Preventing and Managing Dermatologic Toxicity in EGFR-Mutated NSCLC

Panelists discuss prophylactic versus reactive dermatologic management across first-line regimens for epidermal growth factor receptor (EGFR)-mutated advanced non-small cell lung cancer (NSCLC). With single-agent osimertinib, the panel describes generally modest toxicity and an acneiform rash affecting the scalp, central face, upper chest, and back, managed with a gentle unscented cleanser and moisturizer, topical clindamycin lotion, escalation to an oral antibiotic such as doxycycline, early dermatology referral, and diluted bleach soaks for paronychia developing within the first months of treatment. Panelists also review checking zinc levels, citing evidence for a role in EGFR activation and expression, and monitoring copper when supplementing. For amivantamab plus lazertinib, the discussion turns to COCOON prophylaxis from the start of therapy, with dexamethasone before the first infusion, broad-spectrum sun protection, clobetasol solution, chlorhexidine and vinegar soaks, and prophylactic twice-daily doxycycline with topical hydrocortisone continued for several months.