Subcutaneous Amivantamab and Q4W Dosing for First-Line EGFR-Mutant NSCLC

Dr. Rodriguez turns to treatment burden, a central concern for Mr. Smith, who cannot drive because of seizure precautions, lives 45 minutes from clinic, and has a wife who works part-time. She describes the subcutaneous (SC) formulation of amivantamab and how it changes the administration schedule: dosing is approximately 5 minutes versus up to 4 to 5 hours for intravenous (IV) chemotherapy, and the maintenance interval moves from every 2 weeks to every 4 weeks (Q4W). Patients still come weekly during cycle 1, with maintenance visits less frequent thereafter.

By contrast, osimertinib plus chemotherapy under FLAURA2 requires infusion-center visits every 3 weeks, with approximately 4 hours in the chair for the first 4 cycles and continued pemetrexed maintenance every 3 weeks thereafter as long as the patient can tolerate it. For Mr. Smith’s logistics, this is a heavier long-term schedule than SC amivantamab plus lazertinib.

PALOMA-3 demonstrated noninferior pharmacokinetics for SC versus IV amivantamab, including comparable activity in the brain, and an approximately 80% reduction in administration-related reactions (13% with SC versus 66% with IV). Dr. Rodriguez notes that her cancer center has fully transitioned to the SC formulation and that this is currently the only subcutaneous combination regimen available for first-line treatment in EGFR-positive metastatic NSCLC. For Mr. Smith specifically, fewer clinic visits, shorter time on-site, and the side-effect profile she has described aligned with the priorities he and his wife stated.

In the next episode, “Evolving Treatment Landscape and Future Directions n First-Line EGFR-Mutant NSCLC,” Dr. Rodriguez closes the case by considering how the first-line decision shapes later-line options and what is on the horizon.