Dr Patel on the Safety Profile of Bispecific Antibodies in Follicular Lymphoma

“A [primary] takeaway [regarding] current and emerging treatments in follicular lymphoma is the efficacy, but more importantly the safety, of bispecific antibody therapies. When I [examined] the data of bispecific antibody combination and monotherapy treatments, there were very low rates of high-grade cytokine release syndrome or immune effector cell–associated neurotoxicity syndrome.”

Vivek G. Patel, MD, assistant professor of medicine, Division of Hematology Oncology, Vanderbilt University Medical Center, discussed the safety profile of bispecific antibodies for the treatment of patients with follicular lymphoma, which he highlighted during a presentation at a State of the Science Summit™ on hematologic malignancies.

In general, bispecific antibodies, such as mosunetuzumab-axgb (Lunsumio) and epcoritimab-bysp (Epkinly), have shown low rates of high-grade cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) in patients with follicular lymphoma, both as monotherapy and combination components, Patel began.

Data from the phase 2 Mithic-FL1 trial presented during the 2024 ASH Annual Meetingrevealed that patients with follicular lymphoma who received frontline mosunetuzumab (n = 78) experienced any-grade CRS at a rate of 54%; these events were mostly grade 1 (51%) and there were no instances of grade 3 or higher CRS. Notably, there were no reports of ICANS-like toxicities. Findings from the phase 1b/2 EPCORE NHL-2 study (NCT04663347) showed that among 111 patients with relapsed/refractory follicular lymphoma who received epcoritamab in combination with rituximab (Rituxan) and lenalidomide (Revlimid), the incidence of CRS was mostly grade 1 to 2 (50%), with 1% of patients experiencing grade 3 and 4 CRS and no grade 5 events. There was only 1 instance of ICANS, which was low grade and was quickly resolved.

Patel noted that protocols are now in place to optimize step-up dosing with bispecific antibodies and the time to onset of CRS is predictable. Importantly, most instances of CRS can be treated in the outpatient setting, he added. Overall, bispecific antibodies are safe and do not have similar non-relapse mortality rates compared with CAR T-cell therapies, Patel explained.

Bispecific antibodies are safe, effective, and ideal for use in the community-based setting, Patel noted. These agents will enable investigators to further expand access to care for patients with follicular lymphoma, he concluded.