How Bundled Prophylaxis Changes First-Line Amivantamab Use

Wade T. Iams, MD, of Tennessee Oncology, and Luis E. Raez, MD, of Miami Cancer Institute, discuss how COPERNICUS combines once-monthly subcutaneous delivery, enhanced dermatologic prophylaxis, and anticoagulation for first-line amivantamab plus lazertinib in epidermal growth factor receptor–mutated lung cancer. Dr Iams explains that discontinuations with intravenous amivantamab in MARIPOSA were driven mainly by infusion-related reactions, venous thromboembolism, and skin toxicity, and that the COPERNICUS protocol addresses each one. In his experience, subcutaneous delivery nearly eliminates infusion-related reactions, while skin toxicity remains the biggest issue he manages in clinic. Dr Raez sees little reason to use the intravenous formulation today and notes that his center moved patients to subcutaneous delivery once it was approved in the United States. He argues that COPERNICUS reflects everyday practice, and that the MARIPOSA safety profile in the label and educational materials may alarm patients without reflecting what they will experience.