Recent findings highlight the need for proactive management strategies to address adverse events associated with GPRC5D-targeted therapies. These therapies, noted for their expression in hair follicles, nail beds, and specific structures of the tongue, can lead to unique toxicities that clinicians must navigate carefully.
Understanding Dermatologic Manifestations
Patients undergoing treatment with GPRC5D-targeted agents may experience various dermatologic issues. Common reactions include rashes that respond well to topical corticosteroids, as well as severe dry or scaly skin that requires moisturization and exfoliation. Nail-related toxicities can be particularly challenging, with symptoms ranging from brittleness to complete nail loss.
To mitigate these effects, patient education is crucial. Recommendations such as keeping nails closely trimmed and utilizing nail hardeners can help prevent traumatic injuries that could lead to further complications.
Tackling Dysgeusia and Nutritional Challenges
Among the most significant adverse effects of GPRC5D therapies is dysgeusia, which leads to profound alterations in taste. This condition can severely impact a patient’s nutritional intake and overall quality of life. Early involvement from nutritionists is essential in formulating strategies that help maintain adequate caloric intake despite these taste changes.
Typically, dysgeusia improves after six months or more of continued treatment. Clinicians may consider dose modifications and extended dosing intervals to accelerate recovery. For patients who achieve rapid, deep responses, transitioning to a dosing schedule every four weeks may help minimize taste-related toxicities.
Oral complications are also common, including dry mouth, which can be managed with biotin supplementation, and dysphagia, which requires thorough swallowing assessments and potential dietary adjustments.
Unlike therapies that target B-cell maturation antigen, GPRC5D-targeted agents generally result in less severe hypogammaglobulinemia. As such, the decision to use intravenous immunoglobulin prophylaxis should be individualized rather than universally applied.
Standard protocols for managing cytokine release syndrome and neurotoxicity remain applicable, and it is recommended that all patients receiving GPRC5D-directed bispecific therapy undergo prophylaxis for pneumocystis jirovecii pneumonia.
As research continues to evolve, clinicians must remain vigilant in addressing these on-target, off-tumor toxicities to enhance patient care and treatment outcomes.