Our Therapies

RYBREVANT® Infusion Therapy

autoimmune condition affecting the eyes and surrounding tissues

About RYBREVANT® Infusion Therapy

RYBREVANT® (amivantamab-vmjw) is a targeted biologic therapy given as an intravenous (IV) infusion. It is a bispecific antibody, which means it attaches to two different targets at once: EGFR, the epidermal growth factor receptor, and MET. Blocking both shuts down the growth signals certain lung cancers depend on, and because it is a low-fucose antibody, it also helps your immune system recognize and attack the tumor cells it binds to.

It helps to know what this therapy is and what it is not. RYBREVANT® is a targeted antibody aimed at two specific proteins on your tumor, not an immunotherapy that releases the brakes on your immune system. Treatment begins only after an FDA-approved test confirms that your tumor carries one of the EGFR mutations this drug is approved to treat.

Your dose is set by your weight at the start of treatment, using two fixed tiers rather than a milligram-per-kilogram calculation. Once your dose is set, it does not change if your weight changes later. Which schedule you follow depends on what RYBREVANT® is paired with:

With lazertinib, or as a single agent: 1,050 mg if you weigh less than 80 kg, or 1,400 mg if you weigh 80 kg or more, given weekly for five doses through week five, no dose in week six, then every two weeks from week seven onward
With carboplatin and pemetrexed: 1,400 mg if you weigh less than 80 kg, or 1,750 mg if you weigh 80 kg or more, given weekly for four doses through week four. After a two-week gap, the dose steps up to 1,750 mg or 2,100 mg every three weeks from week seven onward

Your first dose is split across two consecutive days, 350 mg on day one and the remainder on day two. This is a deliberate safety measure, since infusion reactions are most likely on that first exposure. Plan for two visits that week.

Treatment continues until the disease progresses or side effects become unmanageable. RYBREVANT® does have defined dose reductions, so if you have a difficult reaction your team can often step the dose down rather than stopping treatment outright.

A few medication safety rules guide every infusion:

Premedications are given before every infusion. An antihistamine and acetaminophen each time, with a corticosteroid added for the early doses and started two days before your very first infusion
The first two weeks are given through a peripheral IV line rather than a port, which lowers the risk of an infusion reaction. A central line can be used from week three onward
It is given through an in-line filter, and never infused through the same line as another medication
On chemotherapy days, pemetrexed goes first, carboplatin second, and RYBREVANT® last. If your plan includes lazertinib, that oral dose is taken any time before the infusion
If you are receiving RYBREVANT® with lazertinib, you will also take a preventive blood thinner for the first four months to lower the risk of blood clots

Skin care starts on day one rather than after a rash appears. Expect an oral antibiotic, doxycycline or minocycline, twice daily for the first 12 weeks, then a clindamycin scalp lotion for the following nine months, along with a non-comedogenic moisturizer for your face and body, a daily chlorhexidine wash for your hands and feet, and sun protection during treatment and for two months after your last dose.

One product note: RYBREVANT® is the intravenous formulation. It is not interchangeable with RYBREVANT FASPRO® (amivantamab and hyaluronidase-lpuj), the subcutaneous version, which has its own doses and schedule.

Conditions treated by this therapy

RYBREVANT® is used only when an FDA-approved test confirms that your non-small cell lung cancer (NSCLC) carries a specific EGFR mutation. Testing can be done on tumor tissue or a blood sample, at any point from diagnosis onward, and does not need to be repeated once your mutation status is known. Once that result is in, your care team may consider this therapy for:

First-line treatment of locally advanced or metastatic NSCLC with EGFR exon 19 deletions or exon 21 L858R substitution mutations, in combination with lazertinib
Locally advanced or metastatic NSCLC with EGFR exon 19 deletions or exon 21 L858R substitution mutations that has progressed on or after an EGFR tyrosine kinase inhibitor, in combination with carboplatin and pemetrexed
First-line treatment of locally advanced or metastatic NSCLC with EGFR exon 20 insertion mutations, in combination with carboplatin and pemetrexed
Locally advanced or metastatic NSCLC with EGFR exon 20 insertion mutations that has progressed on or after platinum-based chemotherapy, as a single agent

Your specific mutation determines both the regimen and the schedule. The exon 20 insertion indications and the exon 19 deletion or L858R indications are not interchangeable, so the mutation named on your pathology report matters as much as the diagnosis itself.

RYBREVANT® is approved for adults. Its safety and effectiveness in children have not been established.

Your oncologist will confirm whether RYBREVANT® is right for you before treatment begins.

RYBREVANT® Price

The cost of prescription medications can vary depending on your insurance coverage. If you're concerned about the price of your medication:

Contact your insurance provider to understand your coverage
Ask your doctor or pharmacist about lower-cost alternatives
Check with the drug manufacturer about financial assistance programs
Explore patient assistance options if you're uninsured or underinsured

Remember, many resources exist to help patients access necessary medications. Don't hesitate to ask for help if you're struggling with medication costs. No patient should go without necessary treatment due to financial limitations. If you have questions about financial assistance opportunities, contact a member of our Violet Health team.

What to Expect During RYBREVANT® Infusion Therapy

When you arrive at our Violet Health location, you'll settle into a private, welcoming space designed with your comfort and peace of mind in mind. Infusion reactions are common with RYBREVANT®, especially with that first dose, so our team stays close from start to finish. Before and during your intravenous infusion, our experienced team will:

Review your current health status and any new symptoms, including a new or worsening cough, shortness of breath, chest pain, swelling or pain in one leg, rash or blistering, painful nail beds, mouth sores, or changes in your vision
Check your vital signs
Give your premedications, which include an antihistamine and acetaminophen before every infusion and a corticosteroid on the schedule set for your early doses
Confirm your skin care regimen and your preventive blood thinner, if lazertinib is part of your plan
Place your IV using gentle, practiced technique, using a peripheral vein for your first two weeks of treatment
Administer your RYBREVANT® infusion through a dedicated line with an in-line filter, starting slowly and increasing the rate as you tolerate it
Monitor you closely throughout and afterward for infusion-related reactions, with emergency medications and equipment on hand
Protect your privacy and comfort throughout the visit

Plan for a long first week. Your first dose is split across two consecutive days. Day one usually runs about four to six hours of infusion time, day two about six to eight hours, and visits after that settle to roughly two hours. The rate starts low and steps up after about two hours if you are doing well, which is why the early visits take longer than the later ones.

Order matters on combination days. If you receive carboplatin and pemetrexed, the pemetrexed goes in first, carboplatin second, and RYBREVANT® last. If lazertinib is part of your plan, you take that tablet at home any time before your infusion.

The rhythm changes as you go. Treatment starts weekly, for either four or five doses depending on your regimen, then pauses for a week or two before settling into a steady every-two-week or every-three-week schedule from week seven onward.

RYBREVANT® Side Effects

As with any medication, RYBREVANT® may cause side effects. Being informed helps you know what to watch for and when to contact your healthcare team. Across the clinical trials, the most common reactions were:

Rash, the standout in every study, usually an acne-like eruption on the face, scalp, chest, and back
Nail changes, including redness, tenderness, splitting, and infection around the nail bed
Infusion-related reactions
Mouth sores and mucosal inflammation
Low albumin and swelling in the face, arms, or legs
Fatigue
Dry skin and itching
Nausea, vomiting, and decreased appetite
Constipation or diarrhea
Muscle and bone pain
Cough and shortness of breath
Electrolyte changes, including low magnesium, calcium, sodium, potassium, and phosphate, and changes in liver blood tests

If RYBREVANT® is given with carboplatin and pemetrexed, the chemotherapy adds its own effects, most often low blood counts, hair thinning, and numbness or tingling in the hands and feet. Much of that burden comes from the chemotherapy rather than from RYBREVANT® itself.

Infusion reactions deserve their own note. They occurred in roughly two-thirds of patients in the trials, and almost all of them happened during the very first infusion, typically about an hour in. Fever, chills, flushing, shortness of breath, chest discomfort, nausea, and a drop in blood pressure are the usual signs. Tell us the moment you feel any of them. We pause the infusion, treat the symptoms, and usually restart at half the rate once you are comfortable. This is exactly why the first dose is split across two days and why the first two weeks go through a peripheral line.

RYBREVANT® does not carry a boxed warning, and it does not carry the immune-mediated warnings that come with checkpoint inhibitor therapies. It does have serious risks of its own. Please alert our clinical staff or seek medical attention immediately if you notice any of the following:

Severe infusion reactions or anaphylaxis: trouble breathing, wheezing, throat tightness, chest pain, severe flushing, or feeling faint. Treatment is stopped permanently after a severe allergic reaction
Interstitial lung disease or pneumonitis: a new or worsening cough, shortness of breath, or fever. Treatment is held while this is investigated and stopped permanently if it is confirmed
Blood clots: swelling, pain, or warmth in one leg, sudden shortness of breath, or chest pain. The risk is higher when RYBREVANT® is combined with lazertinib, which is why a preventive blood thinner is given for the first four months of that regimen
Severe skin reactions: widespread rash, blistering, or peeling skin, including rare but serious conditions such as toxic epidermal necrolysis. Report any rash that spreads quickly, blisters, or involves the mouth or eyes
Eye problems: blurred vision, eye pain or redness, dryness, light sensitivity, or corneal changes. Tell your team if you wear contact lenses, since eye symptoms need prompt evaluation
Severe mouth sores: sores that make eating, drinking, or swallowing difficult

Skin and sun care: Skin reactions are the most predictable part of this therapy, which is why prevention starts on day one rather than after a rash appears. Along with the oral antibiotic, scalp lotion, moisturizer, and chlorhexidine hand and foot wash, limit sun exposure, wear protective clothing, and use a broad-spectrum sunscreen during treatment and for two months after your last dose.

Dose changes: Unlike some infused therapies, RYBREVANT® has a defined ladder of dose reductions. If a reaction is difficult, your team can often hold treatment, let you recover, and resume at a lower dose rather than stopping altogether.

Pregnancy and breastfeeding: RYBREVANT® can harm an unborn baby. Your pregnancy status is verified before your first dose. Use effective contraception during treatment and for three months after your last dose, and do not breastfeed during treatment or for three months after your last dose. Tell your care team right away if you become pregnant or think you might be.

RYBREVANT® Infusion Therapy at Violet Health

Your comfort during RYBREVANT® infusion therapy at Violet Health is our priority. Our patients enjoy walk-up parking, complimentary entertainment and snacks, and a team of highly trained providers during each treatment. Plus, Violet Health's evening and weekend hours and convenient city and rural locations make it easier to schedule your appointments.