Implementing Dermatologic Toxicity Management in Clinical Practice for Amivantamab-Lazertinib in EGFR-Mutated NSCLC

Dr. Gumbleton discusses how proactive dermatologic management translates into day-to-day clinical practice for patients receiving amivantamab-lazertinib for EGFR-mutated NSCLC. His central message is that prevention initiated before toxicity develops is far more effective than reactive management. He illustrates this with a patient who completed a 3-week outdoor rafting trip during cycle 2 of amivantamab-lazertinib without significant rash by adhering to sun-protective measures, sun-protective clothing, and a broad-brimmed hat throughout. He shares a practical supplemental approach used in his practice: dilute vinegar soaks at 10% concentration applied to nails or skin for approximately 5 minutes once or twice daily, which reduces bacterial colonization and has produced meaningful improvements in paronychia and skin toxicity in his patients.

Dr. Gumbleton recommends using the early weekly visit schedule as an educational opportunity rather than a burden: each visit allows the care team to reinforce adherence to prophylactic measures, assess early toxicity, and intervene before grade escalation occurs. He emphasizes that all team members, including advanced practice providers (APPs), nurses, and pharmacists, should be aligned on the management plan.

Dr. Fidler adds that her institution uses an electronic medical record treatment plan (BEACON system) with all supportive care agents pre-built, including timepoint-specific adjustments at the approximately 12-week mark when some prophylactic elements can be modified. Providing patients with a written calendar of prophylactic regimen adjustments reduces confusion and supports adherence throughout the dose-dense early treatment period.