PMC9879059_01
Timeline management of cutaneous toxicity in the course of cabozantinib treatment.
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Treatment was discontinued until control of symptoms, from December 2019 to February 2020, and a different thyroid hormone supplementation with levothyroxine was prescribed ( Figure 1 ).
MRI: Radiological signs of hypophysitis. Inhomogeneous and enlarged appearance of the pituitary gland showing "tent" morphology due to tension of the meninges with thickening of the pituitary stalk.
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Due to the headache and dizziness, a magnetic resonance imaging (MRI) of the brain was performed and highlighted the radiological signs of a meningeal irritation attributable to an hypophysitis ( Figure 2 ).
PMC9879059_02
Timeline management of nephrological toxicity in course of ICI- and TKI-based treatment.
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In March 2022, total body CT showed stable disease and treatment with cabozantinib 40 mg per day is still ongoing ( Figure 3 ).
PMC9879059_03
Timeline of the management of liver toxicity during ICI-based treatment. Pe, pembrolizumab; Ax, axitinib.
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Thanks to the help of the hepatologist and medical therapy, liver toxicity quickly resolved, and the patient resumed the scheduled treatment with pembrolizumab and axitinib at a reduced dosage of 3 mg daily bid, which is currently ongoing with good compliance and clinical results ( Figure 4 ).
PMC9879059_04
Timeline management of cutaneous toxicity in the course of cabozantinib treatment.
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Therefore, considering the stability of the disease, the results of the laboratory tests, the cardiovascular evaluation, and the improvement in symptoms, the patient continued the scheduled therapy, which is still ongoing with good tolerability ( Figure 5 ).
PMC9879059_05
Timeline management of cardiovascular toxicity in the course of ICI- and TKI-based treatments.
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One month later, at the beginning of the third cycle, we found a worsening of cutaneous toxicity, with lesions resembling cigarette burns ( Figure 6 ). At the subsequent visits, the patient showed a reduction in the skin toxicity ( Figure 6 ), up to a total regression of the lesions on the hand in July 2021.