Source: European Medicines Agency (EU) Revision Year: 2022 Publisher: Janssen-Cilag International NV, Turnhoutseweg 30, B-2340 Beerse, Belgium
Rybrevant as monotherapy is indicated for treatment of adult patients with advanced non-small cell lung cancer (NSCLC) with activating epidermal growth factor receptor (EGFR) Exon 20 insertion mutations, after failure of platinum-based therapy.
Treatment with Rybrevant should be initiated and supervised by a physician experienced in the use of anticancer medicinal products.
Rybrevant should be administered by a healthcare professional with access to appropriate medical support to manage infusion-related reactions (IRRs) if they occur.
Before initiation of Rybrevant therapy, EGFR Exon 20 insertion mutation-positive status must be established using a validated test method (see section 5.1).
Premedications should be administered to reduce the risk of IRRs with Rybrevant (see below “Dose modifications” and “Recommended concomitant medicinal products”).
The recommended dose of Rybrevant is provided in Table 1, and the dosing schedule is provided in Table 2 (see below “Infusion rates”).
Table 1. Recommended dose of Rybrevant:
Body weight of patient (at baseline*) | Recommended dose | Number of vials |
---|---|---|
Less than 80 kg | 1,050 mg | 3 |
Greater than or equal to 80 kg | 1,400 mg | 4 |
* Dose adjustments not required for subsequent body weight changes
Table 2. Dosing schedule for Rybrevant:
Weeks | Schedule |
---|---|
Weeks 1 to 4 | Weekly (total of 4 doses) |
Week 5 onwards | Every 2 weeks starting at Week 5 |
It is recommended that patients are treated with Rybrevant until disease progression or unacceptable toxicity.
If a planned dose is missed, the dose should be administered as soon as possible and the dosing schedule should be adjusted accordingly, maintaining the treatment interval.
Dosing should be interrupted for Grade 3 or 4 adverse reactions until the adverse reaction resolves to ≤ Grade 1 or baseline. If an interruption is 7 days or less, restart at the current dose. If an interruption is longer than 7 days, it is recommended restarting at a reduced dose as presented in Table 3. See also specific dose modifications for specific adverse reactions below Table 3.
Table 3. Recommended dose modifications for adverse reactions:
Body weight (at baseline) | Initial dose | 1st dose modification | 2nd dose modification | 3rd dose modification |
---|---|---|---|---|
Less than 80 kg | 1,050 mg | 700 mg | 350 mg | Discontinue Rybrevant |
Greater than or equal to 80 kg | 1,400 mg | 1,050 mg | 700 mg |
Interrupt infusion at the first sign of IRRs. Additional supportive medicinal products (e.g., additional glucocorticoids, antihistamine, antipyretics and antiemetics) should be administered as clinically indicated (see section 4.4).
If the patient develops a Grade 2 skin or nail reaction, supportive care should be initiated; if there is no improvement after 2 weeks, dose reduction should be considered (see Table 3). If the patient develops a Grade 3 skin or nail reaction, supportive care should be initiated, and interruption of Rybrevant should be considered until the adverse reaction improves. Upon recovery of the skin or nail reaction to ≤ Grade 2, Rybrevant should be resumed at a reduced dose. If the patient develops Grade 4 skin reactions (including toxic epidermal necrolysis (TEN)), permanently discontinue Rybrevant (see section 4.4).
If the patient develops interstitial lung disease (ILD) or ILD-like adverse reactions (e.g., pneumonitis), permanently discontinue Rybrevant (see section 4.4).
Prior to infusion (Week 1, Days 1 and 2), antihistamines, antipyretics, and glucocorticoids should be administered to reduce the risk of IRRs (see Table 4). For subsequent doses, antihistamines and antipyretics are required to be administered. Antiemetics should be administered as needed.
Table 4. Dosing schedule of premedications:
Premedication | Dose | Route of administration | Recommended dosing window prior to Rybrevant administration |
---|---|---|---|
Antihistamine* | Diphenhydramine (25 to 50 mg) or equivalent | Intravenous | 15 to 30 minutes |
Oral | 30 to 60 minutes | ||
Antipyretic* | Paracetamol/Acetaminophen (650 to 1,000 mg) | Intravenous | 15 to 30 minutes |
Oral | 30 to 60 minutes | ||
Glucocorticoid‡ | Dexamethasone (10 mg) or Methylprednisolone (40 mg) or equivalent | Intravenous | 45 to 60 minutes |
* Required at all doses.
‡ Required at initial dose (Week 1, Days 1 and 2); optional for subsequent doses.
There is no relevant use of amivantamab in the paediatric population in the treatment of non-small cell lung cancer.
No dose adjustments are necessary (see section 4.8, section 5.1, and section 5.2).
No formal studies of amivantamab in patients with renal impairment have been conducted. Based on population pharmacokinetic (PK) analyses, no dose adjustment is necessary for patients with mild or moderate renal impairment. Caution is required in patients with severe renal impairment as amivantamab has not been studied in this patient population (see section 5.2). If treatment is started, patients should be monitored for adverse reactions with dose modifications per the recommendations above.
No formal studies of amivantamab in patients with hepatic impairment have been conducted. Based on population PK analyses, no dose adjustment is necessary for patients with mild hepatic impairment. Caution is required in patients with moderate or severe hepatic impairment as amivantamab has not been studied in this patient population (see section 5.2). If treatment is started, patients should be monitored for adverse reactions with dose modifications per the recommendations above.
Rybrevant is for intravenous use. It is administered as an intravenous infusion following dilution with sterile 5% glucose solution or sodium chloride 9 mg/mL (0.9%) solution for injection. Rybrevant must be administered with in-line filtration.
For instructions on dilution of the medicinal product before administration, see section 6.6.
Following dilution, the infusion should be administered intravenously at the infusion rates presented in Table 5 below. Due to the frequency of IRRs at the first dose, amivantamab should be infused via a peripheral vein at Week 1 and Week 2; infusion via a central line may be administered for subsequent weeks when the risk of IRR is lower (see section 6.6). It is recommended for the first dose to be prepared as close to administration as possible to maximise the likelihood of completing the infusion in the event of an IRR.
Table 5. Infusion rates for Rybrevant administration:
1,050 mg dose | |||
Week | Dose (per 250 mL bag) | Initial infusion rate | Subsequent infusion rate‡ |
Week 1 (split dose infusion) | |||
Week 1 Day 1 | 350 mg | 50 mL/hr | 75 mL/hr |
Week 1 Day 2 | 700 mg | 50 mL/hr | 75 mL/hr |
Week 2 | 1,050 mg | 85 mL/hr | |
Subsequent weeks* | 1,050 mg | 125 mL/hr | |
1,400 mg dose | |||
Week | Dose (per 250 mL bag) | Initial infusion rate | Subsequent infusion rate‡ |
Week 1 (split dose infusion) | |||
Week 1 Day 1 | 350 mg | 50 mL/hr | 75 mL/hr |
Week 1 Day 2 | 1,050 mg | 35 mL/hr | 50 mL/hr |
Week 2 | 1,400 mg | 65 mL/hr | |
Week 3 | 1,400 mg | 85 mL/hr | |
Subsequent weeks* | 1,400 mg | 125 mL/hr |
* After Week 5, patients are dosed every 2 weeks.
‡ Increase the initial infusion rate to the subsequent infusion rate after 2 hours in the absence of IRRs.
No maximum tolerated dose has been determined in a clinical study in which patients received up to 1,750 mg administered intravenously. There is no known specific antidote for amivantamab overdose. In the event of an overdose, treatment with Rybrevant should be stopped, the patient should be monitored for any signs or symptoms of adverse events and appropriate general supportive measures should be instituted immediately until clinical toxicity has diminished or resolved.
Unopened vial:
24 months.
After dilution:
Chemical and physical in-use stability has been demonstrated for 10 hours at 15°C to 25°C in room light. From a microbiological point of view, unless the method of dilution precludes the risk of microbial contamination, the product should be used immediately. If not used immediately, in-use storage times and conditions are the responsibility of the user.
Store in a refrigerator (2°C to 8°C).
Do not freeze.
Store in the original package in order to protect from light.
For storage conditions after dilution of the medicinal product, see section 6.3.
7 mL concentrate in a Type 1 glass vial with an elastomeric closure and aluminium seal with a flip-off cap containing 350 mg amivantamab. Pack size of 1 vial.
Prepare the solution for intravenous infusion using aseptic technique as follows:
Preparation:
Administration:
This medicinal product is for single use only and any unused medicinal product that is not administered within 10 hours should be disposed of in accordance with local requirements.
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