“Amivantamab, a bispecific monoclonal antibody directed against the epidermal growth factor receptor (EGFR) and mesenchymal–epithelial transition factor (MET), has demonstrated significant clinical activity and is increasingly incorporated into frontline regimens for EGFR-mutant non–small cell lung cancer (NSCLC).”

A new case report was published in Volume 13 of Oncoscience, titled “Erosive pustular dermatosis–like scalp reaction following cranial radiotherapy in a patient with EGFR-mutant NSCLC treated with amivantamab.”

The study was led by first author Vasiliki Nikolaou and corresponding author Ioannis-Alexios Koumprentziotis from the National and Kapodistrian University of Athens Medical School, Athens, Greece.

In this report, the authors describe a rare and previously unrecognised skin toxicity in a patient with EGFR-mutant non–small cell lung cancer undergoing treatment with amivantamab.

The patient developed painful, crusted erosive lesions on the scalp that were confined to a previously irradiated area following cranial radiotherapy.

While amivantamab is already known to cause common dermatologic side effects such as acneiform eruptions and xerosis, this case highlights a distinct presentation resembling erosive pustular dermatosis (EPD), a condition typically associated with chronic skin damage.

Importantly, this reaction appeared only after radiotherapy, suggesting a potential interaction between targeted therapy and radiation-induced tissue injury.

The authors propose that the underlying mechanism may involve impaired wound healing due to dual inhibition of EGFR and MET signalling pathways, which are essential for keratinocyte function and tissue repair.

When combined with radiation-induced inflammation, this disruption may predispose patients to ulcerative scalp lesions.

“This case draws attention to the importance of recognising EPD-like scalp ulcerations as a potential adverse event in patients receiving amivantamab, particularly in the setting of recent or concurrent radiotherapy.”

The patient responded well to topical corticosteroids and supportive care without discontinuing amivantamab, underscoring the importance of early recognition and appropriate management.

The authors emphasise that misdiagnosis of such lesions could lead to unnecessary interruption of effective cancer therapy.

Overall, this case highlights the need for increased awareness of emerging toxicities associated with novel targeted therapies, particularly when used alongside radiotherapy.

Early dermatologic evaluation and proactive management may help maintain treatment continuity while minimising patient discomfort and complications.

Article: Erosive pustular dermatosis–like scalp reaction following cranial radiotherapy in a patient with EGFR-mutant NSCLC treated with amivantamab

Source: Impact Journals LLC