Moik Florian, Absenger Gudrun, Wurm Robert, Hochmair Maximilian J, Ay Cihan
Department of Internal Medicine, Division of Oncology, Medical University of Graz, 8036 Graz, Austria.
Department of Medicine I, Division of Haematology & Haemostaseology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Cancers (Basel). 2025 Jan 14;17(2):259. doi: 10.3390/cancers17020259.
Improved efficacy has been shown for amivantamab and amivantamab-based combination therapies in patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) compared to established treatment options in clinical trials. However, a high risk of venous thromboembolism (VTE) was observed in patients treated with amivantamab-based therapies, with considerable differences in VTE risk according to the line of systemic treatment, concomitant treatment with lazertinib, and intravenous vs. subcutaneous amivantamab administration. Based on early reports of high VTE rates, prophylactic anticoagulation has been implemented in ongoing clinical trials for the first 4 months of amivantamab-lazertinib therapy. However, open questions remain concerning the type, dosing, and duration of primary pharmacological thromboprophylaxis in patients treated with amivantamab-based therapies. Therefore, the aim of this clinical opinion piece is to provide provisional guidance on how to mitigate VTE risk in patients treated with amivantamab-based therapies following existing clinical practice guidelines on primary thromboprophylaxis and treatment of VTE in ambulatory patients with cancer.
与临床试验中的既定治疗方案相比，在表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者中，已显示出阿米万他单抗及基于阿米万他单抗的联合疗法具有更高的疗效。然而，接受基于阿米万他单抗的疗法的患者中观察到静脉血栓栓塞（VTE）的高风险，根据全身治疗线、与拉泽替尼的联合治疗以及阿米万他单抗静脉给药与皮下给药，VTE风险存在显著差异。基于早期高VTE发生率的报告，在正在进行的临床试验中，已在阿米万他单抗-拉泽替尼治疗的前4个月实施预防性抗凝。然而，对于接受基于阿米万他单抗的疗法的患者，初级药理学血栓预防的类型、剂量和持续时间仍存在未解决的问题。因此，本临床观点文章的目的是根据关于门诊癌症患者VTE的初级血栓预防和治疗的现有临床实践指南，就如何降低接受基于阿米万他单抗的疗法的患者的VTE风险提供临时指导。
