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Strategies to Minimize Toxicities, and the Pharmacist’s Role in Educating and Supporting Patients With NSCLC

A panelist discusses how to minimize EGFR tyrosine kinase inhibitor (TKI) adverse effects through preventive measures such as maintaining good skin regimens with moisturizers and SPF 30+ sunscreen, prescribing topical steroids and antibiotics for skin rash, and managing diarrhea with hydration, diet modifications, and loperamide.

Management Strategies for EGFR TKI Adverse Effects: Summary for Physicians

Dermatologic Toxicity Management

  • Proactive skin care regimen before initiating EGFR TKIs:
  • Recommend non–alcohol-based creamy moisturizers (morning and night)

  • Daily SPF 30+ sunscreen on exposed areas

  • Encourage protective clothing (hats, long sleeves)
  • Treatment options for acneiform rash:
  • Topical steroids

  • Topical clindamycin gel

  • Oral doxycycline (helps reduce severity and prevent superimposed infection)

  • Consider dermatology referral for severe cases

Diarrhea Management

  • Patient education:
  • Instruct patients to monitor and track stool frequency above baseline

  • Emphasize adequate hydration
  • Dietary modifications:
  • Recommend BRAT-style diet (bananas, rice, apples, toast)

  • Low-fiber, bland foods

  • Avoid dairy, greasy, and fatty foods
  • Pharmacologic intervention:
  • Provide step-by-step loperamide (Imodium) dosing instructions

  • Review medication list for potential exacerbating agents

  • Instruct patients to hold laxatives/stool softeners during diarrhea episodes

Clinical Pearls

  • Male patients may require additional encouragement regarding skin care regimens
  • Emphasize importance of patient communication between visits
  • Always perform medication reconciliation to identify potential contributory medications
  • Ensure patients have clear instructions for all prescribed treatments

This approach focuses on proactive management to minimize adverse events while maintaining treatment efficacy.

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