Dr. Ross on Toxicity Concerns With Combination Therapies in EGFR+ NSCLC

Helen J. Ross, MD, medical oncologist, Banner MD Anderson Cancer Center, discusses toxicity concerns with combinations therapies in EGFR-mutant non–small cell lung cancer (NSCLC).

In cases of resistance to first-, second-, or third-generation EGFR inhibitors, combination therapies have been evaluated, says Ross. For example, if a patient develops resistance to osimertinib (Tagrisso), adding agents such as gefitinib (Iressa) or erlotinib (Tarceva) could be beneficial, Ross explains. However, on-target toxicities, such as inflammation, irritation, gastrointestinal toxicities, and skin toxicities, have limited the utility of this treatment approach, says Ross.

Similarly, evaluation of combination TKIs and immunotherapy was halted because of severe immune-related toxicities, including cardiac and pulmonary adverse effects (AEs), in this patient population, Ross explains. As such, developing a better understanding of the mechanisms of these toxicities, as well as identifying whether a specific patient population may have a lower risk of developing severe AEs, could allow these combination approaches to enter the treatment paradigm, concludes Ross.