TRANSCRIPTION:
DR RUGO: So fatigue is a big issue with everolimus and also with the CDK4/6 inhibitors. And it’s a tough one to manage. I’ve used methylphenidate in our metastatic patients where I didn’t want to reduce the dose or because of their bulk of disease or other issues. Dose reducing, giving a holiday for a few weeks helps, if you can do that. And again, I’ve found that methylphenidate can be useful as well for these patients. It’s a tough one.
I mean, I think we obviously want to rule out other causes, such as hypothyroidism and polypharmacy, but fatigue is clearly a side effect we see over time in these patients. For mTOR inhibition, we’re still dealing with the issue of interstitial pneumonitis. And that does occur in patients over the course of their treatment. And most of what we see is just radiographic, and we don’t have to do anything. But clearly, physician and patient education is critical to catch it at Grade 2 and never get to Grade 3.
DR LOVE: I was going to ask you about pneumonitis, because I was surprised. We had a case recently presented of a patient who had, as you said, commonly, asymptomatic pneumonitis — actually, this patient actually had a few symptoms, I think — where it was held. The symptoms went away. The patient got corticosteroids. And then it was restarted, which kind of surprised me, at a lower dose. Is that the way you approach these patients?
DR RUGO: I do, actually. I restart at a lower dose. The only time I wouldn’t is if somebody is truly hypoxic and very, very sick with Grade 3 pneumonitis or worse. But I do think that if you catch these patients early, you never see Grade 3. And the way to do that is to stop drug for Grade 2 pneumonitis, treat as needed with steroids. And if you’re going to restart, wait for them to really get better before you restart. That really makes a big difference. I don’t do anything if I just see interstitial changes on the scan.
T, AC