Dr Battiwalla on the Expanding Use of Bispecific Antibodies in NHL

Minoo Battiwalla, MD, MS, director, Blood Cancer Outcomes Research, Sarah Cannon Research Institute, TriStar Medical Group, discusses the variety of bispecific antibodies available or under investigation for patients with non-Hodgkin lymphoma (NHL), including those with diffuse large B-cell lymphoma (DLBCL).

Bispecific antibodies have emerged as a promising treatment option for patients with NHL, offering an effective and timelieralternative to CAR T-cell therapy, Battiwalla begins. Although CAR T-cell therapies are highly potent, they are also associated with an increased risk of toxicity, he notes. Bispecific antibodies may serve as a viable treatment option for patients with lower performance status, as well as those who have previously undergone stem cell transplantation or CAR T-cell therapy, he says.

The number of bispecific antibodies under investigation in NHL is rapidly expanding, with several agents already FDA approved for various indications, Battiwalla notes. Mosunetuzumab-axgb (Lunsumio) is approved for patients with follicular lymphoma (FL) who have progressed on 2 or more prior lines of therapy. Epcoritamab-bysp (Epkinly) and glofitamab-gxbm (Columvi) are both approved for patients with DLBCL who have relapsed following 2 or more lines of therapy. Notably, the biologics license application for odronextamab (REGN1979) for the treatment of patients with relapsed/refractory DLBCL and FL who have received at least 2 prior lines of therapy was issued a CRL in March 2024. 

Despite the variety of treatment options for patients with NHL, most cancer centers may initially choose agents based on familiarity rather than specific clinical data, as differences between these agents are often subtle, Battiwalla describes. Epcoritamab stands out in the treatment paradigm because of its subcutaneous administration, which may be more convenient for patients than intravenous agents, he explains. Since all these agents have maintenance dosing schedules that range from every 2 weeks to every 4 weeks, there is minimal differentiation regarding dosing frequency, he emphasizes. Overall, the continued integration of bispecific antibodies into the therapeutic arsenal for aggressive NHL subtypes will require careful consideration of available data and dosing information, Battiwalla concludes.