Keytruda (pembrolizumab) vs Rybrevant (amivantamab-vmjw)

Keytruda (pembrolizumab) is an immune checkpoint inhibitor that works by blocking the PD-1 pathway, thereby enhancing the body's immune response against cancer cells, and is widely used for various types of cancer, including melanoma, lung cancer, and head and neck cancer. Rybrevant (amivantamab-vmjw), on the other hand, is a bispecific antibody that targets both EGFR and MET receptors and is specifically approved for the treatment of non-small cell lung cancer (NSCLC) with EGFR exon 20 insertion mutations after failure of platinum-based therapy. The choice between Keytruda and Rybrevant would depend on the specific type of cancer, its molecular profile, the patient's previous treatments, and overall health status, and should be made in consultation with an oncologist who can evaluate the suitability of each medication based on the patient's individual case.

Difference between Keytruda and Rybrevant

Metric	Keytruda (pembrolizumab)	Rybrevant (amivantamab-vmjw)
Generic name	Pembrolizumab	Amivantamab-vmjw
Indications	Various types of cancers including melanoma, lung cancer, head and neck cancer, Hodgkin lymphoma, and others	Non-small cell lung cancer (NSCLC) with EGFR exon 20 insertion mutations
Mechanism of action	Programmed death receptor-1 (PD-1) blocking antibody	Bispecific antibody that targets EGFR and MET receptors
Brand names	Keytruda	Rybrevant
Administrative route	Intravenous infusion	Intravenous infusion
Side effects	Fatigue, musculoskeletal pain, decreased appetite, itching, diarrhea, nausea, rash, fever, cough, dyspnea, constipation, pain, and abdominal pain	Infusion-related reactions, skin rash, paronychia, musculoskeletal pain, dyspnea, nausea, edema, cough, vomiting, and fatigue
Contraindications	Severe hypersensitivity to pembrolizumab or any of its excipients	Severe hypersensitivity to amivantamab-vmjw or any of its excipients
Drug class	Anti-PD-1 monoclonal antibody	Bispecific EGFR and MET receptor-directed antibody
Manufacturer	Merck & Co.	Janssen Biotech, Inc.

Efficacy

Keytruda (pembrolizumab) Efficacy in Lung Cancer

Keytruda, also known by its generic name pembrolizumab, is a highly effective immunotherapy medication used in the treatment of certain types of lung cancer. It is a programmed death receptor-1 (PD-1) blocking antibody that works by enhancing the body's immune response against cancer cells. In non-small cell lung cancer (NSCLC), Keytruda has shown significant efficacy, particularly in patients whose tumors express PD-L1 with a proportion score of 1% or more, and who have previously undergone chemotherapy. In these patients, Keytruda has been associated with improved overall survival and progression-free survival compared to chemotherapy alone.

For patients with advanced NSCLC with no EGFR or ALK genomic tumor aberrations, Keytruda in combination with chemotherapy has demonstrated a significant improvement in overall survival compared to chemotherapy alone. The efficacy of Keytruda has led to its approval as a first-line treatment option for metastatic NSCLC, highlighting its role in changing the treatment paradigm for this disease. The benefits of Keytruda are most pronounced in patients with high PD-L1 expression, where it can be used as a monotherapy, providing a chemotherapy-sparing option for eligible patients.

Rybrevant (amivantamab-vmjw) Efficacy in Lung Cancer

Rybrevant, with the generic name amivantamab-vmjw, is a bispecific antibody that targets both the epidermal growth factor receptor (EGFR) and MET receptors. It has been approved for the treatment of adult patients with NSCLC with EGFR exon 20 insertion mutations, whose disease has progressed on or after platinum-based chemotherapy. This targeted therapy has shown a significant clinical benefit in this patient population, which historically has had limited treatment options and poor prognosis.

In clinical trials, Rybrevant has demonstrated a meaningful objective response rate (ORR) in patients with NSCLC harboring EGFR exon 20 insertion mutations. The duration of response (DOR) observed in these trials suggests that Rybrevant can provide a durable response for patients who have few other therapeutic alternatives. As an off-label use, further research may expand the indications for Rybrevant, potentially offering new hope for patients with other types of EGFR or MET-altered lung cancers.

Regulatory Agency Approvals

Keytruda

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Health Canada
Therapeutic Goods Administration (TGA), Australia
Medsafe (NZ)

Rybrevant

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA

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