Dr. Nguyen on Managing Mobocertinib-Related GI Toxicities in EGFR Exon 20 Insertion+ NSCLC

Danny Nguyen, MD, medical oncologist and hematologist, assistant clinical professor, Department of Medical Oncology & Therapeutics Research, City of Hope, discusses management strategies for mobocertinib (Exkivity)-related gastrointestinal (GI) toxicities in EGFR exon 20 insertion–positive non–small cell lung cancer (NSCLC).

Findings from a poster presentation, which were presented during the 2021 ESMO Congress, characterized GI toxicities reported by patients with EGFR exon 20 insertion–positive NSCLC receiving mobocertinib. Ultimately, the study showed that GI toxicities were common among patients receiving mobocertinib; diarrhea was the most common adverse effect reported.

As such, management strategies are needed when prescribing mobocertinib. For example, patients should be treated with an anti-diarrheal medication, such as loperamide (Imodium), early to ensure the diarrhea does not cause significant complications, Nguyen says. Additionally, it is important to set patient and provider expectations prior to treatment.

Additional management strategies include identifying food triggers that cause diarrhea and altering the time of day the patient takes mobocertinib, Nguyen explains. Early hydration is also a key step in minimizing severe complications, such as dehydration and electrolyte imbalances, from diarrhea.

Ultimately, mobocertinib-related GI toxicities were mostly low grade and were manageable. Findings from a patient-reported analysis that were presented during the 2021 World Conference on Lung Cancer showed that overall health-related quality of life was maintained for patients during treatment with mobocertinib despite toxicities, such as rash and GI-related symptoms. This is likely because lung cancer–related symptoms like dyspnea, chest pain, and coughing, improved for patients on mobocertinib, Nguyen concludes.