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There is little risk of transmission as long as the lesions remain covered and no one who is pregnant or has a weakened immune system comes into contact with the lesions. Draining lesions must remain covered with an airtight and watertight dressing until they are no longer draining. Dressing should be changed once a week
During the clinical trials, fevers with BRAK/MEK inhibitor therapy occurred in about 54% of patients. Fevers usually start after about 30 days of treatment, lasting 2-3 days, and typically improving after 6 months. Your patient must contact the oncology team if they begin to experience fevers. For low-grade fevers of 99-101°F, they can take antipyretics as directed by the provider. Also make sure your patient is drinking plenty of water. For a fever higher than 101°F, the oncology team member most likely will hold the BRAF inhibitor, and if the patient’s temperature is higher than 104°F, he/she will hold both medications and see the patient in clinic. The patient might need supportive care such as IV hydration and to begin low dose prednisone as recommended by the prescribing information. Some patients might need a dose holiday and dose reduction until fevers resolve. Keeping well hydrated is very important, especially with higher temperatures, to avoid dehydration.
That’s a logical question, given that the checkpoint inhibitors alter the immune response. Advise your patients not to receive live vaccines (eg, measles, mumps, and rubella and the varicella vaccine) because they have not been evaluated in this setting. The use of attenuated vaccines has been and continues to be evaluated. Counsel patients to discuss all immunizations with the oncology team prior to administration so the benefits and risks can be weighed on an individual basis.
There are no standard dosage reductions for irAEs associated with pembrolizumab. The dose is either held until the irAE resolves sufficiently (typically to Grade 0 or Grade 1) or, if the irAE is severe enough, pembrolizumab is discontinued permanently.
Generally, the safety profile of pembrolizumab is similar across tumor types. However, the context may be different—patients with other tumor types may have differing comorbidities or underlying organ dysfunction. For example, lung cancer patients may have underlying lung disease that will exacerbate shortness of breath associated with pneumonitis.
The prescribing information indicates until disease progression or unacceptable toxicity. The interpretation of these criteria varies from institution to institution and from provider to provider
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