(amivantamab and hyaluronidase-lpuj)
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Last Updated: 03/30/2026
| IRR | RYBREVANT FASPRO + LAZCLUZE (n=206) | RYBREVANT + 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) |
| Abbreviation: IRR, infusion-related reaction. | ||
| RYBREVANT FASPRO + LAZCLUZE (n=206) | RYBREVANT + LAZCLUZE (n=210) | |
|---|---|---|
| Chills | 6 | 14 |
| Pyrexia | 3 | 3 |
| Dyspnea | 3 | 20 |
| Nausea | 3 | 20 |
| Vomiting | 2 | 15 |
| Cough | 2 | 8 |
| Hypoxia | 2 | 9 |
| Sinus tachycardia | 2 | 5 |
| Hypotension | 1 | 8 |
| Erythema | 1 | 3 |
| Chest discomfort | 0.5 | 6 |
| Hypertension | 0.5 | 6 |
| Flushing | 0 | 12 |
| Dizziness | 0 | 4 |
| Rash | 0 | 3 |
| Hyperhidrosis | 0 | 2 |
| Increased heart rate | 0 | 2 |
| Abbreviation: AE, adverse event. Note: The safety population included all patients who had undergone randomization and received ≥1 dose of any trial treatment. | ||
| Medication | Dose | Route | Approximate Dosing Window Before Amivantamab Administration | Cycle/Day |
|---|---|---|---|---|
| Glucocorticoid | Dexamethasone (10 mg) or methylprednisolone (40 mg) or equivalent | IV | 45-60 mins | C1D1 C1D2 (RYBREVANT only) |
| Oral | At least 60 mins | |||
| Antihistamine | Diphenhydramine (25-50 mg) or chlorphenamine (10 mg) or equivalent | IV | 15-30 mins | All |
| Diphenhydramine (25-50 mg) or equivalent | Oral | 30-60 mins | ||
| Antipyretic | Paracetamol (acetaminophen 650-1000 mg) or equivalent | IV | 15-30 min | All |
| Oral | 30-60 min | |||
| Abbreviations: C1D1, cycle 1 day 1; C2D2, cycle 2 day 2; IV, intravenous.a | ||||
| Medication | Dose | Route | Approximate Dosing Window Before Amivantamab Administration | Cycle/Day |
|---|---|---|---|---|
| Glucocorticoidc | Dexamethasone (10 mg) or methylprednisolone (40 mg) | IV | 45-60 mins | C1D8 and beyond |
| Oral | 60-90 mins | |||
| H2-antagonist | Ranitidine (50 mg) or equivalent | IV | 15-30 mins | Any |
| Antiemetic | Ondansetron (16 mg) or equivalent | IV | 15-30 min | Any |
| Ondansetron (8 mg) or equivalent | Oral | |||
| Abbreviations: C1D1, cycle 1 day 1; C2D2, cycle 2 day 2; C1D8, cycle 1 day 8; H2, histamine type 2 receptor; IV, intravenous.aIf a medication noted in this table is not locally available, a similar medication and dose may be substituted and administered per local guidelines.bPatients for whom suggested medications are contraindicated should explore alternative medications with their study physician. If alternative medications are not suitable for the intent above, patients are not required to take the corresponding medication.cBeginning with C1D8, optional predose steroids may be administered prior to amivantamab if clinically indicated for patients who experienced an IRR on C1D1 or C1D2. | ||||
Optional postdose medications (mentioned in the below table) were prescribed and continued for up to 48 hours after any dose if clinically indicated, at the discretion of the treating physician.15
| Dose | Route | Administration Instructions | Cycle/Day | |
|---|---|---|---|---|
| Glucocorticoid | Dexamethasone (10 mg) or comparable corticosteroid | IV or oral | As clinically indicated | Any |
| Antihistamine | Diphenhydramine (25-50 mg) or equivalent | IV or oral | As clinically indicated | Any |
| Antipyretic | Paracetamol (acetaminophen 650-1,000 mg) | IV or oral | As clinically indicated | Any |
| Opiates | Meperidine (25-100 mg) | IV or oral | As clinically indicated | Any |
| Antiemetic | Ondansetron (8-16 mg) or equivalent | IV | As clinically indicated | Any |
| Ondansetron (8 mg) or equivalent | Oral | |||
| Abbreviation: IV, intravenous.aOptional medications are used prophylactically as clinically indicated. If a medication noted in this table is not locally available, a similar medication and dose may be substituted and administered per local guidelines. | ||||
| IRR Gradinga | Treatment/Intervention | Premedication at Subsequent Dosing |
|---|---|---|
| Grade 1: Mild reaction | Monitor patient as medically indicated until recovery from symptoms. If occurring with initial dose (ie, C1D1 or C1D2), consider early infusion interruption to prevent more severe symptoms. | Antihistamine, antipyretic, and glucocorticoid per Table: Required Predose Medications for RYBREVANT FASPRO or RYBREVANT (All Arms) |
| Grade 2: Moderate reaction; therapy or infusion interrupted but responds promptly to symptomatic treatment | Interrupt infusion, if ongoing: If clinically indicated, start IV fluids; give diphenhydramine 50 mg (or equivalent) IV and/or paracetamol (acetaminophen) 650-1000 mg; consider corticosteroids, bronchodilator therapy and supplemental oxygen; monitor patient closely until recovery from symptoms. First interruption for IRR—restart infusion at 50% of the rate at the time of interruption: If no further evidence of IRR after 30 minutes, the rate may be increased to 100% of the infusion rate at the time of interruption; monitor patient closely. Infusion rate escalation may resume after the infusion has been administered for at least 30 minutes at 100% of the infusion rate used at the time of dose interruption. Second interruption for IRR: Stop and consider discontinuation of further drug treatment at that visit; administer diphenhydramine 50 mg IV or equivalent and monitor patient until resolution of symptoms. If continuing administration after the second interruption, restart infusion at 50% of the rate at the time of the second interruption. If no further evidence of IRR after 30 minutes, the rate may be increased to 100% of the infusion rate at the time of interruption; monitor patient closely. Infusion rate escalation may resume after the infusion has been administered for at least 30 minutes at 100% of the infusion rate used at the time of dose interruption. | Antihistamine, antipyretic, and glucocorticoid per Table: Required Predose Medications for RYBREVANT FASPRO or RYBREVANT (All Arms) Consider meperidine if patient experiences chills and rigors. |
| Grade 3/4 Grade 3: severe reaction, prolonged (ie, not rapidly responsive to symptomatic medication and/or brief interruption of infusion); recurrence of symptoms following initial improvement; hospitalization indicated for other clinical sequelae (eg, renal impairment, pulmonary infiltrates) Grade 4: life-threatening; pressor or ventilator support indicated | Stop infusion, if ongoing: Start IV saline infusion; recommend bronchodilators, supplemental oxygen, epinephrine 0.2-1 mg of a 1:1000 solution for SC administration or 0.1-0.25 mg of a 1:10,000 solution injected slowly for IV administration, and/or diphenhydramine 50 mg IV with methylprednisolone 100 mg IV (or equivalent), as needed (other drugs as appropriate). Patient should be monitored until the treating physician is comfortable that the symptoms will not recur. Physicians should follow their institutional guidelines for the treatment of anaphylaxis. In the case of late-occurring hypersensitivity symptoms (eg, appearance of a localized or generalized pruritus within 1 week after treatment), symptomatic treatment may be given (eg, oral antihistamine, corticosteroid), as appropriate. | Based on severity of symptoms, consider permanent discontinuation of drug. |
| Abbreviations: C1D1, cycle 1 day 1; C2D2, cycle 2 day 2; IRR, infusion-related reaction; IV, intravenous; SC, subcutaneous.aPer National Cancer Institute - Common Terminology Criteria for Adverse Events Version 5.0. | ||
| 1 | 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. |
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