Asia-Pacific practical consensus in the management of adverse events related to amivantamab-based therapies in non-small cell lung cancer

Abstract

Amivantamab, an epidermal growth factor receptor (EGFR)-MET bispecific antibody, has demonstrated clinically meaningful benefits for patients with EGFR-mutated advanced non-small cell lung cancer (NSCLC). Consistent with EGFR and MET inhibition, amivantamab-containing regimens are associated with adverse events (AEs) including dermatologic AEs, edema, hypoalbuminemia, venous thromboembolism (VTE), and infusion-related reactions (IRRs). Here we provide practical consensus guidelines developed by a steering committee of 12 clinicians and supported by a literature review of current clinical recommendations, in addition to interviews with representatives of 2 patient advocacy groups, on managing the safety profile of amivantamab-containing regimens for clinicians in the Asia-Pacific (APAC) region. Consensus clinical guidelines recommend prophylactic anticoagulants, minocycline/doxycycline, and moisturizers as key management of common AEs associated with amivantamab, with detailed guidance provided for reactive management across AE grades. Guidance was based on published supportive care strategies for amivantamab and previous evidence on managing EGFR and MET tyrosine kinase inhibitor-related AEs. Prophylactic strategies and reactive treatments were summarized for skin-related AEs, paronychia, mucositis, and stomatitis. Recommendations for preventing and treating MET-related AEs, VTEs, and IRRs were also provided. Multidisciplinary team involvement in early intervention and management of AEs was encouraged. Patient advocacy groups advised clinicians to clearly explain the rationale for prophylactic and reactive treatments and to educate patients on how to appropriately and most efficiently utilize daily supportive care. Appropriate strategies based on these guidelines are encouraged and achievable for APAC clinicians to improve patient care during treatment with amivantamab-containing regimens.