Dr Baretti on Mitigating Toxicities Associated With FGFR Inhibition in Cholangiocarcinoma

Marina Baretti, MD, assistant professor, oncology, Johns Hopkins Medicine, discusses some common adverse effects (AEs) associated with FGFR inhibition in patients with cholangiocarcinoma, as well as strategies to mitigate these AEsin clinical practice.

As a drug class, FGFR inhibitors exhibit a distinctive toxicity profile, Baretti begins. The most commonly observed AEs associated with these agents are hyperphosphatemia, or elevated phosphate levels; gastrointestinal complications, such as diarrhea; and dermatological toxicities ranging from hair loss to nail and skin toxicity, Baretti reports. Additionally, ocular toxicity, though rare, has been observed in patients who have received these agents, she adds. Addressing FGFR inhibitor–associated hyperphosphatemia was initially challenging for many clinicians, but accumulated experience with FGFR inhibitors has provided valuable insights into the management of this toxicity, Baretti says. Educating patients on the importance of adopting a low-phosphate diet and the potential use of hydration or phosphate binder medicationshas proven effective in most cases, Baretti states. These strategies can eliminate the need for dose reductions or interruptions, she explains.

Similar proactive strategies, such as comprehensive patient education on symptom recognition, hygiene, and guidelines for prompt health-care provider communication, apply to the management of nail and skin toxicities, Baretti continues. Ocular toxicities are best addressed through routine eye evaluations at baseline and at regular intervals throughout the treatment course, Baretti advises. Additional eye assessments may be prompted by any patient-reported vision changes. Proactive management ensures the safe handling of these AEs and can also reduce their severity to baseline conditions, she emphasizes.

Overall, a proactive approach to patient and caregiver education, combined with timely interventions, is the recommended strategy for addressing AEs and minimizing the need for reductions or interruptions of FGFR inhibitor doses,Baretti says. This, in turn, contributes to improved treatment outcomes for patients with cholangiocarcinoma who harbor FGFR alterations, Baretti concludes.