Targeted Therapies in EGFR-Mutated NSCLC: Managing Treatment-Related AEs
Key Points
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Cutaneous toxicities and venous thromboembolism are common adverse events (AEs) from treatment with amivantamab, lazertinib, and osimertinib.
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Proactive AE management can reduce treatment-related toxicities by half in patients with EGFR-mutated non-small cell lung cancer.
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Topical and oral antibiotics, as well as antiseptic creams, play a key role in managing skin-related AEs.
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Expert panel discussion on when dose reductions may be appropriate to maintain quality of life without compromising efficacy.
Treatment for EGFR -mutated non-small cell lung cancer (NSCLC) has evolved significantly in recent years with the use of targeted therapies, specifically, third-generation tyrosine kinase inhibitors such as osimertinib and lazertinib, and the bispecific antibody amivantamab. These agents have improved progression-free survival (PFS) and overall survival in patients with NSCLC, but they are also associated with adverse events (AEs).
During a featured roundtable discussion at the 2025 American Society of Clinical Oncology Annual Meeting, Estela Rodriguez, MD, MPH, University of Miami Health System; Helena Yu, MD, Memorial Sloan Kettering Cancer Center; and Joshua Sabari, MD, NYU Langone Health, elaborated on the commonly seen AEs like cytopenias, venous thromboembolism, and upper gastrointestinal and cutaneous toxicities.
The panel, which was led by Rahul Gosain, MD, MBA, and Rohit Gosain, MD, shared best practices for AE management. Because these treatment-related AEs are worse upfront, they can be mitigated with timely interventions, such as oral antibiotics, topical antibiotics, corticosteroids, and patient education, according to the panel. Furthermore, providers can partner with specialists, such as dermatologists or podiatrists, to address site-specific concerns.
When a treatment becomes intolerable or affects a patient’s quality of life, providers can consider dose reductions or temporary holds. The MARIPOSA trial provided encouraging data that showed dose holds had no negative effect on a patient’s PFS.