What to Know About Rybrevant (Amivantamab-vmjw)

A drug used to treat non-small cell lung cancer with the EGFR exon 20 insertion

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Rybrevant is an intravenous (IV) prescription medication used to treat adults who have non-small cell lung cancer (NSCLC) with a specific genetic alteration called an epidermal growth factor receptor (EGFR) exon 20 insertion mutation. Rybrevant is the first fully human, bispecific antibody that works by targeting EGFR and MET receptors, which helps hinder tumor growth.

Lung cancer is the leading cause of cancer-related death worldwide. Non-small cell lung cancer is the most common type of lung cancer, making up about 80%–85% of cases. About 2%–3% of people with NSCLC have an EGFR exon 20 insertion mutation, as detected by a test approved by the Food and Drug administration (FDA). This group of mutations causes rapid cell growth, which enables cancer to spread.

The FDA granted Rybrevant accelerated approval status in May 2021.

Rybrevant

Uses

Rybrevant is FDA-approved to treat adults with NSCLC who have all of the following:

  • The genetic mutation EGFR exon 20 insertion (the third most prevalent activating EGR mutation)
  • Cancer that has spread to other areas of the body (metastasized) or that can’t be surgically removed
  • Disease that has worsened while taking or after taking chemotherapy containing platinum 

EGFR Exon 20 Insertion Mutation

People with NSCLC with this mutation have a worse prognosis and shorter survival rates compared to those with other EGFR mutations.

Before Taking

Before you are able to use Rybrevant, your physician will perform testing to make sure it’s a suitable treatment for you.

If you meet the criteria, your physician may recommend Rybrevant as a first-line treatment for your disease.

Before starting this medication, you need to tell your physician about all prescription, nonprescription, illegal, recreational, herbal, nutritional, or dietary drugs you are taking. Some substances can cause dangerous interactions when taken together.

New Test for Rybrevant Candidates

The FDA also recently approved the Guardant360 CDx liquid biopsy blood test, which can be used as a companion diagnostic tool to determine who would benefit from treatment with Rybrevant.

Precautions and Contraindications

Before starting Rybrevant, tell your physician about all your medical conditions, especially if you have a history of lung or breathing problems.

Rybrevant can harm an unborn baby if taken during pregnancy. Let your physician know if you’re pregnant or plan to become pregnant while using this medication.

It’s not known if Rybrevant can pass through breastmilk. It's recommended to avoid breastfeeding while taking this drug and for at least three months after stopping it.

Pregnancy and Rybrevant

If you’re of childbearing age, your physician will likely suggest that you take a pregnancy test before starting on Rybrevant. Women who could become pregnant should use an effective method of birth control during their treatment and for at least three months after receiving Rybrevant.

Dosage

According to the manufacturer, the recommended dose of Rybrevant, which is based on your body weight, is as follows:

  • If you weigh less than 80 kilograms, or roughly 176 pounds, you should be given 1,050 milligrams, which is three vials.
  • If you weigh 80 kilograms or more, or at least 176 pounds, you should be given 1,400 milligrams, which is four vials.

Modifications

If you develop side effects, your physician may suggest that you slow down or stop your treatment with Rybrevant.

You will be given premedications to help prevent a reaction to Rybrevant. These include:

  • An antihistamine (diphenhydramine)
  • An antipyretic (acetaminophen or ibuprofen)
  • A glucocorticoid (dexamethasone or methylprednisolone)

The antihistamine and antipyretic will be given to you prior to each infusion, while the glucocorticoid is required only during the first week (the doses on days one and two) and as needed for subsequent doses.

Tell your physician how you’re feeling during and after your treatment with this medication.

How to Take

Rybrevant comes as a liquid that’s slowly injected into a vein. This is done by a healthcare provider at a medical facility.

At first, Rybrevant is given once a day for two days in a row. After the first two doses, it’s usually administered once every two weeks.

How long you need to take Rybrevant will depend on your side effects, your response to treatment, and other factors.

A healthcare professional will monitor you while you are being given this medication to make sure you don’t have a serious reaction.

Side Effects

Every medication causes side effects, and Rybrevant is no exception. Your physician can help you understand the risks and benefits of taking this drug.

Common Side Effects

Common side effects of Rybrevant include:

  • Rash
  • Swelling of the feet, ankles, hands, face, or body
  • Sores in your mouth
  • Infected skin around the nails
  • Cough
  • Shortness of breath
  • Muscle and joint pain
  • Constipation
  • Nausea or vomiting
  • Fatigue

Rybrevant and Your Skin

Rybrevant can cause severe skin reactions. As such, you should avoid being in the sun while you're getting treatments and for two months after your last treatment. When you are outdoors, wear protective clothing, sunglasses, and sunscreen with a sun protection factor (SPF) of 30 or higher. You can use an alcohol-free moisturizing cream for dry skin.

Severe

Tell your healthcare provider right away if you experience any severe side effects, such as:

  • Severely dry, itchy, cracking, blistering, or shedding skin
  • Eye pain, vision changes, blurred vision, or sensitivity to light
  • Dry, red, teary, itchy, or painful eyes
  • A new or worsening cough or shortness of breath
  • Chest pain
  • Fever
  • Easy bleeding or bruising
  • Bleeding gums or a bleeding nose
  • Blood in the urine or stool
  • Coughing up blood

Rybrevant and Your Eyes

If you develop eye problems during treatment with Rybrevant, your physician might suggest that you see an ophthalmologist, a medical doctor who treats conditions of the eyes. According to the drug manufacturer, you shouldn’t use contact lenses until your eye symptoms are checked by a professional.

Warnings and Interactions

Rybrevant may cause serious lung problems that can lead to death. Symptoms may be similar to those of lung cancer, so it’s important to tell your physician right away if you notice any new or worsening problems.

This medication should not be used by people with interstitial lung disease.

You will need to be under the care and observation of a healthcare professional while receiving Rybrevant. Your healthcare provider will monitor your symptoms and your response to treatment.

It may be helpful to keep a written list of all the medicines and supplements you are taking and bring it with you to your medical appointments. Your physician may need to change the doses of certain medicines or carefully watch your side effects.

Rybrevant can harm an unborn baby if taken during pregnancy. Take a pregnancy test prior to receiving Rybrevant to confirm you are not pregnant, and avoid becoming pregnant during your treatment.

A Word From Verywell

If you have non-small cell lung cancer with the EGFR exon 20 insertion mutation and you think you might benefit from taking Rybrevant, talk to your physician. You can discuss the benefits and risks of receiving Rybrevant and if it will help treat your specific case of NSCLC.

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. U.S. Food and Drug Administration. FDA Approves First Targeted Therapy for Subset of Non-Small Cell Lung Cancer. Updated May 21, 2021.

  3. Oxnard GR, Lo PC, Nishino M, et al. Natural history and molecular characteristics of lung cancers harboring EGFR exon 20 insertionsJ Thorac Oncol. 2013;8(2):179-184. doi:10.1097/JTO.0b013e3182779d18

  4. FDA Prescribing Information. Rybrevant. Updated July, 2021.

  5. MedlinePlus. Amivantamab-vmjw injection. Updated: July 15, 2021.