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PURPOSE Epcoritamab is a subcutaneously administered CD3xCD20 T-cell–engaging, bispecific antibody that activates T cells, directing them to kill malignant CD20+ B cells. Single-agent epcoritamab previously demonstrated potent antitumor activity in dose escalation across B-cell non-Hodgkin lymphoma subtypes. PATIENTS AND METHODS In the dose-expansion cohort of a phase I/II study (ClinicalTrials.gov identifier: NCT03625037 ), adults with relapsed or refractory CD20+ large B-cell lymphoma and at least two prior therapy lines (including anti-CD20 therapies) received subcutaneous epcoritamab in 28-day cycles (once weekly step-up doses in weeks 1-3 of cycle 1, then full doses once weekly through cycle 3, once every 2 weeks in cycles 4-9, and once every 4 weeks in cycle 10 and thereafter) until disease progression or unacceptable toxicity. The primary end point was overall response rate by the independent review committee. RESULTS As of January 31, 2022, 157 patients were treated (median age, 64 years [range, 20‐83]; median of three [range, 2-11] prior therapy lines; primary refractory disease: 61.1%; prior chimeric antigen receptor (CAR) T-cell exposure: 38.9%). At a median follow-up of 10.7 months, the overall response rate was 63.1% (95% CI, 55.0 to 70.6) and the complete response rate was 38.9% (95% CI, 31.2 to 46.9). The median duration of response was 12.0 months (among complete responders: not reached). Overall and complete response rates were similar across key prespecified subgroups. The most common treatment-emergent adverse events were cytokine release syndrome (49.7%; grade 1 or 2: 47.1%; grade 3: 2.5%), pyrexia (23.6%), and fatigue (22.9%). Immune effector cell–associated neurotoxicity syndrome occurred in 6.4% of patients with one fatal event. CONCLUSION Subcutaneous epcoritamab resulted in deep and durable responses and manageable safety in highly refractory patients with large B-cell lymphoma, including those with prior CAR T-cell exposure.

Introduction: Despite advances in the treatment of B-cell non-Hodgkin lymphoma (B-NHL), more efficacious, less toxic, off-the-shelf therapies are needed for patients (pts) with relapsed or refractory (R/R) disease. Epcoritamab is a novel, subcutaneously (SC) administered bispecific antibody (bsAb) that simultaneously binds to CD3 on T cells and CD20 on B cells, inducing activation and cytotoxic activity of T cells for killing of target lymphoma cells. In an open-label, phase 1/2 trial (NCT03625037), initial data demonstrated an encouraging safety profile and potent single-agent clinical activity, even at low doses, in heavily pretreated pts with R/R B-NHL (Hutchings M. EHA 2020, Poster EP1218). Herein, we present updated dose-escalation data, including initial results for the 48-mg recommended phase 2 dose (RP2D) and for pts with mantle cell lymphoma (MCL). Methods: Adults with R/R CD20+ B-NHL after prior therapy, including an anti-CD20 monoclonal antibody (mAb), receive a SC 1-mL injection of flat-dose epcoritamab in 28-day cycles (q1w: cycles 1-2; q2w: cycles 3-6; q4w thereafter) until disease progression or unacceptable toxicity. Risk mitigation for cytokine release syndrome (CRS) includes starting with priming and intermediate doses and use of corticosteroids. Objectives include dose finding, safety, and antitumor activity. Results: As of July 6, 2020, 67 pts were enrolled, which included 45 pts (67%) with diffuse large B-cell lymphoma (DLBCL), 12 (18%) with follicular lymphoma (FL) and 4 (6%) with MCL. Pts were heavily pretreated, with a median (range) of 3.0 (1-6) prior lines of therapy for pts with DLBCL and 4.5 (1-18) for pts with FL; in total 6 pts had received prior CAR-T therapy. Over one-half of pts (37/67; 55%) were refractory to their most recent systemic therapy; 35/67 (52%) were refractory to their most recent anti-CD20 mAb therapy. At a median overall follow-up of 8.3 months, treatment is ongoing in 25 pts (37%); median follow-up is 8.3 months for pts with DLBCL and 8.8 months for pts with FL. Epcoritamab was well tolerated and there were no discontinuations due to treatment-related adverse events (AEs). The most common treatment-emergent AEs (TEAEs) were pyrexia (70%), local injection-site reactions (48%), and fatigue (45%). With increased doses, TEAEs of special interest were consistent with previous reports: CRS events were all grade 1/2 (58%) with no grade 3/4 CRS events, and limited neurotoxicity was observed (6%; grade 1: 3%; grade 3: 3%; all transient). There were no dose-limiting toxicities or febrile neutropenia events, and no deaths due to treatment-related AEs. Antitumor activity in evaluable pts with DLBCL and FL is shown in the Table. In 18 pts with DLBCL receiving epcoritamab ≥12 mg, overall response rate (ORR) was 66.7% with 6 pts achieving a complete response (CR). Of the 7 pts who received epcoritamab ≥48 mg (48-mg RP2D n=4; 60-mg n=3), all achieved a response, including CR in 2 pts (28.6%) with limited follow-up. All pts with DLBCL who were previously treated with CAR-T therapy achieved a response (4/4: 2 CR, 2 partial response [PR]). ORR was 100% for the 8 pts with FL receiving epcoritamab ≥0.76 mg, with 2 pts achieving a CR (PET scans were not mandatory and disease assessment by PET was not available in 4/6 pts who achieved a PR). Of the 4 pts with MCL, responses have been observed in 2 pts with blastoid variant MCL (1 CR; 1 PR). Data on duration of response are not yet mature. Longer follow-up data, including additional response evaluations at 48-mg dose and in pts with MCL, will be presented. Conclusions: Epcoritamab, a novel SC bsAb, demonstrates a consistent and favorable safety profile, with no grade ≥3 CRS events and limited neurotoxicity, in support of outpatient administration. Emerging data with longer follow-up are highly encouraging, with substantial single-agent efficacy, including CR in heavily pretreated pts with FL, MCL, and DLBCL. Study support: Genmab A/S. Medical writing: Alyson Bexfield, Caudex, UK, funded by Genmab A/S. Disclosures Hutchings: Celgene, Genmab, Janssen, Novartis, F. Hoffmann-La Roche, Takeda: Research Funding; Genmab, F. Hoffmann-La Roche, Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Mous:Gilead Sciences: Consultancy, Honoraria, Research Funding; Janssen-Cilag: Consultancy, Honoraria, Research Funding; Bristol-Myers Squibb: Honoraria; Celgene: Honoraria; Sandoz: Honoraria; Takeda: Honoraria; MSD Brazil: Honoraria; Roche: Honoraria; AbbVie: Honoraria. Clausen:AbbVie: Other: Travel expenses. Johnson:Incyte: Honoraria; Kite Pharma: Honoraria; Kymera: Honoraria; MorphoSys: Honoraria; Takeda: Honoraria; Genmab: Honoraria; Celgene: Honoraria; Bristol-Myers: Honoraria; Oncimmune: Consultancy; Janssen: Consultancy; Oncimmune: Consultancy; Epizyme: Consultancy, Research Funding; Janssen: Consultancy; Boehringer Ingelheim: Consultancy; Epizyme: Consultancy, Research Funding; Novartis: Honoraria. Linton:Takeda: Honoraria; Celgene: Membership on an entity's Board of Directors or advisory committees; Karyopharm: Membership on an entity's Board of Directors or advisory committees; Gilead: Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy; Beigene: Membership on an entity's Board of Directors or advisory committees; Janssen: Other: Travel, accommodations, expenses ; Celgene: Other: Travel, accommodations, expenses. Chamuleau:Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Bristol-Myers Squibb: Research Funding; Genmab: Research Funding; Gilead: Membership on an entity's Board of Directors or advisory committees, Research Funding. Sureda Balari:Gilead/Kite: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; BMS: Speakers Bureau; Celgene: Consultancy, Honoraria; Incyte: Consultancy; Janssen: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Merck Sharpe and Dohme: Consultancy, Honoraria, Speakers Bureau; Celgene/Bristol-Myers Squibb: Consultancy, Honoraria; Takeda: Consultancy, Honoraria, Speakers Bureau; Roche: Honoraria. Cunningham:Bayer: Research Funding; AstraZeneca: Research Funding; Merrimack: Research Funding; Celgene: Research Funding; Amgen: Research Funding; Merck: Research Funding; Sanofi: Research Funding; MedImmune: Research Funding; OVIBIO: Membership on an entity's Board of Directors or advisory committees; Lilly: Research Funding; Janssen: Research Funding; Clovis Oncology: Research Funding; 4SC: Research Funding. Oliveri:Genmab: Current Employment, Current equity holder in publicly-traded company. DeMarco:Genmab: Current Employment, Current equity holder in publicly-traded company. Elliott:Genmab: Current Employment. Chen:Genmab: Current Employment. Lugtenburg:Servier: Honoraria, Research Funding; Takeda: Honoraria, Research Funding; Roche: Research Funding; Genentech: Honoraria; Genmab: Honoraria; Celgene: Honoraria; Incyte: Honoraria. OffLabel Disclosure: Epcoritamab is an investigational agent undergoing evaluation in patients with relapsed/refractory B-cell non-Hodgkin lymphoma.

BackgroundImmune thrombocytopenia (ITP) is an auto-immune disorder characterized by enhanced platelet destruction and, subsequently, the potential for increased bleeding. Thrombopoietin receptor (TPO-R) agonists have recently emerged as promising therapies for ITP patients who are refractory to other treatments. While eltrombopag (EPAG) is the only TPO-R agonist US Food and Drug Administration approved for use in pediatric patients, romiplostin (ROMI) has been used in Phase III clinical studies.MethodsA cost-consequence model (CCM) was developed to evaluate the costs of EPAG, ROMI, and watch-and-rescue (W&R) in relation to their respective treatment outcomes in previously-treated pediatric chronic ITP (cITP) over a 26-week time horizon. The costs of drugs, administration, routine care, rescue medications, adverse events, and mortality were included. Data on platelet count response rate, bleeding events, and adverse events were derived from all relevant identified Phase III-registered clinical trials, health outcomes were compared via indirect treatment comparison.ResultsThe overall estimated cost of EPAG per patient was US$66,550, compared to US$101,056 for ROMI and US$32,720 for W&R. EPAG’s lower cost compared to ROMI was largely due to lower drug costs (US$62,202 vs US$84,396), administration costs (US$0 vs US$1,955), and significantly lower costs due to severe bleeding (US$354 vs US$10,191). When assessing cost per severe bleeding event avoided, EPAG was dominant over ROMI (less expensive and more effective). EPAG was again dominant over ROMI when assessing the cost per responder and per bleeding event (any grade). Sensitivity analysis was consistent with the base case findings.ConclusionEPAG was the preferred TPO-R agonist to treat cITP when indirectly compared to ROMI, largely driven by its favorable severe bleeding outcomes and lower drug and administration costs.

Combining PET/CT with laboratory data improves the accuracy of prediction of relapse/progression within 12 months compared with each test alone. Thus, integration of PET/CT into myeloma follow-up is recommended, and the impact of this approach on management should be explored.