Amivantamab and hyaluronidase-lpuj (Rybrevant Faspro)™

How to Take Amivantamab and Hyaluronidase-lpuj

This medication is given subcutaneously (under the skin in the abdomen). It may be given in combination with other medications or alone. Your dose will depend on your weight. How often you have this medication will depend on what other medications you are getting in your treatment plan.

This medication can cause a reaction that may make you have chills, flushing, shortness of breath, chest discomfort, fever, low blood pressure, nausea, and vomiting. Reactions are common during the first injection, but can happen at any time during treatment. You will also be given medications to take before and after the injection to prevent an injection reaction. These include:

• An oral or IV antihistamine (diphenhydramine/Benedryl).
• An oral of IV corticosteroid (dexamethasone).
• Oral or IV acetaminophen (Tylenol).

Possible Side Effects of Anivantamab and Hyaluronidase-lpuj

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

Nail and Skin Changes

The medication may cause skin and nail changes. These side effects are common and can often be managed by making changes to how you care for your skin and nails.

You may have a rash that looks like acne, but it is not acne and should not be treated with acne products. The rash can be:

• Red, swollen, dry, or crusty.
• Sore or tender.
• Itchy or flaky.
• Your skin may also be very dry and can crack, peel, or feel scaly.

This rash often starts in the first week of treatment, but it can happen at any time.

How to Take Care of Your Skin

• Moisturize your skin at least twice a day with a thick, alcohol-free lotion or cream, especially after bathing.
• Protect your skin from the sun by using sunscreen (SPF 30 or higher), wearing a hat and sunglasses, and avoiding direct sunlight.
• Bathe or shower in lukewarm water (not hot) and gently pat your skin dry.
• Use gentle, fragrance-free soaps, lotions, and laundry products.
• Wear gloves when doing housework, dishes, or gardening.
• Drink plenty of water.
• Try not to scratch your skin.
• Call your provider if you get a rash – they can suggest or prescribe creams or pills to reduce symptoms.
• Call right away if your skin blisters or peels.

This medication may also cause changes to the skin around your fingernails and toenails. This is called paronychia.

You might have:

• Red, swollen, or painful skin around your nails.
• Small cuts or cracks (like paper cuts) near your nails or knuckles.
• Nails that become thick, have ridges, or fall off.

These changes might not go away after treatment, or they may start months after you start treatment.

How to Take Care of Your Nails

• Follow the same skin care tips listed above.
• Don’t bite your nails or cut your cuticles.
• Keep nails clean and dry.
• You can use regular nail polish, but avoid fake nails (like gels, acrylics, or overlays).
• Tell your provider if your nails fall off, become painful, or if you notice any changes or discomfort.

Your provider will prescribe an oral antibiotic to use for the first 12 weeks of treatment. You will then be given an antibiotic lotion for your scalp to use for the next 9 months. You should also wash your hands and feet every day with an antiseptic (4% chlorhexidine) solution.

Joint or Muscle Pain

You may have joint or muscle pain:

• Arthralgia pain is like arthritis pain. It can cause morning stiffness, and you may feel it in your joints at different times during the day. It can also cause pain in your elbows, shoulders, wrists, knees, feet, pelvic and hip bones, or back.
• Myalgia is pain or aching in your muscles.

Your providers can recommend medication and other ways to relieve pain.

Mouth Ulcers

This medication can cause sores or soreness in your mouth and/or throat, called mucositis. Tell your provider if your mouth, tongue, inside of your cheek, or throat becomes white, has ulcers, or is painful. Medications can be used to manage pain. Regular mouth care can help prevent or manage mouth sores. Some things you can do are:

• Brush with a soft-bristle toothbrush or cotton swab twice a day.
• Avoid mouthwashes that contain alcohol. A baking soda and/or salt with warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon of salt in an eight-ounce glass of warm water) can be used a few times each day.
• If your mouth gets dry, eat moist foods, drink plenty of fluids (6 to 8 glasses), and suck on sugarless hard candy.
• Avoid smoking and chewing tobacco, and drinking alcoholic beverages and citrus juices.

Fatigue

Fatigue can cause exhaustion, feeling worn out, and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.

Fluid Retention

Fluid retention happens when your body holds on to too much fluid or is unable to excrete (put out) fluid. You may have swelling throughout your body, bloating of your abdomen (belly) called ascites, and a hard time breathing as fluid builds up in the lining of your lungs (pleural effusion) or around your heart.

Call your provider right away if you have new or worsening swelling, unexpected weight gain, shortness of breath, or have a dry cough.

Nausea and/or Vomiting

Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty, spicy, or acidic foods like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.

Call your provider if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.

Low Platelet Count (Thrombocytopenia)

Platelets are blood cells that help your blood clot. Thrombocytopenia is when your platelet count is lower than normal, and you are at a higher risk of bleeding. Tell your providers if you have any bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If your count gets too low, you may receive platelets from a donor.

• Do not use a razor (an electric razor is fine).
• Do not do activities that can cause injury or bleeding.
• Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) like Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), and others. These can raise the risk of bleeding. Talk to your providers before using over-the-counter medications and supplements during treatment.
• Do not floss or use toothpicks, and use a soft-bristle toothbrush to brush your teeth.

Decreased White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) help your body fight infection. While you have cancer treatment, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:

• Hand washing: both yours and your visitors is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or live with someone with these symptoms).
• When working outside, wear clothes that protect you, like long pants and gloves.
• Do not handle pet waste.
• Keep all cuts and scratches clean.
• Shower or bathe daily.
• Brush your teeth at least twice a day.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your providers before scheduling dental appointments or procedures.
• Ask your providers before you or someone you live with has any vaccines

Low Red Blood Cell Count

Anemia is when your red blood cell count is lower than normal. Red blood cells carry oxygen to the tissues in your body. When your red cell count is low, you may feel tired or weak. Tell your providers if you have shortness of breath, trouble breathing, or pain in your chest. If your count gets too low, you may receive a blood transfusion.

Liver Toxicity

This medication can cause liver toxicity, or liver problems, which your provider may monitor for with blood tests called liver function tests. Symptoms may be:

• Yellowing of your skin or eyes.
• Dark or brown urine.
• Pain in your abdomen (belly).

Tell your provider if you have any of these symptoms.

Electrolyte Changes

This medication can affect the normal levels of fluid and electrolytes (potassium, magnesium, calcium, etc.) in your body. Your providers will use blood tests to make sure these levels aren’t too high or too low.

If your levels become too low, there are certain electrolytes or fluids your provider can give you by IV or that you can take by mouth. Tell your provider before taking any supplements.

Infusion-Related Side Effects

Some people may have a reaction during infusion of this medication. These can be:

• Chills.
• Fever.
• Low blood pressure.
• Nausea.
• Vomiting.

Your provider will monitor you for symptoms of infusion-related reactions. 

Important but Less Common Side Effects

• Lung Inflammation: This medication can cause inflammation (swelling and irritation) of your lungs, called pneumonitis. It can also cause scarring of your lungs, called interstitial lung disease. If you have any new or worsening symptoms, like shortness of breath, cough (with or without mucous), fever, or chest pain, call your provider right away. If you are finding it hard to breathe, call 911 right away.
• Blood clots: This medication can put you at a higher risk for blood clots like deep vein thrombosis (DVT) or pulmonary embolism (PE). Symptoms may be
  • Swelling, redness, or pain in an arm or leg.
  • Sudden shortness of breath.
  • If you have any of these symptoms, call 911.

Reproductive Concerns

There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy.  If you can become pregnant, you will need to use effective birth control for 3 months after the last dose of this medication, even if your menstrual cycle has stopped or changed. You should not breastfeed during treatment and for 3 months after the last dose of this medication.