Treatment of Aggressive B Cell Lymphoma with Epcoritamab - Real World Single Institution Experience
Authors: Krishnakumar Manaswini , Kumar Swarup , Zafar Maha , Reddy Aswanth 
Published: December 2024

Treatment of Aggressive B cell Lymphoma with Epcoritamab - Real World Single Institution Experience
Manaswini Krishnakumar, Maha Zafar (Mercy Hospital Fort Smith), Swarup Kumar (University of Connecticut Health), Aswanth Reddy (Mercy Hospital Fort Smith)
Introduction
Epcoritamab, a bispecific CD20-directed CD3 T-cell engager, was evaluated in EPCORE NHL-1 (NCT03625037), an open-label, multi-cohort, multicenter, single-arm trial in patients with relapsed or refractory B-cell lymphoma. In the updated results, the median overall survival was 18.5, with an estimated 58% of patients alive at 12 months. The most common treatment-related adverse effect was neutropenia, and 6% of patients reported immune effector cell-associated neurotoxicity syndrome.
Methods: We analyzed the patients treated for aggressive B cell lymphoma in our institution. Diagnoses included diffuse large B cell lymphoma (DLBCL), high-grade B cell lymphoma, and any transformed aggressive B cell lymphoma (TBCL) from a previous history of low-grade B cell lymphoma. We analyzed data on demographics, previous therapies, ECOG performance status, and adverse events. The third dose of treatment was offered in the outpatient setting if patients had a support system at home.
Results: A total of five patients who received epcoritamab from June 2023 (post-FDA approval) to June 2024 were included in our analysis. All patients were heavily pretreated with at least three lines of therapy before starting epcoritamab. No patients in our study had autologous bone marrow transplant or CAR-T cell therapy in the past. Performance status was ECOG 3 on 4/5 patients before starting treatment. Three patients had TBCL (2 follicular and one patient with CLL), and two patients had de novo DLBCL. Four patients received the step-up (third dose) dosing in the outpatient setting and were monitored for six hours post-treatment in the infusion room on days 1 and 2. Treatment responses were seen in 2 patients with de novo DLBCL, with objective responses confirmed by imaging. All three patients with TBCL had no response and progressed while on treatment. Regarding serious adverse events, no patient had neurotoxicity related to the drug. All three patients who did not respond to treatment had hospital admission for treatment of pneumonia, pain control, and hospice transition. One patient had a local injection site reaction. No grade 3 or 4 drug-related adverse reaction was documented.
Conclusion: We report the first real-world experience with epcoritamab. We made specific, meaningful observations, including inferior clinical responses for patients with TBCL (no responses). Compared to the trial data, we had no neurological toxicity in our patients, and hospitalization was only seen in unresponsive patients related to disease progression. 4/5 patients received the third dose in the infusion room and tolerated it well. Most patients had an performance status ECOG 3 before starting therapy, which makes epcoritamab a desirable treatment option for patients ineligible for transplant/CAR-T therapy. Although the data is limited, we believe step-up dosing can be safely given in the outpatient setting, considering good patient support, and it appears that the patients with TBCL will likely not benefit from epcoritamab.