Discussing the Time and Financial Toxicities Associated With Combination Therapies and Potential Mitigation Strategies

EP: 1.The Evolution of EGFR-Mutated Advanced NSCLC Treatment: Present Considerations and Future Treatment Options

EP: 2.Has Combination Therapy Become the New Frontline Treatment Standard for EGFR-Mutant Metastatic NSCLC?

EP: 3.Decision Points to Consider When Choosing Treatment With Monotherapy or Combination Therapy for EGFR-Mutant mNSCLC

EP: 4.Evaluating Patient Preferences for the Treatment of EGFR-Mutant mNSCLC

EP: 5.Comparing the Combination Therapies for the Treatment of EGFR-Mutant mNSCLC

EP: 6.Considering Resistance Mechanisms When Choosing Therapy in the Frontline Setting

EP: 7.The Importance of Maintaining Quality of Life and Intervening Early When Adverse Events Occur in the Frontline Treatment Setting

EP: 8.Weighing the 1-Year Projected Overall Survival Benefit With MARIPOSA in the Frontline Treatment of EGFR-Mutant mNSCLC

Now Viewing

EP: 9.Discussing the Time and Financial Toxicities Associated With Combination Therapies and Potential Mitigation Strategies

EP: 10.Discussing Potential Combination Therapy Medication-Associated Toxicities With Patients

EP: 11.Evaluating the Clinical Utility of Subcutaneous Amivantamab in the Treatment of EGFR-Mutant mNSCLC

EP: 12.The Importance of Multidisciplinary Collaboration With Subspecialty Physicians in the Toxicity Management With Treatment

EP: 13.Exploring Second-Line Treatment Options Including Targeted Radiation and Surgery for the Management of EGFR-Mutant mNSCLC

EP: 14.Tissue vs Plasma Biopsy After First Disease Progression in EGFR-Mutant NSCLC

EP: 15.Deciding Between a Biomarker-Directed Approach and a Biomarker-Agnostic Approach for Second-Line Treatment of EGFR-Mutant NSCLC

EP: 16.Continuing the Targeted TKI in the Second Line for the Treatment of EGFR-Mutant NSCLC

EP: 17.When to Consider Retreatment With Chemotherapy After FLAURA2 for EGFR-Mutant NSCLC

EP: 18.Patient Case Presentation: A 45-Year-Old With Newly Diagnosed EGFR-Mutant mNSCLC and Liver Metastases

EP: 19.Patient Case Presentation: A 69-Year-Old With Newly Diagnosed EGFR-Mutant mNSCLC and Symptomatic Brain Metastases

This segment addresses the significant time and financial burdens associated with combination therapies for EGFR-mutant metastatic non–small cell lung cancer, which often serve as primary drivers in patient decision-making. While osimertinib monotherapy allows for relatively infrequent visits after initial monitoring (eventually every 3 months), combination regimens require substantially more healthcare encounters. The FLAURA-2 regimen necessitates visits every 3 weeks for pemetrexed maintenance, while amivantamab requires weekly visits initially, followed by biweekly visits indefinitely. These frequent visits create substantial time toxicity, particularly challenging for young patients with families from being able to “forget that I exist for a while.” Infusion center inefficiencies compound these burdens, and patients may require additional urgent care visits for treatment-related adverse effects.

The management of pemetrexed maintenance therapy in real-world practice often differs from clinical trial protocols, with clinicians employing various strategies to balance efficacy with patient quality of life. While trials recommend continuing pemetrexed indefinitely, practicing oncologists demonstrate flexibility in their approach. Some maintain the every-3-week schedule as per protocol, while others have lower thresholds for discontinuation, particularly after initial cycles when good responses are achieved. Creative dosing strategies include spacing pemetrexed to every 4 weeks rather than discontinuing entirely, with careful attention to dose reductions for cumulative toxicities affecting renal function or causing cytopenias. The rationale acknowledges that osimertinib drives the majority of therapeutic benefit, providing reassurance when temporary discontinuation is necessary.

The clinical approach to maintenance therapy reflects the fundamental goal of helping patients “get their lives back” while balancing potential efficacy benefits. Some clinicians adopt more liberal discontinuation practices, particularly when disease biology appears favorable, acknowledging that moving from every-3-week to every-3-month visits represents a significant quality of life improvement. The discussion highlights emerging technologies like minimal residual disease assays and circulating tumor DNA monitoring as potential tools for personalizing maintenance decisions. While clinicians inform patients that deviating from trial protocols might leave therapeutic benefits “on the table,” the emphasis remains on individualized care that considers both survival outcomes and patient preferences for time toxicity management.