Pi3k er et helvete for de som får bivirkninger. Flere her inne uten at jeg husker nick har prøvd å påpeke at det å få kraftig diaré er noe de fleste bøter på for å redde sitt liv.
Legger til et lite utdrag fra flere onkologi eksperter og denne medisinen i R/R FL og MZL.
. I’ve had an occasional patient for whom it has been very tough.
They have been on the drug for a long time, and they had not reported to me that they were having colitis. A lot of these patients participated in some of the earlier trials. At that time, there weren’t great alternatives for the patients. They were afraid to come off the therapy because they didn’t think their doctor had anything else to treat them with, so they would come in and be profoundly sick. Some had to be hospitalized because of the colitis.
Of course, when you have it to that degree, it takes longer to get back on the medication, or they may be unable to get back on it at all. I haven’t had the same success with getting people back on either idelalisib or duvelisib when they have the colitis. In my experience, a minority of patients can successfully get back on 1 of the PI3-kinase inhibitors if they get a real colitis, not just the diarrhea. Jason, is that what you’ve found? Or do you manage things differently? It’s important to hear how people manage it differently.
I react similarly. When you have the grade 3 diarrhea—more than 6 stools above average—that’s pretty bad. For most patients, that’s life altering, and they really don’t like that. It’s hard, even when you get that controlled. Sometimes we can’t get patients to agree to go back on because 10 watery stools a day is rough for a lot of people. It makes them feel pretty bad. Certainly, if it looks like an actual colitis, we put them on steroids of some sort and obviously stop the agent. We also check for, as you said, CMV, Clostridium difficile, colitis, and those things; sometimes we do endoscopies to prove it.
Most of the time, holding the drug works, and the patient will eventually get over it. I agree, though. It’s harder to get the patient to get back on the agent just because of an adverse effect they don’t care for. Even when you reduce the doses, patients are going to have some diarrhea, and it seems like the threshold of tolerance starts to go down with that. That’s right up there with overall infection, as far as the biggest issues we’ve had with the agents themselves: the perfuse diarrhea that they can have with it. I manage it very similarly to how you manage it.