Proactive Care in ALK-Positive NSCLC: Adverse Effect Counseling, Monitoring, and Management

EP: 1.Clinical Case: EGFR-Mutant (Exon 19 del) Advanced NSCLC

EP: 2.The Treatment Landscape For Advanced EGFR-Mutant NSCLC

EP: 3.Emerging Insights From MARIPOSA: OS Updates From Amivantamab/Lazertinib in Advanced NSCLC

EP: 4.Navigating CNS Disease in EGFR-Mutant NSCLC

EP: 5.From Trial to Practice: Integrating Amivantamab/Lazertinib in Advanced NSCLC

EP: 6.Patient Education and IRR Prophylaxis in Practice With Amivantamab/Lazertinib

EP: 7.Managing Dermatologic AEs With Amivantamab/Lazertinib: Updates From the COCOON Clinical Trial

EP: 8.The Multidisciplinary Approach to Care for Advanced NSCLC

EP: 9.Clinical Case: ALK-Positive Advanced NSCLC

EP: 10.Frontline Treatment Decisions in ALK+ NSCLC

EP: 11.Clinical Perspectives and Emerging Updates in Advanced NSCLC

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EP: 12.Proactive Care in ALK-Positive NSCLC: Adverse Effect Counseling, Monitoring, and Management

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Comprehensive patient counseling and proactive monitoring form the foundation of successful ALK inhibitor therapy management, requiring structured approaches to education, adverse event prevention, and early intervention strategies. Patient education protocols must address the distinct adverse effect profiles of different ALK inhibitors, with lorlatinib requiring particular attention to cardiovascular monitoring including blood pressure and lipid management, central nervous system (CNS) toxicity surveillance, and dermatologic care. Baseline assessment and optimization of cardiovascular risk factors, including blood pressure control and lipid management, are essential before initiating lorlatinib therapy.

Monitoring protocols include regular assessment of cardiovascular parameters with appropriate interventions such as ACE inhibitors or statins as clinically indicated, dermatologic surveillance with moisturizing and topical steroid protocols, and gastrointestinal symptom management including constipation prevention through adequate fluid and fiber intake. CNS toxicity monitoring represents a critical component of lorlatinib management, requiring regular assessment of cognitive function, speech patterns, and energy levels, with patient education about the importance of reporting subtle changes that may indicate developing neurotoxicity.

Red flag symptoms requiring immediate reporting include bradycardia that may progress to requiring cardiac pacing, significant weight gain and joint pain that impact quality of life, and any CNS symptoms including cognitive changes or speech difficulties. Health care teams must implement systematic approaches to capture these symptoms through regular questioning, as patients may not spontaneously report gradual changes or may attribute symptoms to other causes. Laboratory monitoring including liver function tests, lipid panels, and creatinine assessment should be performed at regular intervals with more frequent monitoring during treatment initiation. The collaborative approach between physicians, advanced practitioners, nurses, and support staff ensures comprehensive patient surveillance and timely intervention when adverse events develop.