Year in Review 2024: Updates in the Management of Advanced EGFR-Mutant NSCLC - Episode 5
Balancing Safety and Efficacy in the Frontline Management of Advanced EGFRm NSCLC
Panelists discuss how balancing safety and efficacy in frontline regimens involves managing distinct toxicity profiles, with FLAURA2 requiring standard chemotherapy monitoring vs MARIPOSA necessitating complex supportive care for EGFR-related skin toxicity and venous thromboembolism prophylaxis.
This video segment focuses on balancing safety and efficacy considerations when selecting frontline treatment regimens for advanced EGFR-mutated non–small cell lung cancer (NSCLC). The discussion centers on the distinct toxicity profiles of 2 major combination approaches: FLAURA2 (osimertinib plus chemotherapy) and MARIPOSA (amivantamab plus lazertinib), emphasizing how these differences should inform treatment decisions and patient counseling.
The FLAURA2 regimen combines osimertinib with intravenous carboplatin and pemetrexed, presenting familiar chemotherapy-related adverse effects that most oncology practices are experienced in managing. Common toxicities include increased fatigue, myelosuppression (which may be more pronounced in this combination than with other regimens), nausea, and cumulative renal toxicity from pemetrexed. While these adverse effects require careful monitoring and supportive care measures like antiemetics, they follow established management protocols. A particular concern is the potential for cumulative renal toxicity with prolonged administration, which could impact future clinical trial eligibility given the extended survival expectations in this patient population.
In contrast, the MARIPOSA regimen presents a completely different toxicity spectrum. Key adverse effects include infusion-related reactions (though these may decrease with subcutaneous formulations), EGFR-related dermatologic toxicities that can significantly impact quality of life, cumulative edema related to MET inhibition, and notably, an increased risk of venous thromboembolism requiring prophylactic anticoagulation for the first 4 months of treatment. While supportive care protocols are being developed to manage these toxicities, including prophylactic medications and dermatology consultations, the regimen requires extensive patient education and coordination of multiple supportive medications. Both approaches demand close monitoring and strong nursing support to ensure optimal patient quality of life throughout extended treatment periods.
Related Content:
