Abstract
Abstract Background Amivantamab is a human antibody targeting epidermal growth factor receptor (EGFR) and c-MET. It is approved in patients with advanced non-small cell lung cancer (NSCLC) with EGFR exon 20 insertion after progression with platinum-based chemotherapy. The most frequent adverse effects (AEs) are rash, infusion-related reactions, paronychia, and peripheral edema. Pneumonitis is a rare side effect, and there is no evidence about the possibility of reintroducing amivantamab after pulmonary toxicity. Clinical case A 56-year-old male was diagnosed with squamous cell lung cancer in 2021, with brain metastasis at diagnosis. The brain lesion was resected, and histopathologic assessment revealed metastasis from squamous cell lung cancer, and an exon 20 insertion mutation was identified. Chemotherapy with immunotherapy (carboplatin + paclitaxel + pembrolizumab) was initiated in October 2021, and progression was observed after three maintenance cycles. Amivantamab was started in May 2022, and partial response was observed after 2 months of treatment. In September 2022, the patient complained of dyspnea on exertion and dry cough. Computed tomography (CT) scan showed scattered ground-glass opacities. A pneumonitis grade 2 CTCAE was assumed, and corticosteroid therapy was started, with improvement in both symptoms and imaging abnormalities. After discussion with a multidisciplinary team, it was decided to restart treatment with amivantamab in January 2023 and there is no evidence of pulmonary toxicity to this date. Conclusion Amivantamab-related pneumonitis is a rare side effect and usually predicts drug discontinuation. In this clinical case, it was possible to reintroduce the drug without reoccurrence of the toxicity successfully. This possibility of reintroducing treatment after non-life-threatening toxicity occurs can be of great importance as therapeutic options for these patients are limited.
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