Preparing Patients for Bispecific-Antibody Based First-Line Therapy

Panelists discuss preparing the same patient for amivantamab plus lazertinib as an alternative to chemotherapy-containing first-line therapy in epidermal growth factor receptor (EGFR)-mutated advanced non-small cell lung cancer (NSCLC). The conversation covers the high likelihood of an infusion-related reaction with intravenous dosing, prophylactic dexamethasone before the first exposure, the split first dose requiring visits on consecutive days, and a practice of stopping the infusion and returning the next day rather than rechallenging. Panelists note that the subcutaneous formulation substantially reduces reaction risk and chair time while still requiring post-injection monitoring and the same dermatologic prophylaxis, and that lazertinib requires several months of anticoagulation for venous thromboembolism prevention. The discussion covers follow-up calls after the first treatment, bleeding precautions, adherence to prophylactic antibiotics and skin care when no rash is present, oral care for stomatitis, and the reminder that chemotherapy-free does not mean toxicity-free.