Framing the First Treatment Conversation With Patients and Families

Wade Iams, MD, MSCI, of Tennessee Oncology, describes how he opens the first treatment conversation with patients who have EGFR-mutated advanced non–small cell lung cancer and with their families, after Edgardo Santos, MD, FACP, FASCO, of Starling Oncology, notes that grade 3 or higher adverse events were more common with amivantamab plus lazertinib than with osimertinib in MARIPOSA. Dr Iams offers to review trial numbers, but says families differ in how much detail they want and sometimes ask that a loved one hear them instead. His first point is that combination therapy is more likely to let patients live longer, so he steers away from osimertinib monotherapy. He then spends most of the visit comparing the toxicity profiles of platinum-based chemotherapy plus osimertinib and of amivantamab plus lazertinib, noting that the gap in grade 3 event rates between those 2 combinations is much narrower than the gap between either combination and osimertinib alone.