Discussing Potential Combination Therapy Medication-Associated Toxicities With Patients

EP: 1.The Evolution of EGFR-Mutated Advanced NSCLC Treatment: Present Considerations and Future Treatment Options

EP: 2.Has Combination Therapy Become the New Frontline Treatment Standard for EGFR-Mutant Metastatic NSCLC?

EP: 3.Decision Points to Consider When Choosing Treatment With Monotherapy or Combination Therapy for EGFR-Mutant mNSCLC

EP: 4.Evaluating Patient Preferences for the Treatment of EGFR-Mutant mNSCLC

EP: 5.Comparing the Combination Therapies for the Treatment of EGFR-Mutant mNSCLC

EP: 6.Considering Resistance Mechanisms When Choosing Therapy in the Frontline Setting

EP: 7.The Importance of Maintaining Quality of Life and Intervening Early When Adverse Events Occur in the Frontline Treatment Setting

EP: 8.Weighing the 1-Year Projected Overall Survival Benefit With MARIPOSA in the Frontline Treatment of EGFR-Mutant mNSCLC

EP: 9.Discussing the Time and Financial Toxicities Associated With Combination Therapies and Potential Mitigation Strategies

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EP: 10.Discussing Potential Combination Therapy Medication-Associated Toxicities With Patients

EP: 11.Evaluating the Clinical Utility of Subcutaneous Amivantamab in the Treatment of EGFR-Mutant mNSCLC

EP: 12.The Importance of Multidisciplinary Collaboration With Subspecialty Physicians in the Toxicity Management With Treatment

EP: 13.Exploring Second-Line Treatment Options Including Targeted Radiation and Surgery for the Management of EGFR-Mutant mNSCLC

EP: 14.Tissue vs Plasma Biopsy After First Disease Progression in EGFR-Mutant NSCLC

EP: 15.Deciding Between a Biomarker-Directed Approach and a Biomarker-Agnostic Approach for Second-Line Treatment of EGFR-Mutant NSCLC

EP: 16.Continuing the Targeted TKI in the Second Line for the Treatment of EGFR-Mutant NSCLC

EP: 17.When to Consider Retreatment With Chemotherapy After FLAURA2 for EGFR-Mutant NSCLC

EP: 18.Patient Case Presentation: A 45-Year-Old With Newly Diagnosed EGFR-Mutant mNSCLC and Liver Metastases

EP: 19.Patient Case Presentation: A 69-Year-Old With Newly Diagnosed EGFR-Mutant mNSCLC and Symptomatic Brain Metastases

This segment focuses on the critical toxicities that clinicians must discuss when presenting combination therapy options for EGFR-mutant metastatic non–small cell lung cancer. For osimertinib plus chemotherapy combinations, patients should expect fatigue that significantly impacts quality of life, pancytopenia requiring frequent laboratory monitoring, and gastrointestinal adverse effects including nausea, vomiting, and diarrhea. The addition of osimertinib contributes dermatologic toxicities such as rash and paronychia. For the amivantamab plus lazertinib combination, infusion-related reactions represent the primary concern, along with lengthy infusion times. The most distinctive requirement is mandatory anticoagulation for the first 4 months due to venous thromboembolism risk, while skin-related toxicities including paronychia, rash, and stomatitis requiring supportive care with intravenous fluids and specialized mouthwashes are commonly encountered.

The management of these toxicities has evolved significantly with improved supportive care regimens and prophylactic measures. Clinicians emphasize that early intervention typically results in manageable toxicities, with dose reductions serving as an important mitigation strategy. Skin toxicities, while visually jarring for patients, can be addressed through prophylactic protocols including doxycycline and specialized topical applications. However, these preventive regimens are notably complex, requiring multiple medications administered several times daily, often with significant out-of-pocket costs. The complexity becomes particularly challenging for patients with lower health literacy, as the regimens involve numerous components beyond standard chemotherapy premedications, including various lotions, chlorhexidine applications, and specialized oral care products.

Practical considerations in toxicity management include providing patients with prophylactic antibiotics for chemotherapy-related neutropenia, particularly in community settings without immediate urgent care access. An important counseling point for amivantamab-based regimens is that adverse effects typically improve after the first few months of therapy, which can influence patient decision-making regarding quality of life trade-offs. The financial burden of supportive care medications, many of which are not covered by insurance, represents an additional layer of treatment complexity that must be addressed during patient education and ongoing care coordination.