Subcutaneous Amivantamab Allows for Potential Increases in Adherence, Treatment Options: Martin Dietrich, MD, PhD

Martin Dietrich, MD, PhD, a medical oncologist at the Cancer Care Centers of Brevard and an assistant professor at the University of Central Florida, spoke about how subcutaneous amivantamab stacks up when compared with other forms of treatment for non–small cell lung cancer (NSCLC) and how the option may help with adherence compared with the intravenous (IV) form of amivantamab.

This transcript has been lightly edited for clarity; captions are auto-generated.

Transcript

What are the pros and cons of using subcutaneous amivantamab compared with other treatments for NSCLC?

Subcutaneous formulations have a number of advantages for us. I think the predominant one in the case of amivantamab is the significant reduction of infusion-related reactions. We're seeing that these are less common and less severe than they are with the [IV] application. Again, it's always a trade-off. We want the immunogenic activation of the antibody, but we want to do so safely and without necessarily spending a lot of time. Currently with the [IV] application, we experience infusion-related reactions in the majority of patients, if not all the patients, at least to some extent. And I think it's partly baked into the mechanism of action of an immunogenic antibody.

For the subcutaneous one, again, the slower onset of absorption is going to make a difference with regard to the safety, how we give it, the convenience for the patients, the speed with which the infusion and areas can turn over patients and treat patients for treatment, and it allows for a maintenance phase treatment that is certainly much less involved than it was before. Going forward, if I have both options available, I believe the subcutaneous version is going to take the lead for virtually every patient. When we look at patient preferences between IV and subcutaneous application, we actually find that the vast majority of patients prefer the subcutaneous application. It saves you from having an IV placed, and we don't require a central venous access for treatment. We do have a significant advantage there from a patient preference perspective. And so I believe the subcutaneous one will be the formulation that's going to be used going forward in the vast majority of patients.

How will the option of subcutaneous amivantamab affect adherence to treatment?

We have to go back and ask ourselves, why do we actually use the subcutaneous formulation or the [IV] formulation of amivantamab? I think it's important to go back and look at the efficacy and what it can do in patients that have EGFR receptor mutations. We're seeing, and this was just published, actually this week in the New England Journal of Medicine, this significant overall survival improvement, with both a median improvement in survival as well as a significant improvement in the landmarks at 4 and projected at 5 years and beyond. It does help us really frame and contextualize this as an enhancement of the standard of care. With the third-generation EGFR [tyrosine kinase inhibitors] in the backbone, we're adding an additional medication to make these responses more durable. And this allows us, obviously, a number of options.

But if you think about those years, and while we want to strive for as long as possible, having to come in for an additional treatment is definitely a challenge when you think about that you have to do this potentially for many, many years. Thereby, making it as easy as possible really facilitates for patients the ability to access this medication as quickly and as conveniently as possible. It's a major factor. We want to take as little time away from patients as possible through our treatments. We do believe that the ratio of gain and overall survival and the subcutaneous application in the maintenance setting of amivantamab are definitely in a favorable ratio. My preference would be to look at this as an opportunity to deliver a drug that has proven efficacy and a well-established safety profile to enhance its applicability across the board and make the initiation of treatment and the maintenance of treatment faster, easier, and safer.