Shifting From Reactive to Proactive Adverse Event Management

Prophylaxis marks the shift from reacting to adverse events to getting ahead of them, says Amanda Edmond, PA-C, of Banner MD Anderson Cancer Center at Banner Gateway Medical Center, discussing amivantamab plus lazertinib in EGFR-mutated non-small cell lung cancer. In MARIPOSA, no prophylaxis was used and clinicians responded only after problems appeared, while COPERNICUS builds upfront prophylaxis against venous thromboembolism, including pulmonary embolism and deep vein thrombosis, into the protocol alongside skin care prophylaxis for paronychia and rash. Most adverse reactions appear in the first 4 months then taper substantially, a timeline Edmond uses to give patients a light at the end of the tunnel. The regimen includes daily chlorhexidine nail soaks, a ceramide-containing moisturizer, daily sunscreen, twice-daily doxycycline or minocycline, and an anticoagulant, started before cycle 1, day 1. Anticoagulation for the first 4 months brought venous thromboembolism from about 37% in MARIPOSA back toward the 10% baseline in lung cancer.