| Non-Small Cell Lung Carcinoma

Enhertu vs Rybrevant

Side-by-side clinical, coverage, and cost comparison for non-small cell lung carcinoma.

Deep comparison between: Enhertu vs Rybrevant with Prescriber.AI

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Safety signalsRybrevant has a higher rate of injection site reactions vs Enhertu based on FDA-approved prescribing information

Coverage gaps3 major payers require step therapy for Rybrevant but not Enhertu, including UnitedHealthcare

Category

Enhertu

Rybrevant

At A Glance

RouteIV infusion

FrequencyEvery 3 weeks

ClassHER2-directed antibody-drug conjugate with topoisomerase I inhibitor

RouteIntravenous

FrequencyWeekly x 4-5 weeks, then every 2-3 weeks

ClassBispecific EGFR/MET antibody

Indications

Breast Carcinoma
Non-Small Cell Lung Carcinoma
Gastric Adenocarcinoma

Non-Small Cell Lung Carcinoma

Dosing

Breast Carcinoma (HER2-positive, HER2-low, or HER2-ultralow) 5.4 mg/kg IV infusion every 3 weeks until disease progression or unacceptable toxicity

Breast Carcinoma (HER2-positive, first-line with pertuzumab) Cycle 1 Day 1: 5.4 mg/kg IV followed by pertuzumab 840 mg; subsequent cycles: 5.4 mg/kg IV followed by pertuzumab 420 mg every 3 weeks

Non-Small Cell Lung Carcinoma (HER2-mutant) 5.4 mg/kg IV infusion every 3 weeks until disease progression or unacceptable toxicity

Gastric Adenocarcinoma (HER2-positive) 6.4 mg/kg IV infusion every 3 weeks until disease progression or unacceptable toxicity

Non-Small Cell Lung Carcinoma (EGFR Exon 19 Del or L858R, first-line with lazertinib) 1,050 mg (<80 kg) or 1,400 mg (>=80 kg) IV weekly for 5 weeks (Week 1 split over Day 1 and Day 2), then every 2 weeks starting Week 7.

Non-Small Cell Lung Carcinoma (EGFR Exon 19 Del or L858R, post-TKI with chemotherapy) 1,400 mg (<80 kg) or 1,750 mg (>=80 kg) IV weekly for 4 weeks (Week 1 split over Day 1 and Day 2), then 1,750 mg (<80 kg) or 2,100 mg (>=80 kg) every 3 weeks starting Week 7, in combination with carboplatin AUC 5 every 3 weeks for up to 12 weeks and pemetrexed 500 mg/m2 every 3 weeks.

Non-Small Cell Lung Carcinoma (EGFR Exon 20 insertion, first-line with chemotherapy) 1,400 mg (<80 kg) or 1,750 mg (>=80 kg) IV weekly for 4 weeks (Week 1 split over Day 1 and Day 2), then 1,750 mg (<80 kg) or 2,100 mg (>=80 kg) every 3 weeks starting Week 7, in combination with carboplatin AUC 5 every 3 weeks for up to 12 weeks and pemetrexed 500 mg/m2 every 3 weeks.

Non-Small Cell Lung Carcinoma (EGFR Exon 20 insertion, post-platinum as single agent) 1,050 mg (<80 kg) or 1,400 mg (>=80 kg) IV weekly for 5 weeks (Week 1 split over Day 1 and Day 2), then every 2 weeks starting Week 7.

Contraindications

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Drug Interactions

188View drug interactions

162View drug interactions

Adverse Reactions

Most common (>=20%) Decreased white blood cell count, nausea, decreased hemoglobin, decreased neutrophil count, decreased lymphocyte count, fatigue, decreased platelet count, increased aspartate aminotransferase, increased alanine aminotransferase, increased blood alkaline phosphatase, vomiting, alopecia, decreased blood potassium, constipation, musculoskeletal pain, diarrhea, decreased appetite

Serious Interstitial lung disease, pneumonitis, pneumonia, febrile neutropenia, vomiting, nausea, hypokalemia, pulmonary embolism, sepsis

Most common (>=20%) Rash (72-90%), nail toxicity (45-71%), infusion-related reaction (42-64%), fatigue (32-51%), musculoskeletal pain (30-47%), stomatitis (26-43%), edema (27-43%), nausea (21-45%), constipation (23-39%), decreased appetite (24-36%), diarrhea (15-31%), vomiting (12-25%), VTE (36% in combination with lazertinib), paresthesia (35% in combination with lazertinib), hemorrhage (25% in combination with lazertinib), dry skin (25% in combination with lazertinib), pruritus (24% in combination with lazertinib), COVID-19 (21-26%), dyspnea (37% as single agent), cough (17-25%), paronychia (50% as single agent).

Serious Infusion-related reactions including anaphylaxis, interstitial lung disease/pneumonitis, venous thromboembolic events (11% in combination with lazertinib), dermatologic reactions including toxic epidermal necrolysis, ocular toxicity.

Postmarketing Anaphylaxis/anaphylactic reactions.

Pharmacology

Fam-trastuzumab deruxtecan-nxki is a HER2-directed antibody-drug conjugate consisting of a humanized anti-HER2 IgG1 antibody linked to a topoisomerase I inhibitor (DXd). After binding to HER2 on tumor cells, the drug undergoes internalization and lysosomal cleavage, releasing the membrane-permeable DXd that causes DNA damage and apoptotic cell death.

Amivantamab-vmjw is a bispecific antibody that binds EGFR and MET extracellular domains, disrupting ligand binding and receptor degradation, and targeting tumor cells for immune-mediated destruction via ADCC and trogocytosis.

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Most Common Insurance

Anthem BCBS

Enhertu