Management Strategies for Adverse Events Associated With EGFR TKIs in Non-Small Cell Lung Cancer

Abstract

New advances in the treatment of non-small cell lung cancer (NSCLC) have afforded patients longer progression-free survival times, but these therapies are also associated with specific side effects that may not be seen with chemotherapy or radiotherapy. One class of agents includes the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), which have been shown to be efficacious in patients whose tumors harbor EGFR-activating mutations. Certain adverse effects, particularly rash and diarrhea, as well as mucositis/stomatitis, paronychia, ocular disorders, and interstitial lung disease, are seen with this class as a function of their mechanism of action. This review presents the suggested pathogenesis of these toxicities as well as specific management strategies to assist advanced practitioners in helping patients receive the full benefit of treatment with EGFR TKIs.

Figure 1

Mechanism of tumorigenesis by mutated EGFR and of inhibition by EGFR TKIs. ATP = adenosine triphosphate; EGFR TKI = epidermal growth factor receptor tyrosine kinase inhibitor.

Table 1

Incidence of Class-Specific Adverse Events Associated With EGFR TKIs for Treatment of NSCLCa

Figure 2

Acneiform rash induced by EGFR TKIs. (A) Grade 1, gefitinib; (B) grade 2, erlotinib; (C) grade 3, erlotinib; (D) grade 4, erlotinib. EGFR TKI = epidermal growth factor receptor tyrosine kinase inhibitor. Reproduced with permission from Melosky et al. (2015). Copyright 2015 by Multimed Inc.

Figure 3

Rash of the scalp induced by an EGFR TKI. EGFR TKI = epidermal growth factor receptor tyrosine kinase inhibitor. Photo courtesy of Wendy Vogel.

Figure 4

Grade 3 paronychia of the toes induced by erlotinib. Reproduced with permission from Melosky et al. (2015). Copyright 2015 by Multimed Inc.

Table 2

Preventive Steps to Minimize the Impact of Adverse Events Before Starting an EGFR TKI