Dr Salgia on Unmet Needs Associated With Treatment-Related Toxicity in Lung Cancer

Ravi Salgia, MD, PhD, medical oncologist, Arthur & Rosalie Kaplan Chair, medical oncology, City of Hope, discusses the 2023 Bridging the Gaps in Lung Cancer meeting, highlighting unmet needs that remain regarding treatment-related toxicities that can arise with commonly used agents in patients with lung cancer.

The assumption that all TKIs are safe is not true, Salgia begins. For instance, EGFR-directed TKIs, such as osimertinib (Tagrisso), are associated with their share of potential adverse effects (AEs), he says. Osimertinib can lead to a rash, diarrhea, alterations in nail beds, and cardiac changes, Salgia emphasizes, noting that these AEs necessitate vigilant monitoring of the heart, liver, and kidneys. Therefore, the assertion that TKIs are universally safe is an oversimplification. When AEs transpire, they significantly impair patients’ quality of life.

Awareness of toxicities is important, as each lung cancer treatment agent is associated withdistinct AEs. For instance, MET inhibitors, such as tepotinib (Tepmetko) and capmatinib (Tabrecta), may trigger general body anasarca or edema in the lower extremities, as well as liver dysfunction, Salgia expands. Thorough monitoring and appropriate management of these AEs are essential in such cases. Moreover, KRAS inhibitors, such as adagrasib (Krazati) and sotorasib (Lumakras), are associated with liver dysfunction, alongside the potential for nausea and vomiting, he emphasizes. Furthermore, the co-administration of KRAS inhibitors and immunotherapy agents amplifies the likelihood of these toxicities.

These targeted drugs, despite their precision, are associated with off-target AEs, necessitating vigilance throughout treatment. Salgia says oncologists are unable to predict which specific AEs a given patient might experience in response to a particular drug. Notably, the toxicities associated with immunotherapy agents can be formidable, ranging from hypophysitis to pneumonitis, colitis, nephritis, and hepatitis. The likelihood of these AEs underscores the need for health care practitioners to remain aware of these potential complications, he concludes.