Prophylaxis, Patient Communication, and Dose Modifications in Practice

Elizabeth Dennis, MSN, APRN, FNP-C, shares how she manages amivantamab plus lazertinib in patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer, starting with prevention on day 1. She begins dermatologic prophylaxis before treatment initiation, discusses venous thromboembolism (VTE) risk and warning signs up front, and explains prophylactic anticoagulation during the first 4 months. Ms. Dennis tells patients she expects side effects and wants to hear about them early, emphasizing that no side effect is too small and that reporting symptoms does not mean treatment is failing. She notes that skin, nail, and VTE-related toxicities tend to occur within the first 4 months and cites a MARIPOSA analysis suggesting dose modifications did not appear to compromise efficacy. She follows prescribing information guidance, uses dose interruptions or reductions when appropriate, and relies on proactive toxicity assessments, patient-reported symptom monitoring, and multidisciplinary collaboration. Her key message for advanced practice providers: proactive management matters just as much as treatment itself.