Future Perspectives in 1L Treatment of Advanced NSCLC

EP: 1.1L Treatment for Advanced NSCLC

EP: 2.Insights from COCOON: Prophylactic Dermatologic Management With Amivantamab + Lazertinib in Advanced NSCLC

EP: 3.Clinical Approaches for Dermatologic AEs Associated With Amivantamab + Lazertinib in Advanced NSCLC

EP: 4.Clinical Impact of COCOON: Advancing Dermatologic AE Management

EP: 5.Translating Clinical Data Into Practice: Strategies to Implement Enhanced Dermatologic Management With Amivantamab + Lazertinib in Advanced NSCLC

EP: 6.Translating Clinical Data Into Practice: Patient Considerations for Success with Prophylactic Management of Dermatologic AEs

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EP: 7.Future Perspectives in 1L Treatment of Advanced NSCLC

Summary for Physicians: Impact of MARIPOSA, SKIPPirr, and COCOON on First-Line Treatment Decisions and Standard of Care

Impact on First-Line Treatment Decision-Making:

1. Overall survival (OS) benefit of amivantamab + lazertinib:

• The MARIPOSA trial shows that the combination of amivantamab + lazertinib provides a clear OS benefit over the standard of care in the first-line treatment of EGFR-mutated NSCLC. This adds a strong rationale for incorporating this regimen into first-line decision-making for eligible patients, especially those with EGFR exon 19 deletions or exon 21 L858R mutations.
• The OS advantage from amivantamab + lazertinib could significantly influence treatment choices, as survival is a key factor in decision-making. Physicians may prioritize this combination for patients with advanced or metastatic EGFR-mutant NSCLC to optimize long-term outcomes.

2. Addressing AEs with combination regimen:

• The SKIPPirr and COCOON studies provide valuable data on how to manage AEs associated with the amivantamab + lazertinib combination. Both trials evaluate strategies for proactively managing AEs, which could enhance patient tolerability and compliance with the treatment regimen.
• The evidence from these studies can guide physicians in tailoring the management of common AEs, such as skin reactions, gastrointestinal disturbances, and immune-related events, ensuring that patients can continue treatment with minimal interruptions and better quality of life.

3. Holistic approach to treatment:

• With the added OS benefit from amivantamab + lazertinib and the clearer understanding of AE management, first-line treatment decisions can now be more comprehensive. Physicians can balance the efficacy of this combination with strategies to prevent or mitigate AEs, leading to more sustainable and effective treatment outcomes.
• These updates underscore the importance of a multidisciplinary approach to patient care, where oncologists, dermatologists, nurses, and pharmacists collaborate to proactively address potential adverse effects and improve adherence.

Impact on Current Standard of Care:

1. Potential shift in standard of care:

• As amivantamab + lazertinib demonstrates significant survival benefits over current standards (such as osimertinib), it may become the new standard of care for patients with EGFR-mutated NSCLC in the first-line setting. The OS benefit and the possibility of improved management of AEs will make this regimen more appealing compared with older treatments.
• As more data emerge from studies such as SKIPPirr and COCOON, physicians may feel more confident in adopting this combination earlier in treatment paradigms, particularly for patients who are suitable for EGFR-targeted therapy.

2. Integration of proactive AE management into standard of care:

• The evidence from the SKIPPirr and COCOON trials reinforces the need for proactive AE management to complement the efficacy of first-line therapies. The standard of care may evolve to include comprehensive care pathways that not only focus on the efficacy of drugs but also on managing adverse effects more effectively, reducing interruptions in treatment.
• In clinical practice, this may lead to the development of more structured protocols for managing skin, gastrointestinal, and other common AEs, making treatment regimens such as amivantamab + lazertinib more feasible for a broader range of patients.

Conclusion: The updates from the MARIPOSA, SKIPPirr, and COCOON trials suggest that amivantamab + lazertinib could be the next preferred first-line treatment for EGFR-mutant NSCLC, owing to its OS benefits. Additionally, the strategies for managing AEs from these studies will allow for a more seamless integration of this combination into routine clinical practice, potentially reshaping the current standard of care to emphasize both efficacy and proactive management of adverse effects.