Provider Perspectives on Managing EGFRm NSCLC
Panelists discuss how dermatologic adverse events with EGFR inhibitors are more severe than previously seen with third-generation tyrosine kinase inhibitors, requiring reactive management strategies including topical steroids, antibiotics, and dermatologic consultations that are often difficult to obtain.
Health care providers acknowledge that EGFR-related dermatologic toxicities have returned with increased severity compared with third-generation EGFR tyrosine kinase inhibitors like osimertinib. These adverse events significantly impact quality of life, particularly concerning for patients receiving chemotherapy-free regimens who expect better tolerability. The toxicities are generally manageable with appropriate prophylactic strategies, rarely leading to dose reductions, interruptions, or treatment discontinuation when properly addressed through proactive management approaches.
Reactive management strategies before the COCOON study included topical steroids of varying potency depending on location and severity, occasional low-dose oral steroids for grade 3 or higher reactions, and topical calcineurin inhibitors despite insurance authorization challenges. Paronychia management proved particularly difficult, requiring antimicrobial soaks twice daily, topical antimicrobials or antibiotics, oral antibiotics when other strategies failed, and sometimes topical steroids. The success rate of reactive management approaches was approximately 50-50, with half of patients responding well while others struggled significantly.
The importance of quality of life has become paramount in modern oncology practice, especially for patients with EGFR-mutated non–small cell lung cancer, who tend to be younger, more educated about their disease, and actively engaged with advocacy groups. These patients expect to maintain normal activities without visible signs of illness, making effective dermatologic management crucial for psychological well-being and social functioning during extended treatment periods in the first-line setting.
