(lazertinib)
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Last Updated: 10/10/2024
Administer premedications before each RYBREVANT infusion as recommended (Table: Premedications).3
Administer diluted RYBREVANT IV according to the infusion rates in the Table: Infusion Rates for RYBREVANT in Combination with Carboplatin and Pemetrexed and Table: Infusion Rates for RYBREVANT in Combination with Lazertinib or RYBREVANT as a Single Agent, with the initial dose as a split infusion in Week 1 on Day 1 and Day 2.3
Administer RYBREVANT via peripheral line for Week 1 Day 1 and Day 2 and Week 2 to reduce the risk of IRRs.3
When administering RYBREVANT in combination with carboplatin and pemetrexed, infuse pemetrexed first, carboplatin second, and RYBREVANT last.3
When administering RYBREVANT in combination with lazertinib, administer anticoagulant prophylaxis to prevent venous thromboembolic (VTE) events for the first 4 months of treatment.3
Select patients for treatment with RYBREVANT based on the presence of a mutation as detected by a United States (US) Food and Drug Administration (FDA)-approved test (see table below). Information on FDA-approved tests is available at: http://www.fda.gov/CompanionDiagnostics.
Indication | Treatment Regimen | Source for Testing |
---|---|---|
First-line treatment of NSCLC with EGFR Exon19del or Exon 21 L858R substitution mutations | RYBREVANT in combination with lazertinib |
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Previously treated locally advanced or metastatic NSCLC with EGFR Exon19del or Exon 21 L858R substitution mutations (progressive disease on an EGFR tyrosine kinase inhibitor) | RYBREVANT in combination with carboplatin and pemetrexed | |
First-line treatment of NSCLC with EGFR Exon20ins mutations | RYBREVANT in combination with carboplatin and pemetrexed | |
Previously treated NSCLC with EGFR Exon20ins mutations | RYBREVANT as a single agent | |
Abbreviations: EGFR, epidermal growth factor receptor; Exon19del, Exon 19 deletion; Exon20ins, Exon 20 insertion; NSCLC, non-small cell lung cancer. |
The recommended dosages of RYBREVANT, administered in combination with carboplatin and pemetrexed, based on baseline body weight are provided in the table below.3
Body Weight at Baselinea | Recommended Dose | Dosing Schedule |
---|---|---|
<80 kg | 1400 mg |
|
1750 mg |
| |
≥80 kg | 1750 mg |
|
2100 mg |
| |
Abbreviation: Q3W, every 3 weeks. aDose adjustments not required for subsequent body weight changes. |
The recommended order of administration and regimen for RYBREVANT in combination with carboplatin and pemetrexed is provided in the table below.3
Administer the regimen in the following order: pemetrexed first, carboplatin second, and RYBREVANT last. | ||
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Drug | Dose | Duration/Timing of Treatment |
Pemetrexed |
|
|
Carboplatin |
|
|
RYBREVANT |
|
|
Abbreviations: AUC, area under curve; IV, intravenous; PI, Prescribing Information; Q3W, every 3 weeks. |
Body Weight at Baselinea | Recommended Dose | Dosing Schedule |
---|---|---|
<80 kg | 1050 mg |
|
| ||
≥80 kg | 1400 mg |
|
| ||
Abbreviation: Q2W, every 2 weeks. aDose adjustments not required for subsequent body weight changes. |
When given in combination with lazertinib, administer RYBREVANT any time after lazertinib when given on the same day. Refer to the lazertinib Prescribing Information for recommended lazertinib dosing information. Administer RYBREVANT in combination with lazertinib until disease progression or unacceptable toxicity.3
When initiating treatment with RYBREVANT in combination with lazertinib, administer anticoagulant prophylaxis to prevent VTE events for the first 4 months of treatment. If there are no signs or symptoms of VTE events during the first 4 months of treatment, consider discontinuation of anticoagulant prophylaxis at the discretion of the healthcare provider. Refer to the lazertinib Prescribing Information for information about concomitant medications.3
When initiating treatment with RYBREVANT in combination with lazertinib, administer alcohol-free (eg, isopropanol-free, ethanol-free) emollient cream and encourage patients to limit sun exposure during and for 2 months after treatment, to wear protective clothing, and to use broad-spectrum ultraviolet (UV)-A/B sunscreen to reduce the risk of dermatologic ARs. Consider prophylactic measures (eg, use of oral antibiotics) to reduce the risk of dermatologic ARs. Refer to the lazertinib Prescribing Information for information about concomitant medications.3
Prior to the initial infusion of RYBREVANT (Week 1, Day 1 and Day 2), administer premedication as described in the
Glucocorticoid administration is required for Week 1, Day 1 and Day 2 dose only and upon re‑initiation after prolonged dose interruptions, then as necessary for subsequent infusions (see table below). Administer both antihistamine and antipyretic prior to all infusions.3
Medication | Dose | Route of Administration | Dosing Window Prior to RYBREVANT Administration |
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Antihistaminea | Diphenhydramine (25-50 mg) or equivalent | IV | 15-30 minutes |
Oral | 30-60 minutes | ||
Antipyretica | Acetaminophen (650-1000 mg) | IV | 15-30 minutes |
Oral | 30-60 minutes | ||
Glucocorticoidb | Dexamethasone (20 mg) or equivalent | IV | 45-60 minutes |
Glucocorticoidc | Dexamethasone (10 mg) or equivalent | IV | 45-60 minutes |
Abbreviation: IV, intravenous. aRequired at all doses. bRequired at initial dose (Week 1 Day 1). cRequired at second dose (Week 1 Day 2); optional for subsequent doses. |
The recommended RYBREVANT dose reductions for ARs are listed in the
Dosea | 1st | 2nd | 3rd |
---|---|---|---|
1050 mg | 700 mg | 350 mg | Discontinue RYBREVANT |
1400 mg | 1050 mg | 700 mg | |
1750 mg | 1400 mg | 1050 mg | |
2100 mg | 1750 mg | 1400 mg | |
Abbreviation: AR, adverse reaction. aDose at which the AR occurred. |
The recommended RYBREVANT dosage modifications and management for ARs are provided in the table below.3
AR | Severity | Dosage Modifications |
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IRR | Grade 1-2 |
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Grade 3 |
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Grade 4 |
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ILD/pneumonitis | Any grade |
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VTE events | Grade 2 or 3 |
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Dermatologic ARs (including dermatitis acneiform, pruritus, dry skin) | Grade 1 or 2 |
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Grade 3 |
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Grade 4 |
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Severe bullous, blistering or exfoliating skin conditions (including TEN) |
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Other ARs | Grade 3 |
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Grade 4 |
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Abbreviations: AR, adverse reaction; ILD, interstitial lung disease; IRR, infusion-related reaction; TEN, toxic epidermal necrolysis; VTE, venous thromboembolic. |
When administering RYBREVANT in combination with lazertinib, if there is an AR requiring dose reduction after withholding treatment and resolution, reduce the dose of RYBREVANT first. Refer to the lazertinib Prescribing Information for information about dosage modifications for lazertinib.3
When administering RYBREVANT in combination with carboplatin and pemetrexed, modify the dosage of one or more drugs. Withhold or discontinue RYBREVANT as shown in Table: Recommended RYBREVANT Dosage Modifications and Management for ARs. Refer to Prescribing Information for carboplatin and pemetrexed for additional dosage modification information.3
RYBREVANT is available as a 350 mg/7 mL (50 mg/mL) solution in a single-dose vial. Dilute and prepare RYBREVANT for IV infusion before administration.3
Body Weight <80 kg | |||
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Week | Dose (per 250 mL Bag) | Initial Infusion Rate | Subsequent Infusion Ratea |
Week 1 (split dose infusion) | |||
Week 1 Day 1 | 350 mg | 50 mL/hr | 75 mL/hr |
Week 1 Day 2 | 1050 mg | 33 mL/hr | 50 mL/hr |
Week 2 | 1400 mg | 65 mL/hr | |
Week 3 | 1400 mg | 85 mL/hr | |
Week 4 | 1400 mg | 125 mL/hr | |
Weeks 5 and 6 | No dose | ||
Week 7 and Q3W thereafter | 1750 mg | 125 mL/hr | |
Body Weight ≥80 kg | |||
Week | Dose (per 250 mL Bag) | Initial Infusion Rate | Subsequent Infusion Ratea |
Week 1 (split dose infusion) | |||
Week 1 Day 1 | 350 mg | 50 mL/hr | 75 mL/hr |
Week 1 Day 2 | 1400 mg | 25 mL/hr | 50 mL/hr |
Week 2 | 1750 mg | 65 mL/hr | |
Week 3 | 1750 mg | 85 mL/hr | |
Week 4 | 1750 mg | 125 mL/hr | |
Weeks 5 and 6 | No dose | ||
Week 7 and Q3W thereafter | 2100 mg | 125 mL/hr | |
Abbreviation: IRR, infusion-related reaction. aIn the absence of IRRs, increase the initial infusion rate to the subsequent infusion rate after 2 hours based on patient tolerance. Total infusion time is approximately 4-6 hours for Day 1 and 6-8 hours for Day 2. Subsequent infusion time is approximately 2 hours. |
Body Weight <80 kg | |||
---|---|---|---|
Week | Dose (per 250 mL Bag) | Initial Infusion Rate | Subsequent Infusion Ratea |
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 | 1050 mg | 85 mL/hr | |
Week 3 | 1050 mg | 125 mL/hr | |
Week 4 | 1050 mg | 125 mL/hr | |
Week 5 | 1050 mg | 125 mL/hr | |
Week 6 | No dose | ||
Week 7 and Q2W thereafter | 1050 mg | 125 mL/hr | |
Body Weight ≥80 kg | |||
Week | Dose (per 250 mL Bag) | Initial Infusion Rate | Subsequent Infusion Ratea |
Week 1 (split dose infusion) | |||
Week 1 Day 1 | 350 mg | 50 mL/hr | 75 mL/hr |
Week 1 Day 2 | 1050 mg | 35 mL/hr | 50 mL/hr |
Week 2 | 1400 mg | 65 mL/hr | |
Week 3 | 1400 mg | 85 mL/hr | |
Week 4 | 1400 mg | 125 mL/hr | |
Week 5 | 1400 mg | 125 mL/hr | |
Week 6 | No dose | ||
Week 7 and Q2W thereafter | 1400 mg | 125 mL/hr | |
Abbreviation: IRR, infusion-related reaction. aIn the absence of IRRs, increase the initial infusion rate to the subsequent infusion rate after 2 hours based on patient tolerance. Total infusion time is approximately 4-6 hours for Day 1 and 6-8 hours for Day 2. Subsequent infusion time is approximately 2 hours. |
Abbreviations: AUC, area under curve; D, day; Q3W, every 3 weeks.
A literature search of MEDLINE®
1 | Moores SL, Chiu ML, Bushey BS, et al. A novel bispecific antibody targeting EGFR and cMet is effective against EGFR inhibitor-resistant lung tumors. Cancer Res. 2016;76(13):3942-3953. |
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