Amivantamab (Rybrevant®) and lazertinib (Lazcluze®)

Amivantamab (Rybrevant^®) and lazertinib (Lazcluze^®) can be used to treat non-small cell lung cancer (NSCLC) when the cancer cells have a gene change called EGFR (epidermal growth factor receptor). This gene change makes an abnormal form of the EGFR protein, which makes cancer cells grow.

Amivantamab is a type of targeted therapy drug called a bispecific monoclonal antibody. It targets the EGFR gene. Lazertinib is also a targeted therapy drug called a cancer growth inhibitor. It blocks signals from EGFR to the cancer cells and stops them growing. This treatment is used to treat advanced NSCLC.

It is best to read this information with our information about targeted therapies for lung cancer.

Your cancer team will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.

This information is correct at time of publishing. But sometimes the types of cancer this treatment is used for, or treatment side effects, may change between revision dates.

You can talk to your cancer team if you want more detailed information about this treatment. Or visit the electronic Medicines Compendium (eMC) website, which has patient information leaflets (PIL) for individual drugs.

We explain the most common side effects of this treatment here. We also include some that are less common. 

You may get some of the side effects we mention, but you are unlikely to get all of them. And you may have some side effects, including rarer ones, that we have not listed here. 

Other cancer treatments may cause different side effects. If you are also having other cancer treatment, you may have other side effects.

Always tell your doctor, nurse or pharmacist about any side effects you have. They can give you: 

• drugs to help control some side effects 
• advice about managing side effects. 

It is important to take any drugs exactly as explained. This means they will be more likely to work for you.

Some cancer treatments can cause serious side effects. Sometimes, these may be life-threatening. Your doctor, nurse or pharmacist can explain the risk of these side effects to you.

Your doctor, nurse or pharmacist will give you 24-hour contact numbers for the hospital. If you feel unwell or need advice, you can call at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.

These side effects happen to 10 or more people in every 100 people (10% or more) who have this treatment.

You may feel sick during this treatment, but this is usually mild. Your doctor, nurse or pharmacist may prescribe you anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to. If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids.

If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice.

This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:

• Drink at least 2 litres (3½ pints) of fluids each day.
• Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
• Do regular gentle exercise, like going for short walks.

If you have constipation, contact the hospital on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

This treatment can affect your appetite. Don’t worry if you do not eat much for 1 or 2 days. But if your appetite does not come back after a few days, or if you are losing weight, tell your doctor, nurse or pharmacist. They can give you advice. They may give you food or drink supplements. Or they may suggest changes to your diet or eating habits to help.

This treatment may cause a sore mouth and throat. You may also get mouth ulcers. This can make you more likely to get a mouth or throat infection. Use a soft toothbrush to clean your teeth or dentures in the morning, at night and after meals.

Contact the hospital straight away on the 24-hour number, if:

• a sore mouth or throat affects how much you can drink or eat 
• your mouth, tongue, throat or lips have any blisters, ulcers or white patches. 

They can give you advice, and mouthwash or medicines to help with the pain or to treat any infection. Follow their advice and make sure you:

• drink plenty of fluids
• avoid alcohol and tobacco
• avoid food or drinks that irritate your mouth and throat.

Feeling tired is a common side effect of this treatment. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can help you feel less tired.

If you feel sleepy, do not drive or use machinery.

This treatment may cause a high temperature (pyrexia). A high temperature is also a sign of infection. It is important to get any infection treated as soon as possible.

If you have any signs of an infection, tell your doctor, nurse or pharmacist. These signs include:

• a sore throat
• diarrhoea
• needing to pass urine (pee) often, or discomfort when you pass urine.

Contact the hospital straight away on the 24-hour number if you have any of these symptoms:

• a temperature above 37.5°C
• a temperature below 36°C
• you feel unwell, even with a normal temperature.

This treatment can cause difficult skin changes, such as an acne-like itchy rash, dry skin and small, pus-filled spots on the scalp. Because of this, your cancer team will give you skin care advice to reduce the risk of severe skin changes. It is important to follow their advice.

You may be given a pack that includes:

• moisturising cream
• an antiseptic wash
• antibiotics to take to prevent skin infection
• antibiotic creams.

It is important to protect your skin from the sun during treatment and for 2 months after treatment finishes. To protect your skin in the sun:

• use suncream with an SPF (sun protection factor) of 30 or higher
• stay in the shade
• cover up with clothing and a hat.

This treatment may also affect the nerves and cause changes in sensation such as numbness, tingling or pain in your hands or feet

Contact the hospital on the 24-hour number if you notice any skin changes or changes in sensation in your hands or feet.

This treatment can also affect your nails. It may cause infection in the skin around your nails. You will be given information on how to look after your nails to protect them. This will be included in the advice on skin care you are given.

If the skin around your nails becomes sore and swollen, contact the hospital straight away on the 24-hour number.  

Tell your doctor, nurse or pharmacist if your eyes feel sore, red or dry during treatment. They can prescribe eye drops to help.

Sometimes eye problems can be serious. Contact the hospital straight away on the 24-hour number, if you have:

• swelling or pain in the eyes
• eyesight changes
• eyes that are sensitive to light.

Your eyelashes may also grow longer, curlier or turn inwards. Your doctor, nurse or pharmacist can advise you if your eyelashes are irritating your eyes.

This treatment can affect how the liver works. You will have regular blood tests to check this. Sometimes liver changes can be serious. Contact the hospital straight away on the 24-hour number if you have any of these symptoms:

• yellow skin or eyes
• feeling very sleepy
• dark urine (pee)
• unexplained bleeding or bruising
• pain in the right side of your tummy (abdomen).

If you have black or brown skin, changes in your skin colour may be less noticeable. You might first notice the whites of your eyes look yellow, or that the colour of your urine has changed.

You may get pain in your muscles with this treatment. If this happens, tell your doctor, nurse or pharmacist. They can give you painkillers and advice.

If you have muscle pain, try:

• placing a heat pad or covered hot water bottle against the painful area
• taking warm baths
• planning your activities to include regular rests.

This treatment can cause a build-up of fluid in the body. This will slowly get better after treatment ends. Contact the hospital on the 24-hour number if you:

• are gaining weight 
• have swelling in your face, legs or ankles.

They can give you advice and treatment to help.

This treatment can increase the risk of a blood clot. Contact the hospital straight away on the 24-hour number if you have any of these symptoms during or after treatment:

• throbbing pain or swelling in a leg or arm
• reddening of the skin in the area – if you have black or brown skin, this can be harder to notice, but the skin might become darker
• suddenly feeling breathless or coughing.

Always call 999 if you have:

• chest pain
• difficulty breathing.

A blood clot is serious, but it can be treated with drugs called anticoagulants. These thin the blood. You may be given drugs to reduce the risk of getting a blood clot for the first few months of your treatment.

Your doctor, nurse or pharmacist can give you more information about preventing and treating blood clots.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Cancer doctors usually recommend that people with cancer have vaccinations for flu and coronavirus (covid). They may also recommend other vaccines, such as Shingrix^® for shingles. These all help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

You should not have live vaccines if your immune system is weak. This includes if you are having or recently had chemotherapy, radiotherapy or other cancer treatments that affect your immune system. Live vaccines can make you unwell because they contain a very weak version of the illness they protect you against. There are several live vaccines, including the yellow fever vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use 
• how long after treatment you should continue to use contraception. 

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.