Supporting Patients Through Treatment for Advanced NSCLC
Panelists discuss how dose modifications for ALK inhibitors can significantly improve quality-of-life issues such as brain fog and weight gain while maintaining disease control, emphasizing the importance of multidisciplinary team support, including palliative care from diagnosis.
Dose modification and treatment interruption strategies play crucial roles in maintaining patients on effective ALK inhibitor therapy while optimizing quality of life and treatment tolerability. Clinical guidelines provide clear frameworks for managing grade 2 to 3 toxicities through dose holds until resolution to baseline, followed by either rechallenge at the same dose or dose reduction, depending on toxicity type and severity. For lorlatinib, dose reduction from 100 mg daily to 75 mg daily represents the standard approach for managing recurrent toxicities, with further reductions available if necessary.
Real-world management examples demonstrate the effectiveness of dose modification strategies in improving patient quality of life while maintaining treatment efficacy. Common scenarios requiring dose adjustment include elevated liver enzymes, increased creatinine kinase levels, symptomatic bradycardia with heart rates consistently below 60 beats per minute, and central nervous system toxicities including cognitive impairment or “brain fog” that interferes with daily functioning. Patient anxiety about dose reductions can be addressed through education about the potential for dose reescalation once toxicities resolve and reassurance about maintained efficacy at reduced doses.
The multidisciplinary care team extends beyond the immediate oncology team to include clinical pharmacists for medication interaction monitoring, nurse navigators for appointment coordination and patient support, physical therapists for maintaining functional status, speech therapists for cognitive issues, psychology services for mood and anxiety management, registered dietitians for nutritional optimization, cardiology consultation for cardiovascular toxicity management, and palliative care teams for comprehensive symptom management and quality-of-life optimization. Early palliative care integration from diagnosis provides additional support layers for patients with stage IV lung cancer, addressing not only physical symptoms but also psychosocial needs and care coordination. This comprehensive approach ensures that patients receive holistic support throughout their treatment journey, optimizing both clinical outcomes and quality of life during advanced cancer treatment.
