Management of Common Toxicities in Metastatic NSCLC Related to Anti-Lung Cancer Therapies with EGFR-TKIs

Abstract

Tyrosine kinase inhibitors (TKIs) against the epidermal growth factor receptor (EGFR) are the standard of care treatment in non-small cell lung cancer (NSCLC). TKIs are used first line in EGFR mutation-positive NSCLC; erlotinib is the only TKI approved for subsequent lines of treatment in EGFR wild-type NSCLC. As promising as TKIs are in helping patients avoid some of the side effects of traditional cytotoxic chemotherapy, they do come with a variety of side effects. This article will describe the most common adverse events associated with the epidermal EGFR family of TKIs including diarrhea, rash, mucositis, and paronychia. The objective of this paper is to provide simple guidelines to assist oncologists in managing these common toxicities. As patient survival is often directly correlated with successful therapeutic drug delivery, the management of TKI-induced adverse events ensures proper treatment and may avoid discontinuation or reduction of the therapeutic.

Keywords: EGFR; adverse event management; diarrhea; paronychia; rash; stomatitis/mucositis; tyrosine kinase inhibitor.

Figure 1

Management of diarrhea induced by chemotherapy or EGFR–TKIs. IV, intravenous, SC, subcutaneous, TID, three times daily. Adapted from Hirsh (10).