Mitigation and management of adverse events associated with amivantamab therapy

Amivantamab is a fully human bispecific epidermal growth factor receptor (EGFR)-directed and mesenchymal epithelial transition (MET) receptor-directed antibody. Intravenous amivantamab is approved and recommended by treatment guidelines as a first-line treatment (1L) in combination with lazertinib, as a second-line treatment (2L) in combination with chemotherapy in adults with advanced or metastatic non-small cell lung cancer (NSCLC) with EGFR exon 19 deletions or exon 21 L858R substitution mutations, and as 2L monotherapy or 1L in combination with chemotherapy in adults with advanced or metastatic NSCLC with exon 20 insertion-mutations. Compared with previous therapies, novel treatments such as amivantamab may be associated with distinct and unique adverse reactions that potentially require optimized prevention and management techniques. Commonly reported adverse reactions associated with amivantamab treatment regimens include cutaneous reactions associated with EGFR inhibition, such as rash, paronychia, and pruritus; those associated with MET inhibition, such as peripheral edema and hypoalbuminemia; and general effects, such as infusion-related reactions. Recommendations are summarized from published guidelines and the authors' clinical experience for the prevention and management of adverse reactions associated with amivantamab. An understanding of the expected adverse events with amivantamab regimens, along with the range of prophylactic and management options available, may facilitate maintenance of ongoing treatment in patients deriving clinical benefit and improve patient quality of life on therapy.