Day 1 Prophylaxis With Subcutaneous Amivantamab Plus Lazertinib

Edgardo Santos, MD, FACP, FASCO, of Starling Oncology, details the orders he places on day 1 for a patient starting subcutaneous amivantamab plus lazertinib for EGFR-mutated advanced non–small cell lung cancer. He tells Wade Iams, MD, MSCI, of Tennessee Oncology, that administration has changed considerably since MARIPOSA, where intravenous dosing was split across 2 days and infusion-related reactions were common. The subcutaneous injection takes about 5 minutes and requires only a single dose of dexamethasone in week 1. He uses prophylactic-dose, not full-dose, oral anticoagulation for the first 4 months to address venous thromboembolism. For the skin toxicity that follows dual EGFR blockade, he uses the COCOON approach: oral doxycycline or minocycline 100 mg twice daily from week 1 through week 12, a ceramide-based moisturizer, and chlorhexidine 4% nail soaks to prevent paronychia, then a scalp lotion from week 13 onward.