How would you approach Grade 2-3 rash due to erlotinib for a patient with metastatic EGFR mutated lung adenocarcinoma that is well controlled for > 5 years and NED by PET?

This is a favorable challenge to approach given the complete response on erlotinib for more than 5 years. In addition to treating the current grade 2-3 rash with a 7-10 day interruption of erlotinib, a short course of oral steroids, and aggressive local skin treatment, I would approach based on several scenarios.

Scenario 1, Erlotinib has been tolerated for years with a recent flare in rash.

After improvement to grade 1 or less, I would resume erlotinib. If the rash recurs, consider dose reduct...