Dr Rodriguez on a Case Study of EGFR-Mutated NSCLC

“All this knowledge that you get from being in a big group with multidisciplinary specialists and experts in the field helps us make better decisions for our patients.”

Estelamari Rodriguez, MD, MPH, associate director, Community Outreach – Thoracic Oncology, Sylvester Comprehensive Cancer Center, discusses a case study of a patient with non–small cell lung cancer (NSCLC) harboring an EGFR L858R mutation and a TP53 mutation.

Rodriguez presented this case at the 22nd Annual Winter Lung Cancer Conference. TP53 mutations are associated with resistance to osimertinib (Tagrisso) and a more aggressive disease course, highlighting the need for treatment intensification strategies, Rodriguez begins. Upon disease progression on osimertinib, this patient developed asymptomatic brain metastases, which raised the need to consider the intracranial activity of subsequent lines of therapy, she says.

The case discussion emphasized the varying degrees of central nervous system (CNS) penetration among newer EGFR-targeted agents, Rodriguez explains. Given the increasing number of younger patients with EGFR-mutated NSCLC, selecting therapies with significant CNS activity, such as amivantamab-vmjw (Rybrevant) and lazertinib (Lacluze), is critical to delaying or avoiding brain radiation, she notes. These agents have demonstrated activity against brain metastases, offering a systemic approach to controlling intracranial disease progression, she highlights.

Toxicity management was another key discussion point, including the adverse effects associated with amivantamab and lazertinib, such as dermatologic toxicities and infusion-related reactions, according to Rodriguez. With increasing clinical experience, strategies for mitigating these toxicities have evolved, including premedication regimens, proactive dermatologic care, and dose adjustments, she emphasizes. Patients who have infusion reactions can often continue to receive therapy with modified dosing strategies and supportive care, ensuring continued treatment efficacy, she reports.

This case discussion underscored the importance of multidisciplinary collaboration and expert consultation when managing complex cases, Rodriguez says. Insights from investigators involved in clinical trials of amivantamab and lazertinib provided valuable practical strategies for optimizing patient outcomes, she explains. For instance, one investigator shared an approach of modifying infusion protocols to improve tolerability, she continues. Such shared clinical experiences reinforce the necessity of integrating expertise from multiple disciplines when making treatment decisions, ultimately enhancing therapeutic strategies and improving patient outcomes, she concludes.