so the patients can have informed shared decision-making.
So all of those aspects are important when we interpret what is happening with the patients’ side effects and beyond.
Announcer:
That was Dr. Petros Grivas exploring how to evaluate and interpret treatment-related toxicities in urothelial carcinoma care. To access this and other episodes in our series, visit Project Oncology on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
