EGFR/MET Bispecific Antibody (Specialist Oncology Drug)

Amivantamab

Brand names: Rybrevant

Adult dose

Dose: Refer to BNF, SmPC, and current SACT protocol

Route: Intravenous infusion

Frequency: As per SACT/MDT guidance

Clinical pearls

Indicated for EGFR exon 20 insertion-mutated locally advanced or metastatic NSCLC after platinum-based chemotherapy
CHRYSALIS trial established activity; PAPILLON trial now investigating first-line use with chemotherapy
NICE TA854 (2023): amivantamab recommended for EGFR exon 20 insertion NSCLC (post-platinum)
Bispecific: targets both EGFR and MET simultaneously — useful for insertion mutations not responsive to classic EGFR TKIs
Skin and nail management (moisturisers, antibiotics for infected paronychia, dose reduction) important for tolerability
Subcutaneous formulation (amivantamab-vmjw) in development

Contraindications

See SmPC for full contraindications
Significant hypersensitivity to amivantamab

Side effects

Infusion-related reactions (common — premedicate, manage rate)
Rash/acneiform dermatitis (EGFR class effect — very common)
Paronychia
Hypoalbuminaemia
Oedema
Interstitial lung disease / pneumonitis
Venous thromboembolism

Interactions

See SmPC — no major pharmacokinetic interactions identified to date
Anticoagulants — monitor given VTE risk

Monitoring

Tumour response per SACT protocol (RECIST)
Skin reaction severity (CTCAE grading)
Infusion reactions during each infusion
Pulmonary symptoms (cough, dyspnoea — ILD)
Albumin levels
VTE surveillance

Reference: BNF; NICE TA854 (Amivantamab for EGFR exon 20 insertion NSCLC, 2023); CHRYSALIS trial (J Clin Oncol 2021); ESMO NSCLC Guidelines; https://bnf.nice.org.uk/drugs/amivantamab/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways