Mitigating Potential IRRs with Amivantamab: Clinical Insights from the SKIPPirr

The skipper regimen emerged as a proactive approach to reduce the frequency and severity of infusion-related reactions (IRRs) observed with certain antibody treatments. Initially, patients were routinely warned to expect IRRs, which affected about two-thirds of them, and the standard mitigation strategy was simply to slow down the infusion rate. While this helped somewhat, IRRs remained a common and distressing issue for patients and infusion staff. The skipper regimen introduced a prophylactic use of dexamethasone, administered in a specific schedule: 8 mg twice daily starting two days before treatment, continuing the day prior, and again on the morning of infusion. This approach dramatically reduced the incidence of IRRs from approximately 66% down to 22%, significantly improving the patient experience and easing the burden on clinical staff.

Although IRRs with these therapies are generally not life-threatening, they can be very frightening and time-consuming to manage during infusions. The introduction of the skipper regimen has been a major advancement, offering a way to prevent many reactions before they occur rather than only responding to them once they happen. Despite the reduction in frequency, clinicians continue to counsel patients about the possibility of IRRs, emphasizing early recognition and management to ensure safety and comfort. This proactive strategy represents a valuable evolution in clinical practice as familiarity with the drug and its side effects grows, and future developments such as subcutaneous formulations may further decrease these reactions.

In addition to medication protocols, education plays a crucial role in managing IRRs effectively. Infusion nurses are trained to recognize that not all infusion reactions are the same and that many do not require emergency interventions such as epinephrine. Most IRRs resolve without severe consequences when properly managed. The combination of dexamethasone prophylaxis and comprehensive education has transformed the approach to IRRs, making treatments more tolerable and supporting adherence. This regimen highlights how real-world experience and ongoing adaptation can enhance patient care in the context of new therapies.