Metastatic non-small cell lung cancer (NSCLC), adenocarcinoma, solid-predominant G3, cT2b cN3 cM1b (UICC IVa), EGFR L858R mutation, first diagnosis 07/2025
- 07/2025: Diagnosis of metastatic NSCLC, with L858R mutation in the EGFR gene, G3-cT2b cN3 cM1b (UICC IVa)
- 07/2025: Surgical wedge resection (R0)
- 08/2025: PET-CT showing right upper lobe primary tumor with intrapulmonary spread and lymph node metastases (hilar, mediastinal, supraclavicular), suspected left adrenal metastasis
- 08/2025: Palliative therapy with pembrolizumab
- 09/2025: Initiation of targeted therapy with amivantamab (EGFR-MET bispecific antibody) and lazertinib
- Under therapy: Development of dermatologic toxicity (EGFR inhibitor-associated)
Dermatologic toxicity under amivantamab presented with papulopustular (acneiform) rash predominantly affecting the face and thorax, accompanied by xerosis, pruritus, and inflammatory scalp involvement. Additional findings included periungual inflammation consistent with early paronychia. Severe cutaneous reactions such as extensive scalp erosion were suspected.
Management included temporary interruption of amivantamab therapy. Topical treatment was initiated with corticosteroid-containing scalp solution (Betagalen® Lotio) and silicone-based wound care (Mepithel®) for affected areas. Axillary involvement was treated with topical pimecrolimus (Elidel® cream). Systemic therapy with doxycycline 200 mg daily was started. In case of insufficient response, escalation to systemic retinoid therapy (acitretin) was planned.
Under this regimen, gradual improvement of inflammatory skin lesions and symptom control was observed.
This case illustrates a clinically significant dermatologic toxicity under amivantamab therapy, consistent with EGFR-targeted treatment effects. It highlights the importance of early recognition, proactive management, and interdisciplinary collaboration to maintain oncologic therapy while minimizing morbidity. Preventive strategies and prompt dermatologic intervention are essential to optimize patient outcomes.
