Common adverse reactions (≥20%) include nail toxicity (47%), musculoskeletal pain (43%), constipation (39%), diarrhea (39%), fatigue (37%), and hyperphosphatemia (97% lab incidence).

Frequent Toxicities and Laboratory Abnormalities

Grade ≥3 events include hyperphosphatemia (39%), fatigue (8%), and stomatitis (6%). Laboratory abnormalities span increased phosphate (97%), creatinine (58%), and liver enzymes (ALT: 50%; AST: 46%), alongside cytopenias (lymphopenia: 46%; anemia: 52%). Ocular (dry eye: 25%) and metabolic disturbances (hypokalemia: 22%) require vigilant monitoring. Serious reactions (e.g., gastrointestinal hemorrhage, bile duct obstruction) occurred in 39% of patients.