Les renseignements du Formulaire de médicaments s’adressent aux professionnels de la santé. Il ne s’agit pas d’un avis médical. Certains des renseignements, y compris ceux sur le financement des médicaments anticancéreux, ne s’appliquent pas à tous les patients. Les plans de traitement du cancer sont propres à chaque patient. Si vous êtes un patient, veuillez parler avec votre équipe soignante pour comprendre comment ces renseignements s’appliquent à vous.
CRBPPEME+AMIV
Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR). Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.
This Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
First-line treatment of patients with locally advanced (not amenable to curative therapy) or metastatic non-small cell lung cancer (NSCLC) with activating epidermal-growth factor receptor (EGFR) Exon 20 insertion mutations
Cycle 1:*
| pemetrexed | 500 mg /m² | IV | Day 1 |
| CARBOplatin | AUC 5 | IV | Day 1 |
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amivantamab 1 | 350 mg | IV | Day 1 |
| (This drug is not currently publicly funded for this regimen and intent) | |||
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amivantamab 1 | 1050 mg | IV | Day 2 |
| (This drug is not currently publicly funded for this regimen and intent) | |||
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1Use split dosing of 350 mg on day 1 and 1400 mg on day 2, for body weight at baseline ≥ 80 kg.
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amivantamab 2 | 1400 mg | IV | Days 8 and 15 |
| (This drug is not currently publicly funded for this regimen and intent) | |||
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2 Use 1750 mg for baseline body weight at baseline ≥ 80 kg.
Cycle 2:* |
|||
| pemetrexed | 500 mg /m² | IV | Day 1 |
| CARBOplatin | AUC 5 | IV | Day 1 |
|
amivantamab 2 | 1400 mg | IV | Day 1 |
| (This drug is not currently publicly funded for this regimen and intent) | |||
|
2 Use 1750 mg for body weight at baseline ≥ 80 kg.
|
|||
| pemetrexed | 500 mg /m² | IV | Day 1 |
| CARBOplatin | AUC 5 | IV | Day 1 |
|
amivantamab 3 | 1750 mg | IV | Day 1 |
| (This drug is not currently publicly funded for this regimen and intent) | |||
|
3 Use 2100 mg for body weight at baseline ≥ 80 kg. |
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* Administer in the following order: pemetrexed, carboplatin and then amivantamab.
The product monograph recommends administering amivantamab via peripheral line for the first 4 weeks of treatment, to reduce the risk of infusion-related reactions. If peripheral access is limiting, may consider the use of a central line starting after Cycle 1, day 8, if deemed medically acceptable.
REPEAT EVERY 21 DAYS
For up to 4 cycles, followed by pemetrexed and amivantamab maintenance (PEME+AMIV(MNT)).
If chemotherapy is discontinued due to intolerance, amivantamab may be continued in responding patients as single agent maintenance: AMIV(MNT). (Refer to CDA draft recommendation)
Moderate + NK1 antagonist (Carboplatin AUC ≥ 5) (Day 1)
Minimal (Cycle 1 Days 2, 8 and 15)
- Also refer to CCO Antiemetic Recommendations.
Other Supportive Care:
Screen for hepatitis B virus in all cancer patients starting systemic treatment. Refer to the hepatitis B virus screening and management guideline.
Pemetrexed:
- Vitamin B12 1000mcg IM every 9 weeks, Folic acid 0.4 - 1 mg PO daily (both starting ≥ 1 week prior to pemetrexed administration; continue throughout and 3 weeks after last dose of Pemetrexed).
- Dexamethasone 4mg PO BID for 3 days starting day before chemotherapy suggested for rash prophylaxis. (Dexamethasone 4 mg PO BID can be skipped on Cycle 1 Day 1, if patient is administered 20 mg IV dose of dexamethasone with amivantamab.) (Refer to Zhou et al)
- Note: NSAIDs should be held for 2-5 days prior and 2 days after pemetrexed. (Refer to pemetrexed drug monograph)
Amivantamab Pre-medications (prophylaxis for infusion reaction (IR)):
Cycle 1, Days 1 and 2:
- Dexamethasone 20 mg IV (or equivalent) 45-60 minutes pre-infusion on day 1
- Dexamethasone 10 mg IV (or equivalent) 45-60 minutes pre-infusion on day 2
- Acetaminophen 650-1000 mg PO 30-60 minutes pre-infusion on both days
- Diphenhydramine 25-50 mg IV (or equivalent) 15-30 minutes pre-infusion (or PO 30-60 minutes pre-infusion) on both days
Subsequent Doses:
- Acetaminophen 650-1000 mg PO 30-60 minutes pre-infusion
- Diphenhydramine 25-50 mg IV (or equivalent) 15-30 minutes pre-infusion (or PO 30-60 minutes pre-infusion)
- Optional - Dexamethasone 10 mg IV (or equivalent) 45-60 minutes pre-infusion (may be considered for patients who had an IR on Cycle 1, Day 1 or Day 2).
Prescribing information: Amivantamab (Rybrevant). Janssen Biotech Inc. (USA), September 2024.
Product monograph: Amivantamab (Rybrevant). Janssen Inc., June 28, 2024.
Reimbursement recommendation (draft): amivantamab (Rybrevant). Canada's Drug Agency (CDA).
Zhou C, Tang KJ, Cho BC, et al. Amivantamab plus Chemotherapy in NSCLC with EGFR Exon 20 Insertions. N Engl J Med 2023 Nov 30;389(22):2039-51.
January 2025 new ST-QBP regimen
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.