Severe scalp ulcerations and granulomata during treatment with amivantamab

Abstract

This case series of 9 patients with NSCLC is the first to detail the presentation and treatment of ulcerative scalp lesions associated with amivantamab, a bispecific antibody which targets both epithelial growth factor receptor (EGFR) and mesenchymal-epithelial transition factor (MET). At our institution, 33 % of all patients on amivantamab develop scalp ulcerations, following a classic presentation of papulopustular eruption of the face and trunk (9/9), paronychia (9/9), and oral mucositis (7/9). The scalp lesions began as follicular pustules, progressing to vegetative ulcerative plaques within 23 weeks. Ulcerations were refractory to treatment despite trials of multiple systemic therapies, including prednisone, acitretin, cyclosporine, secukinumab, and oral antibiotics. Prednisone offered the most substantial benefit while topical wound care including dressings and washes such as ketoconazole proprionate, sodium sulfacetamide & sulfur soap, salicylic acid shampoo, and Coloplast®/Duoderm®/Aquacel® dressings provided symptomatic relief. One patient also developed granulomas on her vocal cords. More research on treatment and prevention is needed, as 6/9 patients stopped amivantamab due to their skin toxicities. Meanwhile, oncologists and dermatologists must collaborate to monitor toxicities, prepare patients for the possibility of scalp ulcerations, and provide symptomatic relief whenever possible.