PAPILLON Overall Survival and Subcutaneous Amivantamab

Pasi A. Jänne, MD, PhD, of Dana-Farber Cancer Institute, reviews the phase 3 PAPILLON trial, which established amivantamab, a bispecific EGFR-MET antibody, plus chemotherapy as first-line standard of care for EGFR exon 20 insertion–mutated non–small cell lung cancer, with a median progression-free survival of 11.4 vs 6.7 months with chemotherapy. Lyudmila Bazhenova, MD, of UC San Diego Moores Cancer Center, gives subcutaneous amivantamab from day 1 with intravenous chemotherapy to reduce chair time and infusion-related reactions. She notes that 76% of patients in the chemotherapy arm crossed over to amivantamab-containing therapy and that overall survival did not differ significantly. Dr Jänne remains enthusiastic, since crossover gave the control arm an active agent and the combination still beats chemotherapy. He adds that subcutaneous dosing reduces infusion reactions but not skin toxicity or paronychia, which stem from EGFR inhibition. Dr Bazhenova argues trials should build in crossover without discounting their survival results.