Adverse Event Management

Adverse Event Management Strategies

Proactive adverse event management represents a cornerstone of successful treatment delivery for patients with metastatic pancreatic adenocarcinoma, requiring vigilant monitoring and intervention strategies to maintain treatment tolerability. Myelosuppression emerges as a frequent toxicity across treatment regimens, particularly with gemcitabine plus nab-paclitaxel combinations. Implementing every-2-week dosing schedules rather than standard 3-week cycles significantly reduces myelosuppression incidence and associated treatment delays. For intensive 3-drug regimens like NALIRIFOX and modified FOLFIRINOX, prophylactic pegylated G-CSF support becomes essential to mitigate high-grade neutropenia and neutropenic fever risks, an approach that was permitted and validated within the NAPOLI-3 trial protocol.

Diarrhea management requires comprehensive patient education and early intervention protocols, as this toxicity commonly occurs with NALIRIFOX and modified FOLFIRINOX regimens. Patient counseling must emphasize appropriate dietary modifications, adequate hydration maintenance, and prompt pharmacologic intervention at symptom onset to prevent progression to high-grade toxicity. For liposomal irinotecan-associated diarrhea, clinicians must distinguish between acute and late-onset presentations, requiring extensive patient education on appropriate antidiarrheal usage to prevent severe complications. This proactive educational approach significantly impacts treatment continuation and quality-of-life outcomes.

Neuropathy represents a cumulative dose-limiting toxicity affecting multiple treatment regimens, including gemcitabine plus nab-paclitaxel, modified FOLFIRINOX, and NALIRIFOX. Regular neurologic assessments become crucial by 3 to 4 months of treatment, particularly for patients receiving oxaliplatin-containing regimens. When patients demonstrate treatment response but develop significant neuropathy, discontinuing oxaliplatin while continuing other agents represents a reasonable strategy to maintain efficacy while preserving neurologic function. This approach proves especially important for preserving future treatment options, as severe baseline neuropathy may preclude patients from receiving alternative second-line therapies, potentially limiting therapeutic opportunities in this aggressive disease setting.