Managing Zongertinib Toxicities and Supporting Adherence

This episode focuses on the safety profile of zongertinib and what it takes to keep patients on therapy. The panel describes diarrhea as the most common toxicity, largely low grade and manageable with over-the-counter antidiarrheals, with severe diarrhea far less common than with nonselective EGFR/HER2 inhibitors. Rash also tends to be low grade. Faculty highlight an easily overlooked requirement: frequent transaminase monitoring during the early months of therapy, as specified in the label, with drug holds and dose reductions for severe elevations. The discussion contrasts this profile with platinum-based chemotherapy, including myelosuppression, nausea, fatigue, and the burden of recurring infusions. The pharmacist perspective centers on adherence: setting expectations before the first dose, prescribing supportive care in advance, encouraging early outreach for breakthrough symptoms, and scheduling proactive check-ins for patients who never enter the infusion center, including stable patients seen only every few months.