First-Line Options in EGFR-Mutated Advanced NSCLC: Selecting and Initiating Subcutaneous Amivantamab Plus Lazertinib With Prophylactic Strategies

Edgardo Santos, MD, FACP, FASCO, of Starling Oncology, and Wade Iams, MD, MSCI, of Tennessee Oncology, work through how they choose among first-line options for EGFR exon 19 deletion and L858R advanced non–small cell lung cancer. Both favor a combination regimen over third-generation tyrosine kinase inhibitor monotherapy, citing the overall survival advantage seen with amivantamab plus lazertinib in MARIPOSA and with platinum-based chemotherapy plus osimertinib in FLAURA2. Dr Santos cites 3-year intracranial progression-free survival of 36% with the combination vs 18% with osimertinib in MARIPOSA as the reason he favors it when brain metastases are present. Dr Iams describes the pragmatic COPERNICUS study, which pairs every-4-week subcutaneous amivantamab with prophylactic anticoagulation and enhanced dermatologic prophylaxis, and reports rash falling from roughly 50% to 60% down to 20% to 30%. Dr Santos details his day 1 order set, and across 2 cases the faculty weigh brain metastases, chronic kidney disease, prior thrombosis, travel distance, and patient preference.