For APPs & Nurses

Proactive Approach

Proactive supportive care is recommended

Mutated EGFR is a critical oncogenic driver for many patients with mNSCLC1,2

  • Treatments targeting EGFR such as RYBREVANT® or LAZCLUZE™ cause on-target ARs1
  • EGFR inhibitor-related ARs can affect patients’ quality of life1
  • A proactive supportive-care approach is needed to give patients the best chance of tolerating and staying on EGFR-targeting treatment2

Proactive supportive care was not mandatory across RYBREVANT® studies. Some recommendations are based on the clinical trial experience while others are from guidelines.

Implement proactive supportive care with your patients to support them throughout their treatment journey

AR, adverse reaction; EGFR, epidermal growth factor receptor.

Dermatologic Care

Proactive supportive care may reduce the risk and severity of dermatologic ARs

Use of prophylactic antibiotics (with or without topical skin therapies) has demonstrated3*:

64% reduction

in the risk of developing Grades 2 to 4 skin rash eruptions

46% reduction

in the risk of all
grades skin rash

39% reduction

in the risk of paronychia

*

Based on a systematic review and meta-analysis of 13 studies including 1,073 patients.

MASCC Guidelines recommend proactive measures (Weeks 1 to 6) and ongoing monitoring to reduce the risk of severe reactions4:

Hydrocortisone cream

Hydrocortisone 1% cream with moisturizer and sunscreen twice daily

Medication pill and tablet

Minocycline 100 mg daily OR doxycycline 100 mg twice daily

Proactive lifestyle approach to reduce the risk of dermatologic ARs5:

Medical cross sign and bottle

Use alcohol-free emollient cream (eg, isopropanol-free, ethanol-free) emollient cream

Sunshine

Limit sun exposure during and for 2 months after treatment

Protective hat

Wear protective clothing and use broad-spectrum UVA/UVB sunscreen

Based on RYBREVANT® Prescribing Information

Proactive lifestyle approach to reduce the risk of paronychia

Fingernail icon

Paronychia, an inflammation of the nail folds of the fingernails and toenails, can lead to infection, and the consequent swelling and tenderness often affect patients’ activities of daily living.4

Lifestyle modifications4

Management approaches are aimed at:

  • Minimizing/avoiding trauma and decreasing inflammation in the periungual area
  • Preventing superinfection
  • Eliminating excessive granulation tissue

MASCC Guidelines recommendations4

Approaches to prevent superinfection:

  • Use of antimicrobial soaks
  • Avoid irritants

Consider prophylactic measures (eg, use of oral antibiotics) to reduce the risk of dermatologic adverse reactions5

MASCC, Multinational Association of Supportive Care in Cancer; UVA, ultraviolet A; UVB, ultraviolet B,

VTE

For RYBREVANT® only when combined with LAZCLUZE™

Prophylaxis is recommended to prevent venous thromboembolism (VTE)

Drug-related prophylaxis5

Prophylactic treatment with an anticoagulation medicine is recommended for the first 4 months of treatment with RYBREVANT® + LAZCLUZE™.

  • If there are no signs or symptoms of VTE during the first 4 months of treatment, consider discontinuation of anticoagulant prophylaxis at the discretion of the healthcare provider
  • The use of Vitamin K antagonists is not recommended

~97% of patients in the RYBREVANT® + LAZCLUZE™ arm did not receive prophylactic anticoagulation for the first 4 months.6

Blood clot formulating in a vein

VTE, which includes DVT and PE, is a key cause of morbidity among patients with lung cancer.7

People living with cancer are at 9 times the risk of developing a VTE compared with the general population.8

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) recommendations for cancer-associated VTE disease9

Anticoagulant options for VTE prophylaxis for ambulatory patients with cancer include direct oral anticoagulants (DOACs) and low molecular weight heparins (LMWHs).*†‡

*Recommendations derived from clinical trials of ambulatory patients with cancer with high thrombosis risk (>18 years, Khorana VTE Risk Score of ≥2, initiating new course of chemotherapy) and are not included in product labeling. Prophylaxis duration should be 6 months or longer if risk persists.

†Always refer to the NCCN Guidelines for the comprehensive and most up-to-date recommendations on cancer-associated VTE when considering prophylaxis.

‡When using RYBREVANT® in combination with LAZCLUZE™ please refer to the Prescribing Information for VTE prophylaxis recommendation.

DVT, deep vein thrombosis; NCCN, National Comprehensive Cancer Network; PE, pulmonary embolism.

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References:

  1. Yin X, Zhao Z, Yin Y, et al. Adverse event profiles of epidermal growth factor receptor-tyrosine kinase inhibitors in cancer patients: a systematic review and meta-analysis. Clin Transl Sci. 2021;14(3):919-933.
  2. Hofheinz RD, Deplanque G, Komatsu Y, et al. Recommendations for the prophylactic management of skin reactions induced by epidermal growth factor receptor inhibitors in patients with solid tumors. Oncologist. 2016;21(12):1483-1491.
  3. Petrelli F, Borgonovo K, Cabiddu M, et al. Antibiotic prophylaxis for skin toxicity induced by antiepidermal growth factor receptor agents: a systematic review and meta-analysis. Br J Dermatol. 2016;175(6):1166-1174.
  4. Lacouture ME, Anadkat MJ, Bensadoun RJ, et al; MASCC Skin Toxicity Study Group. Clinical practice guidelines for the prevention and treatment of EGFR inhibitor-associated dermatologic toxicities. Support Care Cancer. 2011;19(8):1079-1095.
  5. RYBREVANT® [Prescribing Information]. Horsham, PA: Janssen Biotech, Inc.
  6. Data on file. Janssen Biotech, Inc.
  7. Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020;38(5):496-520.
  8. Mulder FI, Horváth-Puhó, van Es N, et al. Venous thromboembolism in cancer patients: a population-based cohort study. Blood. 2021;137(14):1959-1969.
  9. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Associated Venous Thromboembolic Disease V2.2024. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed July 29, 2024. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.