Supportive Care Treatments for Toxicities of Anti-EGFR and Other Targeted Agents

Targeting of the epidermal growth factor receptor (EGFR) pathway has become routine practice in the treatment of lung carcinoma. As more health authorities approve targeted compounds in a variety of treatment lines, use of this approach is expected only to increase. Gefitinib, an oral tyrosine kinase inhibitor (TKI), is approved by Health Canada in the first-line setting of advanced non-small-cell lung carcinoma (NSCLC) for tumours that harbour the EGFR gene mutation. Erlotinib, another TKI, is currently approved in advanced NSCLC in the second- and third-line settings. The side-effect profile of this class of drugs is unique. Hematologic toxicity is seldom seen. The most frequent side effects are rash and diarrhea. Although no randomized trials have addressed treatment of the side effects of this class of drugs, some basic principles of management have been agreed on and can likely improve patient compliance and decrease inappropriate dose reduction. The prognostic and predictive implications of side effects are also evolving. Finally, the ALK fusion mutation is being recognized as a mutation driver. The use of crizotinib (again, a TKI) in this setting awaits approval. The side-effect profile of crizotinib is interesting and is also reviewed here.