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Patient Journey Highlights Evolution in EGFR-Mutated NSCLC Treatment Landscape

• A 20-month EGFR-mutated NSCLC patient journey reveals significant treatment advances, including the recent FDA approval of the MARIPOSA regimen combining amivantamab and lazertinib in August 2024.

• Treatment options have expanded from single-agent osimertinib to include multiple combination approaches, offering physicians and patients more choices based on individual factors and disease characteristics.

• The case study emphasizes the importance of comprehensive patient care, including careful adverse effect management, regular monitoring, and integrated support services for optimal treatment outcomes.

The landscape of EGFR-mutated non-small cell lung cancer (NSCLC) treatment has undergone remarkable transformation over the past two years, as illustrated through the experience of patient Melinda Reubens under the care of Dr. Alexander Spira at Virginia Cancer Specialists Research Institute.

Rapid Evolution in Treatment Options

When Reubens was first diagnosed 20 months ago, osimertinib (Tagrisso) stood as the sole approved treatment option. Today, physicians can choose from multiple therapeutic approaches, including the newly FDA-approved MARIPOSA regimen combining amivantamab and lazertinib, osimertinib with chemotherapy (FLAURA2), and various clinical trial options.
"It's going at rocket speed right now," notes Dr. Spira, highlighting how the field has evolved dramatically in just the past eight months. The treatment decision-making process now considers multiple factors, including patient preferences, disease burden, and risk factors.

Clinical Trial Experience and Current Treatment

Reubens initially participated in the phase 3 MARIPOSA-2 trial (NCT04988295), experiencing typical chemotherapy-related adverse effects including nausea and hair loss. She later transitioned to amivantamab (Rybrevant) monotherapy, reporting significantly fewer side effects and better quality of life with infusions every three weeks.
"I feel somewhat normal. I get the infusions every three weeks and keep going with my life," Reubens shares.

Managing Adverse Effects

Julia Lazo, RN, a nurse navigator at the institute, emphasizes the importance of comprehensive patient education regarding potential adverse effects. For amivantamab, these typically include skin-related reactions, nail changes, fatigue, and fluid retention.
Reubens' husband Justin highlights the value of detailed adverse effect information sheets: "Those sheets that we received were very valuable because she has had some of the obscure adverse effects that we've been able to identify and tie back to the medication."

Comprehensive Care Approach

The treatment program incorporates regular monitoring, with patients seen before each treatment and alternating between provider and nurse practitioner visits. The integrated care model includes:
  • Regular laboratory work and imaging every 6-9 weeks
  • Access to nutritionists and palliative care specialists
  • Social worker support when needed
  • Prompt communication channels with healthcare team
"When I've talked to other patients who have cancer, they're amazed at how my treatment is seamless," Reubens notes, praising the coordinated care approach and accessibility of the healthcare team.

Future Treatment Landscape

The current treatment landscape offers several options for newly diagnosed patients:
  • Single-agent osimertinib
  • Osimertinib with chemotherapy
  • MARIPOSA regimen (amivantamab + lazertinib)
  • MARIPOSA-2 regimen (amivantamab + chemotherapy)
  • Clinical trial participation
Dr. Spira emphasizes that clinical trials remain "first and foremost" in consideration, while the choice among approved regimens depends on individual patient factors and preferences.
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