Treatment Burden and Subcutaneous Amivantamab in EGFR-Mutated Non-Small Cell Lung Cancer

Dr. Leal addresses time toxicity data from Dr. Florez and colleagues comparing the clinic and at-home time burden across EGFR-mutated NSCLC frontline regimens. Both intravenous and subcutaneous amivantamab-lazertinib combinations carried higher time toxicity than osimertinib-chemotherapy or osimertinib monotherapy, driven largely by the prophylactic regimens required for dermatologic prophylaxis education and anticoagulation for thromboembolic risk reduction. She notes that with subcutaneous amivantamab now available, infusion-related burden is substantially reduced, and she actively transitions eligible patients to the subcutaneous formulation to minimize both time burden and administration-related adverse events.

Regarding whether the subcutaneous formulation has shifted her risk-benefit calculus, Dr. Leal confirms it has meaningfully improved clinical workflow in both frontline and second-line settings. The PALOMA-3 trial demonstrated comparable efficacy between subcutaneous and intravenous amivantamab-lazertinib with substantially lower administration-related adverse events and reduced thromboembolic events; an exploratory analysis additionally suggested improved OS with the subcutaneous formulation. Based on this evidence and FDA approval, subcutaneous amivantamab is now her default choice when selecting this combination in either treatment line.

Remaining barriers include ensuring consistent implementation of the COCOON dermatologic prophylaxis protocol, access to prophylactic anticoagulation, and sustained patient follow-up. She emphasizes that proactive, early dose modification rather than reactive management after toxicities reach grade 3 is essential, particularly for dermatologic adverse events, a key lesson from the COPERNICUS trial experience.