Managing Dermatologic Toxicity and Holding Therapy

Siddhartha Devarakonda, MD, of Providence Swedish Cancer Institute argues that the regimens patients navigate successfully in epidermal growth factor receptor (EGFR)-mutated advanced non–small cell lung cancer (NSCLC) are the ones their clinicians are comfortable managing. He recounts a patient who had more rash on combination therapy than on chemotherapy but far less fatigue, which mattered because missed work carried a financial cost. Because patients cannot examine their own scalp, his clinic checks it at every visit, holds amivantamab for a couple of doses at the first sign of rash, and uses steroid shampoos and lotions, with scalp toxicity now uncommon. For cutaneous toxicity he holds amivantamab and continues lazertinib unless he believes the tyrosine kinase inhibitor is responsible, noting higher muscle spasm rates and transient paresthesia with lazertinib. Estelamari Rodriguez, MD, MPH, of Sylvester Comprehensive Cancer Center closes by noting that patient preferences shift and should be revisited.