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

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

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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

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 critical balance between maintaining quality of life and treatment efficacy in patients with metastatic lung cancer who cannot be cured. The discussion emphasizes that since approximately 25% to 30% of patients never reach second-line therapy, optimizing first-line treatment while preserving quality of life becomes paramount. A major focus is patient education about potential toxicities and the importance of early intervention for adverse event management. Clinicians stress that patients often fear reporting adverse effects because they worry about treatment discontinuation or dose reductions, which can paradoxically lead to worse outcomes by delaying necessary supportive care interventions.

The panel outlines comprehensive toxicity management strategies tailored to specific treatment regimens. For patients receiving combination therapy, particularly the FLAURA-2 regimen of osimertinib plus chemotherapy, enhanced monitoring protocols are implemented. These include day 8 follow-up visits with repeat laboratory studies, and day 15 check-ins that may be conducted via video visits with local laboratory work for patients with transportation barriers. The approach emphasizes close contact and frequent follow-up, with some institutions utilizing clinical pharmacists to conduct interim assessments. This intensive monitoring strategy aims to identify and address adverse events early, ultimately enabling patients to remain on therapy longer and derive maximum clinical benefit.

Practical implementation varies by practice setting, with community-based practices often having advantages in terms of patient accessibility and convenience. The monitoring approach typically involves pretreatment laboratory assessments a few days before each cycle to ensure adequate organ function, particularly kidney function for carboplatin dosing, followed by day 8 visits during the first cycle. For any tyrosine kinase inhibitor initiation, including osimertinib, patients are generally seen within 2 weeks for laboratory monitoring to detect potential liver enzyme elevations or other early toxicities. The multidisciplinary team approach, including pharmacists and nurses, ensures comprehensive patient support through proactive communication and systematic follow-up protocols designed to maintain both treatment efficacy and patient well-being.