- RYBREVANT (amivantamab-vmjw) is a low fucose, fully human IgG1-based bispecific antibody with immune cell-directing activity that targets EGFR mutations and MET mutations and amplifications in NSCLC.1
- Amivantamab for SC administration is a coformulation of amivantamab with rHuPH20.2
- LAZCLUZE (lazertinib) is a third-generation EGFR tyrosine kinase inhibitor.3
PALOMA-3 study
-
PALOMA-3 (NCT05388669) is an ongoing, phase 3, open-label, international, randomized study evaluating the PK, efficacy, and safety of amivantamab SC plus LAZCLUZE (n=206) vs RYBREVANT IV plus LAZCLUZE (n=212) in patients with EGFR-mutated (Exon19del or Exon 21 L858R) locally advanced or metastatic NSCLC with disease progression on or after osimertinib and platinum-based chemotherapy (N=418). The noninferior coprimary PK endpoints were Ctrough and AUCD1-D15.2,4 The key secondary endpoints were ORR and PFS. OS was a predefined exploratory endpoint.2
- The GMRs for Ctrough at predose (C2D1), Ctrough at steady state (C4D1), and C2 AUCD1-D15 for amivantamab SC and IV administration were 1.15 (90% CI, 1.04-1.26), 1.43 (90% CI, 1.27-1.61), and 1.03 (90% CI,0.98-1.09), respectively.2
- ORR was 30% in the amivantamab SC plus LAZCLUZE group and 33% in the RYBREVANT IV plus LAZCLUZE group, and median PFS was 6.1 and 4.3 months, respectively. OS was longer in the amivantamab SC plus LAZCLUZE vs RYBREVANT IV plus LAZCLUZE group (HR for death, 0.62; 95% CI, 0.42-0.92; nominal P=0.02a).2
- Grade ≥3 AEs were reported in 52% of patients in the amivantamab SC plus LAZCLUZE group and 56% of patients in the RYBREVANT IV plus LAZCLUZE group.2
- All-grade IRRs were reported by 13% of patients in the amivantamab SC plus LAZCLUZE group and 66% of patients in the RYBREVANT IV plus LAZCLUZE group. The VTE rate was 9% in the amivantamab SC plus LAZCLUZE group and 14% in the RYBREVANT IV plus LAZCLUZE group.2
- Median administration time was reduced to 4.8 minutes with SC administration from 5 hours (first infusion) with IV administration.2
- Medical resource utilization parameters (patient time in chair, active HCP time, and patient time in treatment room) were lower with amivantamab SC plus LAZCLUZE vs RYBREVANT IV plus LAZCLUZE on C1D1 and C3D1.5
- More patients receiving amivantamab SC plus LAZCLUZE vs RYBREVANT IV plus LAZCLUZE reported feeling unrestricted by administration (C1D1, 66% vs 29%; C3D1, 60% vs 42%), unbothered by administration time (C1D1, 69% vs 30%; C3D1, 71% vs 45%), time was gained for other activities (C1D1, 36% vs 7%; C3D1, 37% vs 6%), and treatment was convenient/very convenient (C1D1, 85% vs 52%; EOT, 85% vs 35%), all with nominal P-values <0.05.5,a
- Patients receiving amivantamab SC reported minimal moderate to very severe injection-site symptoms (pain [C1D1, 14%; C3D1, 16%], swelling [C1D1, 5%; C3D1, 6%], and redness [C1D1, 5%; C3D1, 6%]).5
- Patients receiving amivantamab SC were satisfied (C1D1, 86%; C3D1, 90%), were likely to prefer it over IV (C1D1, 77%; C3D1, 81%), and indicated that they would recommend it to other patients (C1D1, 78%; C3D1, 81%).5
Note: AE, adverse event; AUCD1-D15, area under the concentration-time curve from D1 to D15; C, cycle; CI, confidence interval; Ctrough, trough concentration; D, day; EGFR, epidermal growth factor receptor; EOT, end of treatment; Exon19del, Exon 19 deletion; GMR, geometric mean ratio; HCP, healthcare professional; HR, hazard ratio; IgG1, immunoglobulin G1; IRR, infusion-related reaction; IV, intravenous; MET, mesenchymal-epithelial transition; NSCLC, non-small cell lung cancer; ORR, objective response rate; OS, overall survival; PFS, progression-free survival; PK, pharmacokinetics; rHuPH20, recombinant human hyaluronidase PH20; SC, subcutaneous; VTE, venous thromboembolism.
aThe endpoint was exploratory and not part of hierarchical hypothesis testing. This endpoint was not adjusted for multiple comparisons. Therefore, the P-value displayed is nominal, and statistical significance has not been established.
Overview2,4
PALOMA-3 (NCT05388669) is a phase 3, open-label, international, randomized study designed to assess the PK, efficacy, and safety of amivantamab SC plus LAZCLUZE vs RYBREVANT IV plus LAZCLUZE in patients with EGFR-mutated (Exon19del or Exon 21 L858R) locally advanced or metastatic NSCLC with disease progression on or after osimertinib and platinum-based chemotherapy
Eligibility criteria2,4
Inclusion criteria:
- Age ≥18 years
- Locally advanced or metastatic NSCLC
- Disease progression on or after osimertinib and platinum-based chemotherapy (irrespective of order)
- EGFR Exon19del or Exon 21 L858R
- ≥1 measurable lesion per RECIST v1.1
- ECOG PS 0-1
Exclusion criteria:
- Symptomatic or progressive brain metastasis
- Untreated leptomeningeal disease
- Uncontrolled pain
- Radiation in the past 7 days
- History of ILD
Study design2,4
PK2
| PK endpointa | Amivantamab SC (n=206) |
Amivantamab IV (n=212) |
GMR (90% CI) |
|---|---|---|---|
| Mean Ctrough, μg/mL (% CV) | |||
| C2D1 (predose) | 365 (33) |
314 (32) |
1.15 (1.04-1.26) |
| C4D1 (steady state) | 224 (39) | 162 (42) | 1.43 (1.27-1.61) |
| Mean C2 AUCD1-D15, μg·h/mL (% CV) | 142,236 (31) | 135,552 (24) | 1.03 (0.98-1.09) |
aThe PK population for evaluating the coprimary PK endpoints included all patients who received all doses without dose modifications prior to the respective endpoint and who provided the PK samples necessary to derive each parameter.
Efficacy results2
| Endpoint | Amivantamab SC (n=206) |
RYBREVANT IV (n=212) |
|---|---|---|
| ORR, % (95% CI) | 30 (24-37) |
33 (26-39) |
| Median OS, months (95% CI) | 12.9 (12.9-NE) |
NE (10.2-NE) |
| Median PFS, months (95% CI) | 6.1 (4.3-8.1) |
4.3 (4.1-5.7) |
- OS was longer in the amivantamab SC plus LAZCLUZE vs RYBREVANT IV plus LAZCLUZE group (HR for death, 0.62; 95% CI, 0.42-0.92; nominal P=0.02a).
Safety results2
- Grade ≥3 AEs were reported in 52% of patients in the amivantamab SC plus LAZCLUZE group and 56% of patients in the RYBREVANT IV plus LAZCLUZE group.
- All-grade IRRs were reported by 13% of patients in the amivantamab SC plus LAZCLUZE group and 66% of patients in the RYBREVANT IV plus LAZCLUZE group.
- The VTE rate was 9% in the amivantamab SC plus LAZCLUZE group and 14% in the RYBREVANT IV plus LAZCLUZE group.
Note: % CV, % coefficient of variation; AE, adverse event; AUCD1-D15, area under the concentration-time curve from D1 to D15; C, cycle; CI, confidence interval; Ctrough, trough concentration; D, day; ECOG PS, Eastern Cooperative Oncology Group performance status; EGFR, epidermal growth factor receptor; Exon19del, Exon 19 deletion; GMR, geometric mean ratio; HR, hazard ratio; ILD, interstitial lung disease; IRR, infusion-related reaction; IV, intravenous; NE, not estimable; NSCLC, non-small cell lung cancer; ORR, objective response rate; OS, overall survival; PFS, progression-free survival; PK, pharmacokinetics; PO, orally; Q2W, every 2 weeks; QD, once daily; QW, once a week; RECIST v1.1, Response Evaluation Criteria in Solid Tumors version 1.1; SC, subcutaneous; VTE, venous thromboembolism.
aThe endpoint was exploratory and not part of hierarchical hypothesis testing. This endpoint was not adjusted for multiple comparisons. Therefore, the P-value displayed is nominal, and statistical significance has not been established.
- PALOMA-3 (NCT05388669) is an ongoing phase 3, open-label, international, randomized study designed to assess the PK, efficacy, and safety of amivantamab SC plus LAZCLUZE vs RYBREVANT IV plus LAZCLUZE in patients with EGFR-mutated (Exon19del or Exon 21 L858R) locally advanced or metastatic NSCLC with disease progression on or after osimertinib and platinum-based chemotherapy.2,4
PALOMA-3 study design2,4
PALOMA-3 (ClinicalTrials.gov Identifier: NCT05388669) enrollment period: August 2022 to October 2023; data cutoff date: January 3, 2024.2
aAll patients were required to undergo brain imaging at baseline; subsequent imaging was performed Q6W in patients with baseline brain metastases or as clinically indicated.
bFor calculating the primary and key secondary outcomes, a sample size of 400 patients was estimated to provide >95% power with a 1-sided alpha of 0.05 allocated to each of the coprimary endpoints and 80% power with a 1-sided alpha of 0.025 allocated to ORR. A hierarchical testing approach at a 2-sided alpha of 0.05 was used for the coprimary endpoints (noninferiority), followed by ORR (noninferiority) and PFS (superiority), which used acombined 2-sided alpha of 0.05.
cTwo definitions of the same endpoint were used per regional health authority guidance.
dSC amivantamab was co-formulated with rHuPH20 at a concentration of 160 mg/mL.
eC1 for IV: D1, D2 (D2 applies to IV split dose only [350 mg on D1 and the remainder on D2]), D8, D15, and D22; C1 for SC: D1, D8, D15, and D22; after C1 for all: D1 and D15 (28-day cycles).
f2240 mg if BW ≥80 kg.
g1400 mg if BW ≥80 kg.
- A total of 418 patients were randomized to receive amivantamab SC plus LAZCLUZE (n=206) or RYBREVANT IV plus LAZCLUZE (n=212).2
Patient disposition2
| Disposition, n (%) | Randomized (N=418) | |
|---|---|---|
| Amivantamab SC + LAZCLUZE (n=206) |
RYBREVANT IV + LAZCLUZE (n=212) |
|
| Received treatment | 206 (100) | 210 (99) |
| Treatment ongoinga | 92 (45) | 96 (46) |
| Discontinued treatment | 114 (55) | 114 (54) |
| PD | 85 (41) | 83 (40) |
| AE | 23 (11) | 25 (12) |
| Withdrawal by patient | 4 (2) | 5 (2) |
| Physician decision | 2 (1) | 1 (0.5) |
| aData cutoff date: January 3, 2024. | ||
Demographics and baseline disease characteristics2
| Characteristic | ||
|---|---|---|
| Amivantamab SC + LAZCLUZE (n=206) |
RYBREVANT IV + LAZCLUZE (n=212) |
|
| Median age, years (range) | 61 (35-82) | 62 (29-81) |
| <65 years, n (%) | 133 (65) | 120 (57) |
| ≥65 to <75 years, n (%) | 55 (27) | 70 (33) |
| ≥75 years, n (%) | 18 (9) | 22 (10) |
| Male/female, n (%) | 68 (33)/138 (67) | 71 (33)/141 (67) |
| Median BW, kg (range) | 61.8 (35-130) | 60.1 (33-150) |
| <80 kg/≥80 kg, n (%) | 184 (89)/22 (11) | 184 (87)/28 (13) |
| Race, n (%) | ||
| Asian | 126 (61) | 129 (61) |
| White | 78 (38) | 77 (36) |
| Black or African American | 1 (0.5) | 3 (1) |
| Multiple | 0 | 1 (0.5) |
| Not reported | 1 (0.5) | 2 (0.9) |
| Region, n (%)a | ||
| North America | 19 (9) | 30 (14) |
| South America | 11 (5) | 17 (8) |
| Europe | 38 (18) | 40 (19) |
| Asia | 126 (61) | 120 (57) |
| Oceania | 12 (6) | 5 (2) |
|
aRussia was counted as part of Europe; Turkey and Israel were counted as part of Asia. |
||
Coprimary PK endpoints (Noninferiority)
- The GMRs for Ctrough and C2 AUCD1-D15 were estimated for amivantamab SC and IV administration.2
GMRs for SC vs IV administration2
| PK endpointa | Amivantamab SC (n=206) |
Amivantamab IV (n=212) |
GMR (90% CI) |
|---|---|---|---|
| Mean Ctrough, μg/mL (%CV) | |||
| C2D1 (predose) | 365 (33) | 314 (32) | 1.15 (1.04-1.26) |
| C4D1 (steady state) | 224 (39) | 162 (42) | 1.43 (1.27-1.61) |
| Mean C2 AUCD1-D15, μg·h/mL (% CV) | 142,236 (31) | 135,552 (24) | 1.03 (0.98-1.09) |
|
aThe PK population for evaluating the coprimary PK endpoints included all patients who received all doses without dose modifications prior to the respective endpoint and who provided the PK samples necessary to derive each parameter. |
|||
- Treatment-emergent anti-amivantamab antibodies were reported in 1 (0.6%) patient in the amivantamab SC group and none in the RYBREVANT IV group.2
- Treatment-emergent anti-rHuPH20 antibodies were reported in 15 (8%) patients in the amivantamab SC group.2
- The ORR, best response, and DCR were evaluated for the amivantamab SC plus LAZCLUZE and RYBREVANT IV plus LAZCLUZE groups.2
Key efficacy endpoints2
| Endpointa | Amivantamab SC + LAZCLUZE (n=206) |
RYBREVANT IV + LAZCLUZE (n=212) |
|---|---|---|
| ORR, % (95% CI)b | ||
| All responders | 30 (24-37) | 33 (26-39) |
| RR (95% CI) | 0.92 (0.70-1.23) | |
| Confirmed responders | 27 (21-33) | 27 (21-33) |
| Best response, n (%) | ||
| CRc | 1 (0.5) | 1 (0.5) |
| PRc | 61 (30) | 68 (32) |
| SD | 93 (45) | 81 (38) |
| PD | 37 (18) | 42 (20) |
| NE | 14 (7) | 20 (9) |
| DCR, % (95% CI)d | 75 (69-81) | 71 (64-77) |
| Median TTR, months (range) | 1.5 (1.2-6.9) | 1.5 (1.2-9.9) |
|
aThe efficacy population included all the patients who had undergone randomization. |
||
- Median DOR among confirmed responders was 11.2 months (95% CI, 6.1-NE) in the amivantamab SC plus LAZCLUZE group and 8.3 months (95% CI, 5.4-NE) in the RYBREVANT IV plus LAZCLUZE group.2
- In total, 29% of patients in the amivantamab SC plus LAZCLUZE group and 14% in the RYBREVANT IV plus LAZCLUZE group had a DOR of ≥6 months.
- Median PFS was 6.1 months (95% CI, 4.3-8.1) in the amivantamab SC plus LAZCLUZE group and 4.3 months (95% CI, 4.1-5.7) in the RYBREVANT IV plus LAZCLUZE group (HR, 0.84; 95% CI, 0.64-1.10; P=0.20).2
- The PFS rates in the amivantamab SC plus LAZCLUZE and RYBREVANT IV plus LAZCLUZE groups, respectively, were 50% (95% CI, 43-58) and 42% (95% CI, 35-50) at 6 months and 37% (95% CI, 28-46) and 20% (95% CI, 8-35) at 12 months.
- ORR across predefined subgroups was evaluated for the amivantamab SC plus LAZCLUZE and RYBREVANT IV plus LAZCLUZE groups.2
ORR across predefined subgroups2
| Subgroup | RR (95% CI) | No. of responders/No. of patients (%) | |
|---|---|---|---|
| Amivantamab SC + LAZCLUZE | RYBREVANT IV + LAZCLUZE | ||
| All randomized patients | 0.92 (0.7-1.23) | 62/206 (30) | 69/212 (33) |
| Age | |||
| <65 years | 0.95 (0.63-1.43) | 35/133 (26) | 38/120 (32) |
| ≥65 years | 0.9 (0.56-1.44) | 27/73 (37) | 31/92 (34) |
| <75 years | 0.93 (0.69-1.26) | 57/188 (30) | 63/190 (33) |
| ≥75 years | 0.86 (0.28-2.61) | 5/18 (28) | 6/22 (27) |
| Sex | |||
| Female | 0.87 (0.61-1.24) | 43/138 (31) | 51/141 (36) |
| Male | 1.09 (0.59-1.99) | 19/68 (28) | 18/71 (25) |
| Race | |||
| Asian | 0.81 (0.54-1.19) | 36/126 (29) | 46/129 (36) |
| Non-Asian | 1.16 (0.69-1.96) | 26/79 (33) | 23/81 (28) |
| BW | |||
| <80 kg | 0.89 (0.65-1.22) | 53/184 (29) | 61/184 (33) |
| ≥80 kg | 1.16 (0.47-2.86) | 9/22 (41) | 8/28 (29) |
| ECOG PS | |||
| 0 | 0.98 (0.54-1.76) | 19/58 (33) | 20/61 (33) |
| 1 | 0.9 (0.63-1.29) | 43/148 (29) | 49/151 (32) |
| History of smoking | |||
| Yes | 1.18 (0.68-2.08) | 23/65 (35) | 20/67 (30) |
| No | 0.82 (0.56-1.19) | 39/141 (28) | 49/145 (34) |
| EGFR mutation | |||
| Exon19del | 0.75 (0.51-1.11) | 35/135 (26) | 48/138 (35) |
| Exon 21 L858R | 1.32 (0.78-2.25) | 27/71 (38) | 21/74 (28) |
| History of brain metastases | |||
| Yes | 1.07 (0.63-1.83) | 24/71 (34) | 23/73 (32) |
| No | 0.85 (0.58-1.25) | 38/135 (28) | 46/139 (33) |
| Last therapy | |||
| Osimertinib | 0.81 (0.48-1.36) | 22/91 (24) | 28/96 (29) |
| Chemotherapy | 1 (0.68-1.45) | 40/115 (35) | 41/116 (35) |
- Median OS was 12.9 months (95% CI, 12.9-NE) in the amivantamab SC plus LAZCLUZE group and NE (95% CI, 10.2-NE) in the RYBREVANT IV plus LAZCLUZE group (HR, 0.62; 95% CI, 0.42-0.92; nominal P=0.02a; endpoint was exploratory and not part of hierarchical hypothesis testing).2
- The OS rates in the amivantamab SC plus LAZCLUZE and RYBREVANT IV plus LAZCLUZE groups, respectively, were 85% (95% CI, 79-89) and 75% (95% CI, 68-80) at 6 months and 65% (95% CI, 52-74) and 51% (95% CI, 37-64) at 12 months.
aThe endpoint was exploratory and not part of hierarchical hypothesis testing. This endpoint was not adjusted for multiple comparisons. Therefore, the P-value displayed is nominal, and statistical significance has not been established.
- At a median follow-up of 7 months (range, 0.1-14.4), median treatment duration was 4.7 months (range, 0.1-13.2) in the amivantamab SC plus LAZCLUZE group and 4.1 months (range, 0-13.2) in the RYBREVANT IV plus LAZCLUZE group. The incidence of AEs reported across both groups was consistent with previous reports of RYBREVANT IV plus LAZCLUZE.2
Safety summary2
| AE, n (%) | Amivantamab SC + LAZCLUZE (n=206) |
RYBREVANT IV + LAZCLUZE (n=210) |
|---|---|---|
| Any AEs | 204 (99) | 209 (99) |
| Grade ≥3 AEs | 107 (52) | 118 (56) |
| Serious AEs | 59 (29) | 64 (30) |
| AEs leading to death | 7 (3) | 10 (5) |
| Any AE leading to | ||
| Interruptions of any agenta | 127 (62) | 127 (60) |
| Reductions of any agent | 63 (31) | 52 (25) |
| Discontinuations of any agent | 26 (13) | 29 (14) |
|
aExcluding infusion/administration-related reactions. |
||
- Median time to treatment discontinuation was 6.7 months (95% CI, 4.9-8.4) in the amivantamab SC plus LAZCLUZE group and 5.6 months (95% CI, 4.2-6.9) in the RYBREVANT IV plus LAZCLUZE group (HR, 0.86; 95% CI, 0.66-1.12).2
- Treatment-related AEs leading to discontinuation were reported in 9% of patients in the amivantamab SC plus LAZCLUZE group and 12% in the RYBREVANT IV plus LAZCLUZE group.2
- The dose reduction rate was 31% in the amivantamab SC plus LAZCLUZE group and 25% in the RYBREVANT IV plus LAZCLUZE group; the corresponding rates due to grade ≥3 AEs were 3% and 4%, respectively.2
- Rash was the leading cause of dose reductions in the amivantamab SC plus LAZCLUZE and RYBREVANT IV plus LAZCLUZE groups (8% vs 4%), with the similar incidence of all-grade rash (46% vs 43%) and grade ≥3 rash (3% vs 4%) in both groups.2
- Median duration of rash was 31 days in the amivantamab SC plus LAZCLUZE group and 44 days in the RYBREVANT IV plus LAZCLUZE group.2
- The most common grade ≥3 AE was dermatitis acneiform, reported in 9% of patients in the amivantamab SC plus LAZCLUZE group and 6% of patients in the RYBREVANT IV plus LAZCLUZE group.2
AE of special interest: IRR-related events
- All-grade IRRs were reported in 13% of patients in the amivantamab SC plus LAZCLUZE group and 66% of patients in the RYBREVANT IV plus LAZCLUZE group.2
- No grade 4-5 events were reported.
- Most IRRs were reported during C1.
Summary of IRRs2
| Parameters | Amivantamab SC + LAZCLUZE (n=206) |
RYBREVANT IV + LAZCLUZE (n=210) |
|---|---|---|
| All-grade IRRs, % | 13 | 66 |
| Grade ≥3 IRRs, n (%) | 1 (0.5) | 8 (4) |
| IRRs leading to discontinuations, n (%) | 0 | 4 (2) |
- The incidence rates of infusion-related AEs ranged between 0% and 6% in the amivantamab SC plus LAZCLUZE group and 2% and 20% in the RYBREVANT IV plus LAZCLUZE group.2
AE of special interest: VTE2
- The incidence of VTE was 9% in the amivantamab SC plus LAZCLUZE group and 14% in the RYBREVANT IV plus LAZCLUZE group, with pulmonary embolism and deep vein thrombosis being the most common.2
- Among all VTE cases, most occurred in the first 4 months (amivantamab SC plus LAZCLUZE vs RYBREVANT IV plus LAZCLUZE, 74% vs 67%).
- VTE was reported in 10% (32/335) of patients receiving prophylactic anticoagulation and 21% (17/81) of patients not receiving prophylactic anticoagulation.2
AE of special interest: VTE2
| n (%) | Amivantamab SC + LAZCLUZE (n=206) |
RYBREVANT IV + LAZCLUZE (n=210) |
|---|---|---|
| Any VTEa | 19 (9) | 30 (14) |
| Grade 1 | 1 (0.5) | 7 (3) |
| Grade 2 | 16 (8) | 16 (8) |
| Grade 3 | 2 (1) | 6 (3) |
| Grade 4 | 0 | 1 (0.5) |
| Grade 5 | 0 | 0 |
| Any VTE leading to death | 0 | 0 |
| Any VTE leading to discontinuation of any agent | 0 | 2 (1) |
|
aVTE events include pulmonary embolism, deep vein thrombosis, embolism venous, venous thrombosis limb, embolism, thrombosis, subclavian vein thrombosis, superficial vein thrombosis, pulmonary infarction, and venous thrombosis. |
||
- Overall, 80% and 81% of patients in the amivantamab SC plus LAZCLUZE and RYBREVANT IV plus LAZCLUZE groups, respectively, received prophylactic anticoagulation.2
Concomitant anticoagulants2
| Anticoagulant use, n (%) | Amivantamab SC + LAZCLUZE (n=206) |
RYBREVANT IV + LAZCLUZE (n=210) |
|---|---|---|
| Patients with ≥1 concomitant anticoagulant | 164 (80) | 171 (81) |
| Antithrombotic agents | ||
| Direct factor Xa inhibitors | 132 (64) | 143 (68) |
| Rivaroxaban | 89 (43) | 76 (36) |
| Apixaban | 38 (18) | 54 (26) |
| Edoxaban | 7 (3) | 17 (8) |
| Heparin group | 48 (23) | 45 (21) |
| Enoxaparin | 39 (19) | 35 (17) |
| Heparin | 4 (2) | 2 (1) |
| Tinzaparin | 3 (2) | 2 (1) |
| Low molecular weight heparin | 3 (2) | 1 (0.5) |
| Bemiparin | 2 (1) | 3 (1) |
| Nadroparin | 1 (0.5) | 2 (1) |
| Dalteparin | 0 | 1 (0.5) |
| Other antithrombotic agents | 1 (0.5) | 3 (1) |
| Fondaparinux | 1 (0.5) | 3 (1) |
| Direct thrombin inhibitors | 0 | 1 (0.5) |
| Dabigatran | 0 | 1 (0.5) |
| Vitamin K antagonists | 0 | 1 (0.5) |
| Warfarin | 0 | 1 (0.5) |
- At C1D1 (study D1), median administration time was reduced to 4.8 minutes (range, 0-18) with amivantamab SC administration from 5 hours (range, 0.2-9.9) for the first infusion with RYBREVANT IV administration.2
- The mTASQ is a 12-item questionnaire measuring the impact of the mode of treatment administration across 5 domains (physical impact, psychological impact, impact on activities of daily living, convenience, and satisfaction) on a scale of 0 to 100, with higher scores indicative of more positive feelings toward therapy.5
- Mean mTASQ scores on C1D1 and C3D1 (study D57) were higher with amivantamab SC plus LAZCLUZE vs RYBREVANT IV plus LAZCLUZE across all domains, except for physical impact.
Treatment convenience and impact on daily activities2,5,6
| Patient responses to mTASQ,% | Amivantamab SC + LAZCLUZE (n=206) |
RYBREVANT IV + LAZCLUZE (n=210) |
Nominal P-Valuea |
|---|---|---|---|
| C1D1b | n=193 | n=195 | |
| Feeling unrestricted by injection/infusionc | 66 | 29 | <0.001 |
| Feeling unbothered by the time it takes for infusion/injectiond | 69 | 30 | <0.001 |
| Feeling time was gained for other activitiese | 36 | 7 | <0.001 |
| Convenient or very convenientf | 85 | 52 | <0.001 |
| C3D1 | n=146 | n=125 | |
| Feeling unrestricted by injection/infusionc | 60 | 42 | 0.004 |
| Feeling unbothered by the time it takes for infusion/injectiond | 71 | 45 | <0.001 |
| Feeling time was gained for other activitiese | 37 | 6 | <0.001 |
| EOTg | n=61 | n=55 | |
| Convenient or very convenientf | 85 | 35 | <0.001 |
|
aThe endpoint was exploratory and not part of hierarchical hypothesis testing. This endpoint was not adjusted for multiple comparisons. Therefore, the P-value displayed is nominal (obtained via Pearson’s chi-squared test), and statistical significance has not been established. |
|||
- In a subgroup analysis of Asian patients in the PALOMA-3 study, 255 (61%) Asian patients (defined by race) were randomized to receive amivantamab SC plus LAZCLUZE (n=126) or RYBREVANT IV plus LAZCLUZE (n=129).7
Demographics and baseline disease characteristics7
| Characteristic | ||
|---|---|---|
| Amivantamab SC + LAZCLUZE (n=126) |
RYBREVANT IV + LAZCLUZE (n=129) |
|
| Median age, years (range) | 61 (40-82) | 62 (29-81) |
| Female, n (%) | 83 (66) | 89 (69) |
| BW <80 kg, n (%) | 122 (97) | 120 (93) |
| Median prior lines of therapy (range) | 2 (1-5) | 2 (1-4) |
| ECOG PS, n (%) | ||
| 0 | 34 (27) | 32 (25) |
| 1 | 92 (73) | 97 (75) |
| EGFR mutation, n (%) | ||
| Exon19del | 75 (60) | 78 (61) |
| Exon 21 L858R | 51 (41) | 51 (40) |
| History of brain metastasis, n (%) | 39 (31) | 43 (33) |
| History of smoking, n (%) | 34 (27) | 38 (30) |
| Last therapy before randomization, n (%) | ||
| Osimertinib | 62 (49) | 63 (49) |
| Chemotherapy | 64 (51) | 66 (51) |
| Adenocarcinoma histology | 126 (100) | 126 (98) |
- Median administration time among Asian patients was <5 minutes with amivantamab SC and 2-5 hours with RYBREVANT IV, consistent with observations in the overall population.7
- The GMR for Ctrough at C2D1 for amivantamab SC (n=106) and IV (n=92) administration was 1.11 (90% CI, 0.97-1.28).7,a
- The GMR for C2 AUCD1-D15 for amivantamab SC (n=95) and IV (n=87) administration was 1.03 (90% CI, 0.96-1.10).7,a
- The PK exposures were similar between SC and IV amivantamab in Asian patients, consistent with observations in the overall population.7
aThe PK analysis for primary endpoints included all patients who received all doses without dose modification and provided the required PK samples through the final required PK sample relevant to the endpoint.
- At a median follow-up of 6.9 months, the DCR was 80% in the amivantamab SC plus LAZCLUZE group and 73% in the RYBREVANT IV plus LAZCLUZE group.7
- Median DOR was NE in the amivantamab SC plus LAZCLUZE group and 7.1 months in the RYBREVANT IV plus LAZCLUZE group.7
- Median PFS was NE (95% CI, 4.27-NE) in the amivantamab SC plus LAZCLUZE group and 5.59 months (95% CI, 4.17-8.41) in the RYBREVANT IV plus LAZCLUZE group (HR, 0.84; 95% CI, 0.58-1.22; P=0.35).7
- At a median follow-up of 7 months, median OS was NE (95% CI, 12.85-NE) in the amivantamab SC plus LAZCLUZE group and NE (95% CI, 10.64-NE) in the RYBREVANT IV plus LAZCLUZE group (HR, 0.6; 95% CI, 0.33-1.08; P=0.08).7
- The OS rates in the amivantamab SC plus LAZCLUZE and RYBREVANT IV plus LAZCLUZE groups, respectively, were 87% vs 80% at 6 months and 77% vs 61% at 12 months.
- Efficacy results among Asian patients were consistent with results in the overall population.7
- Median treatment duration was 6.8 months (range, 0.5-13.4) in the amivantamab SC plus LAZCLUZE group (n=126) and 7 months (range, 0.4-13.7) in the RYBREVANT IV plus LAZCLUZE group (n=127).7
- The safety profile across both groups was consistent with that observed in the overall population.7
Safety summary7
| TEAEs, n (%) | Amivantamab SC + LAZCLUZE (n=126) |
RYBREVANT IV + LAZCLUZE (n=127) |
|---|---|---|
| Any AEs | 125 (99) | 126 (99) |
| Grade ≥3 AEs | 58 (46) | 67 (53) |
| Serious AEs | 33 (26) | 38 (30) |
| Any AE leading to death | 4 (3) | 4 (3) |
| Any AE leading to | ||
| Interruptions of any agent | 76 (60) | 73 (57) |
| Reductions of any agent | 41 (33) | 32 (25) |
| Discontinuations of any agent | 10 (8) | 14 (11) |
AEs of special interest7
| AEs, n (%) | Amivantamab SC + LAZCLUZE (n=126) |
RYBREVANT IV + LAZCLUZE (n=127) |
|---|---|---|
| Rash | 102 (81) | 102 (80) |
| VTE | 16 (13) | 18 (14) |
| IRRa | 13 (10) | 77 (61) |
| Local administration-related reaction | 13 (10) | 0 |
| Pneumonitis/ILD | 4 (3) | 1 (0.8) |
- All-grade IRRs were reported in 10% of patients in the amivantamab SC plus LAZCLUZE group and 61% of patients in the RYBREVANT IV plus LAZCLUZE group.7
- Grade 3 IRRs were reported in 0.8% of patients in the RYBREVANT IV plus LAZCLUZE group.
- IRRs were mostly grade 1-2, with no grade 4-5 events.
aIRR reported in the amivantamab SC plus LAZCLUZE group was considered as a systemic reaction related to SC administration.
| AE | Adverse event | mTASQ | modified Therapy Administration Satisfaction Questionnaire |
|---|---|---|---|
| ALT | Alanine aminotransferase | NE | Not estimable |
| AST | Aspartate aminotransferase | NSCLC | Non-small cell lung cancer |
| AUCD1-D15 | Area under the concentration-time curve from C2 D1 to D15 | ORR | Objective response rate |
| BW | Body weight | OS | Overall survival |
| C | Cycle | PD | Progressive disease |
| CI | Confidence interval | PFS | Progression-free survival |
| CR | Complete response | PK | Pharmacokinetics |
| Ctrough | Trough concentration | PO | Orally |
| %CV | % Coefficient of variation | PR | Partial response |
| D | Day | PRO | Patient-reported outcome |
| DCR | Disease control rate | QD | Once daily |
| DOR | Duration of response | QW | Once a week |
| ECOG PS | Eastern Cooperative Oncology Group performance status | Q2W | Every 2 weeks |
| EGFR | Epidermal growth factor receptor | Q6W | Every 6 weeks |
| EOT | End of treatment | RECIST v1.1 | Response Evaluation Criteria in Solid Tumors version 1.1 |
| Exon19del | Exon 19 deletion | R | Randomization |
| GMR | Geometric mean ratio | RR | Relative risk |
| HCP | Healthcare professional | rHuPH20 | Recombinant human hyaluronidase PH20 |
| HR | Hazard ratio | SC | Subcutaneous |
| IgG1 | Immunoglobulin G1 | SD | Stable disease |
| ILD | Interstitial lung disease | TEAE | Treatment-emergent AE |
| IRR | Infusion-related reaction | TTR | Time to response |
| IV | Intravenous | VTE | Venous thromboembolism |
| MET | Mesenchymal-epithelial transition |
A literature search of MEDLINE®, Embase®, BIOSIS Previews®, and Derwent Drug File (and/or other resources, including internal/external databases) was conducted on 09 October 2025.
- 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.
- Leighl NB, Akamatsu H, Lim SM, et al. Subcutaneous versus intravenous amivantamab, both in combination with lazertinib, in refractory epidermal growth factor receptor-mutated non-small cell lung cancer: primary results from the phase III PALOMA-3 study. J Clin Oncol. 2024;42(30):3593-3605.
- Cho BC, Felip E, Hayashi H, et al. MARIPOSA: phase 3 study of first-line amivantamab + lazertinib versus osimertinib in EGFR-mutant non-small cell lung cancer. Future Oncol. 2022;18(6):639-647.
- Janssen Research & Development, LLC. A phase 3, open-label, randomized study of lazertinib with subcutaneous amivantamab compared with intravenous amivantamab in patients with EGFR-mutated advanced or metastatic non-small cell lung cancer after progression on osimertinib and chemotherapy. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000- [cited 2025 October 09]. Available from: https://clinicaltrials.gov/study/NCT05388669 NLM Identifier: NCT05388669
- Alexander M, Cheng Y, Lee S-H, et al. Subcutaneous versus intravenous amivantamab, both in combination with lazertinib, in refractory EGFR-mutated non-small cell lung cancer: patient satisfaction and resource utilization results from the PALOMA-3 study. Eur J Cancer. 2025;227:115624.
- Alexander M, Cheng Y, Lee S-H, et al. Supplementary Appendix for: Subcutaneous versus intravenous amivantamab, both in combination with lazertinib, in refractory EGFR-mutated non-small cell lung cancer: patient satisfaction and resource utilization results from the PALOMA-3 study. Eur J Cancer. 2025;227:115624.
- Lee S-H, Akamatsu H, Yang JC, et al. Comparing subcutaneous vs intravenous amivantamab with lazertinib in EGFR-mutated advanced NSCLC: analysis of Asian patients from PALOMA-3. Oral Presentation presented at: European Society for Medical Oncology (ESMO) Asia Congress; December 6-8, 2024; Singapore.