COPERNICUS Design, Prophylaxis Counseling, and Brain Metastases

Wade T. Iams, MD, of Tennessee Oncology, walks through the design of COPERNICUS, a single-arm US study of subcutaneous amivantamab plus lazertinib in patients with exon 19 deletion or L858R epidermal growth factor receptor mutations. It enrolled at academic and community sites, allowed 1 chemotherapy cycle before molecular results, and gave apixaban for 4 months plus enhanced skin prophylaxis. To support adherence, Dr Iams frames skin toxicity as the key toxicity from the start and enlists advanced practice providers and nurses. Luis E. Raez, MD, of Miami Cancer Institute, relies on about an hour of nurse practitioner teaching rather than a 20-minute visit. On anticoagulation in the 38% of patients with brain metastases, Dr Iams notes that non–small cell lung cancer brain metastases are rarely hemorrhagic, so he is comfortable with prophylactic dosing in most. Dr Raez adds that these agents penetrate the brain well, which may allow radiation to be deferred.