Yan Leyfman, Medical Correspondent at OncLive, Freelance, shared on LinkedIn:
“How do we control follicular lymphoma without relying on chemotherapy – and without compromising safety?
The EPCORE NHL-2 study provides an important early answer.
In this phase 1b/2 trial, epcoritamab plus rituximab and lenalidomide was evaluated as first – line treatment for follicular lymphoma, combining a CD3×CD20 bispecific antibody with a chemotherapy – free backbone.
After a median follow – up of 35.9 months, the regimen achieved:
- 95% overall response rate (39 of 41 patients)
- Responses maintained over nearly 3 years
- A potential chemotherapy – free approach for frontline therapy
These results are encouraging. But the safety profile deserves equal attention.
Grade 3 – 4 adverse events included:
- Neutropenia: 49%
- Infections: 29%
- COVID-19: 15%
- Serious adverse events: 71%
- Serious infections: 32%
- Cytokine release syndrome: 32%
There were also three treatment – related deaths (7%), due to septic shock, progressive multifocal leukoencephalopathy, and COVID – 19.
This is the central tension with chemotherapy – free treatment: eliminating conventional chemotherapy does not eliminate treatment – related toxicity.
For an indolent lymphoma, the goal is not simply to achieve a high response rate. It is to provide durable disease control with a treatment that patients can safely tolerate and that is practical to deliver.
The key question is therefore:
Can bispecific-based frontline therapy maintain its impressive efficacy while improving safety and long – term tolerability?
EPCORE NHL – 2 provides a strong efficacy signal, but the toxicity profile will be critical in determining how this regimen fits into routine practice.
The next step is not only to ask how deep the responses are, but whether they remain durable – and what patients must endure to achieve them.”
Title: Comparative efficacy and safety of CD19 chimeric antigen receptor T – cell therapy versus CD3/CD20 bispecific antibodies in relapsed refractory mantle cell lymphoma: a meta – analysis of clinical trials and real – world studies
Authors: Julia Wang, Justin Desroches, Fang Yang, Dongni Yi, Yajuan Gao, Robin R. Klebig, Jonas Paludo, Ivana N. Micallef, Muhamad Alhaj Moustafa, Madiha Iqbal, Julio C. Chavez, Javier L. Munoz, Yi Lin, Yucai Wang, Jithma P. Abeykoon.
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