The U.S. Food and Drug Administration (FDA) has granted approval to Rybrevant (amivantamab-vmjw) in combination with Lazcluze (lazertinib) for the first-line treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 L858R substitution mutations, as detected by an FDA-approved test. This approval marks a significant advancement in the treatment landscape for EGFR-mutated NSCLC, providing a chemotherapy-free option with demonstrated superiority over osimertinib.
Clinical Efficacy and Safety
The FDA's decision is supported by data from the Phase 3 MARIPOSA study, a randomized trial involving 1,074 patients. The results, initially presented at the European Society of Medical Oncology (ESMO) 2023 Congress and published in The New England Journal of Medicine, showcased a 30% reduction in the risk of disease progression or death with the Rybrevant plus Lazcluze combination compared to osimertinib (median progression-free survival [PFS]: 23.7 months versus 16.6 months). A secondary endpoint highlighted a nine-month longer median duration of response (DOR) with the combination therapy (25.8 months versus 16.7 months).
Alexander Spira, M.D., Ph.D., FACP, Director, Virginia Cancer Specialists Research Institute, emphasized the clinical benefits observed in the MARIPOSA study, noting that the combination offers a potential new first-line standard of care with significant advantages over osimertinib. This targeted approach aims to optimize patient outcomes while reserving chemotherapy for later stages of treatment.
Addressing Unmet Needs in EGFR-Mutated NSCLC
Lung cancer remains the leading cause of cancer mortality worldwide, with NSCLC accounting for 80-85% of all cases. Among patients with EGFR-mutated NSCLC, a significant proportion do not receive second-line therapy due to disease progression and limited treatment options. The five-year survival rate for advanced EGFR-mutated NSCLC treated with current standard-of-care TKI monotherapy is less than 20%. The Rybrevant plus Lazcluze combination addresses these unmet needs by providing a more effective first-line option that can overcome acquired resistance mechanisms.
Rybrevant and Lazcluze: A Synergistic Approach
Rybrevant is a bispecific antibody targeting EGFR and MET, designed to engage the immune system. Lazcluze is a highly selective, brain-penetrant, third-generation oral EGFR TKI. The combination targets common EGFR mutations directly, offering a multitargeted approach. Jill Feldman, lung cancer survivor and co-founder of the EGFR Resisters, highlighted the importance of this milestone, noting the novel therapeutic approach and the progression-free survival benefits observed in the MARIPOSA study.
Safety Profile and Adverse Events
The safety profile of Rybrevant plus Lazcluze was consistent with the individual treatments. However, venous thromboembolic events (VTE) were observed with the combination, necessitating prophylactic anticoagulation for the first four months of treatment. Common adverse events included rash and nail toxicity. Healthcare providers are advised to monitor patients for signs and symptoms of infusion-related reactions, interstitial lung disease/pneumonitis, dermatologic adverse reactions, and ocular toxicity, and manage them accordingly.
Ongoing Research and Regulatory Milestones
Johnson & Johnson continues to investigate Rybrevant in various clinical trials, including the Phase 3 MARIPOSA-2 study and the Phase 3 PAPILLON study. A Biologics License Application (BLA) for a fixed combination of amivantamab and recombinant human hyaluronidase for subcutaneous administration has been submitted to the FDA and granted Priority Review, potentially offering a more convenient administration route.
Impact on Clinical Practice
The approval of Rybrevant plus Lazcluze is expected to change the treatment paradigm for EGFR-mutated advanced NSCLC. The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for NSCLC already include amivantamab-based regimens as preferred options for certain patient populations, underscoring the growing recognition of their clinical value.
