Opinion
Video
The Effect of Adverse Event Profiles on Treatment Decisions
Author(s):
An expert discusses how different adverse event profiles of antibody-drug conjugates (ADCs) influence treatment decisions by requiring careful patient selection based on comorbidities like prior lung disease, implementing baseline assessments and monitoring protocols for pneumonitis and ocular toxicities, and recognizing that early detection and management of adverse effects allows for continued treatment through dose modifications.
Video content is prompted by the following:
Adverse event profiles significantly influence treatment selection for platinum-resistant ovarian cancer, with pneumonitis being a primary concern across multiple ADC therapies. HER2-targeting drugs carry approximately 10% risk of pneumonitis, while folate receptor α–targeting therapies also present pulmonary toxicity risks. Patients with preexisting interstitial lung disease, prior pneumonitis from immunotherapy, or other restrictive lung conditions are generally not candidates for these therapies due to risk of fatal outcomes. Despite being typically mild and treatable, pneumonitis can progress rapidly from asymptomatic imaging changes to life-threatening respiratory failure requiring intensive care management.
Comprehensive baseline assessments and ongoing monitoring protocols are essential for safe ADC administration in ovarian cancer patients. Pretreatment evaluation should include chest CT imaging to identify baseline lung abnormalities and ophthalmology examinations to establish visual acuity baselines. Many ADCs cause ocular toxicities ranging from blurred vision and corneal disorders to conjunctivitis, requiring regular ophthalmologic monitoring throughout treatment. Additional adverse effects include myelosuppression requiring growth factor support and various organ-specific toxicities depending on the specific ADC target and payload combination.
Early recognition and management of adverse events allows for continued treatment through dose modifications rather than permanent discontinuation. Pneumonitis detection through frequent imaging in the first 3 to 6 months of treatment enables intervention with drug holds and corticosteroid treatment before irreversible lung damage occurs. Similarly, prompt recognition of visual changes through systematic screening questions and regular eye examinations allows for appropriate dose reductions. Most ADC-related toxicities are reversible with proper management including dose delays and reductions, allowing patients to continue benefiting from these highly effective therapies while maintaining acceptable quality of life and safety profiles.
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