Opinion
Video
Integrating Clinical Trial Findings Into Everyday Pharmacy Practice
Author(s):
A panelist discusses how combining therapies for EGFR-positive non–small cell lung cancer (NSCLC) increases both benefits (improved progression-free survival, response rates, and duration of response) and adverse effects, emphasizing that treatment selection should consider patient-specific factors like central nervous system (CNS) metastases, performance status, treatment aggressiveness preferences, and real-world limitations where patients often differ from clinical trial populations in terms of organ dysfunction, concomitant medications, and previous treatments.
Balancing Benefits and Risks in EGFR-Positive NSCLC: Clinical Considerations
Combination Therapy vs Monotherapy: Key Considerations
Benefit-Risk Assessment
- Combination therapies:
- Provide greater efficacy benefits (improved progress-free survival, response rates, duration of response)
- Consistently demonstrate more adverse effects when adding additional agents
- Overall survival data for newer combinations still maturing
- Adverse effect profiles generally consistent with individual components
- Monotherapy approaches:
- Generally more tolerable
- Require patient adherence and reliable reporting of adverse events
- May offer sufficient benefit for select patients
Patient Selection Factors
Critical factors to consider when selecting treatment include:
- Presence of CNS metastases
- Performance status
- Patient/family treatment goals and aggressiveness preferences
- Support system availability
- Ability to manage toxicities
Practical Clinical Perspectives
- Chemotherapy considerations:
- Despite its reputation, chemotherapy used in NSCLC is generally tolerable with proper supportive care
- A strong support system and proactive toxicity management are essential
- Oral targeted therapy considerations:
- Generally well tolerated
- Requires medication adherence
- Necessitates reliable patient communication regarding adverse events
Translating Trial Data to Clinical Practice
Common Challenges
- Real-world patients often differ from trial populations:
- May have renal or hepatic dysfunction
- May take medications with significant drug interactions
- Often have brain metastases or previous radiation (sometimes excluded from trials)
Clinical Approach
- Dose and timing adjustments based on individual patient factors
- Multidisciplinary team discussion for complex cases
- Open discussion with patients about:
- Trial findings
- How their individual case may differ from study populations
- Strategies for toxicity management
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