Managing Dermatologic Adverse Events in Patients Receiving Third-Generation EGFR-TKIs

There were 18 patients at the second institution, and the researchers found skin toxicities were all grade 2. Six patients (33%) experienced acneiform rash; 5 patients (28%) experienced pruritus; 15 patients (83%) developed xerosis; and 11 patients (32%) developed paronychia, with 5 patients having grade 3 paronychia.

The researchers report that patient education, early recognition, and proactive management of EGFR-TKI-related dAEs are critically important to achieve optimal outcomes. “The clinical management with this third generation EGFR-TKI does not differ from other oral agents for cancer,” Ms Culkin told Oncology Nurse Advisor. 

Assessing risk factors for oral chemotherapy adherence is important. Discussions with the patient and caregivers about the plan for oral chemotherapy and its potential side effects are paramount. “Engaging the patient regarding dose, time, and administration of oral agents for cancer offers the patient a stake in their care,” said Ms Culkin. 

Patient portal communication can play a pivotal role. A review of side effects and how best to manage them can lead to significantly better outcomes, Ms Culkin explained. Visits with the oncology nurse at scheduled times of assessment and via telephone may lead to fewer adverse events and better treatment adherence.

Currently, prophylactic topical corticosteroids and topical and oral antibiotics are recommended for reducing the risk of acneiform rash in patients receiving first-generation and second-generation EGFR-TKIs. However, the low rate of acneiform rash with osimertinib is so low that prophylactic measures are not recommended.

The researchers write that management of dAEs is similar for all EGFR-TKIs and is based on dAE grade, except for the use of prophylactic antibiotics and steroids. Emphasizing the importance of strict adherence to the treatment regime is recommended, but also coupling that with discussions on the potential osimertinib-associated dAEs and the best ways of reporting them. 

Ms Culkin said in some cases oncology nurses may need to help patients obtain their medication through specialty pharmacy distribution. “The take-home message for oncology nurses who manage patients receiving osimertinib begins with the nurse-patient relationship. Assessment of oral adherence through patient and caregiver education on how to ingest osimertinib exactly as prescribed,” said Ms Culkin. 

References

Chu CY, Choi J, Eaby-Sandy B, Langer CJ, Lacouture ME. Osimertinib: a novel dermatologic adverse event profile in patients with lung cancer. Oncologist.2018;23(8):1–9891–899.