Managing Diarrhea and Nutrition on First-Line EGFR Therapy

Panelists discuss gastrointestinal management for patients receiving first-line therapy for epidermal growth factor receptor (EGFR)-mutated advanced non-small cell lung cancer (NSCLC). The conversation outlines a practical diarrhea algorithm that begins by reviewing laxatives and stool softeners, asking what the patient has been eating, and steering patients away from greasy, fatty, and fried foods toward a bland diet with increased fluids and electrolyte replacement. Panelists describe starting over-the-counter loperamide for mild episodes, escalating to a prescription antidiarrheal when symptoms persist, and bringing patients in the same day for laboratory work, hydration, and evaluation when episodes become frequent or fatigue and weakness appear. The discussion stresses teaching a clear daily dose ceiling and instructing patients to call, including after hours, once they reach it. Panelists also recommend early referral to oncology dietitians for unintentional weight loss, taste changes, food aversions, and stomatitis.