How to deal with resistance to evantumumab/Carestream

Amivantamab is mainly used for patients with non-small cell lung cancer with specific EGFR mutations, especially to provide a new treatment option after the failure of previous targeted therapies. However, in the actual medication process, some patients may still develop drug resistance or decrease in efficacy after achieving disease control for a period of time. In the face of evantumumab resistance, clinical management ideas usually emphasize "dynamic assessment" and "layered response" rather than simply discontinuing the drug.

First, the type and cause of drug resistance need to be clarified. Evantumumab is a bispecific antibody that acts on both the EGFR and MET pathways. Resistance does not necessarily mean complete failure of the drug. It may be related to enhanced tumor heterogeneity, activation of bypass signaling pathways, or changes in the tumor microenvironment. Therefore, overseas guidelines generally recommend re-performing molecular testing or liquid biopsy when imaging suggests disease progression to assess whether there are new driver gene changes or changes in the degree of MET amplification. This step is important for subsequent treatment selection.

Secondly, in some patients with "slow progression" or local progression, evantumumab does not have to be stopped immediately. In clinical practice, if the overall disease remains stable and only a few areas progress, it may be considered to continue to use evantumumab in combination with local treatments, such as radiotherapy or ablation therapy. This strategy is widely used in real-world studies overseas and helps extend disease control time.

For patients with confirmed systemic drug resistance, the treatment direction usually shifts to combination regimens or switching to drugs with different mechanisms. For example, combine evantumumab with chemotherapy, or switch to other new generation targeted drugs or antibody drugs after evaluation by professional doctors. In recent years, overseas countries have also explored the possibility of combining evantumumab with other signaling pathway inhibitors in order to overcome the resistance mechanism.

Reference materials:https://www.rybrevant.com/