SOHO 2026 | Changing community practice in FL: bispecific antibody delivery and treatment selection

Yeah, I mean, I think we are aware that the bispecific antibodies are now deliverable in the community. So the initial trials mandated hospitalisation, at least, you know, for the first full dose when the risk of CRS was greatest. But we now understand that actually those risks can be very well managed with protocols. We know that, for example, three-step-up dosing for epcoritamab reduces the risk of cytokine release syndrome, so suddenly it’s possible for these therapies to be delivered into the community. But it is important for those community centres to be appropriately trained and to have access to ITU facilities for the rare cases that need them, and that that training extends not just to the doctors and nurses in the community centre but out into the community for patients and their carers as well so that they know when they need to come back in when their risk is greatest and ultimately there will be a rollout of community delivery so beyond that first cycle when the risk of CRS is highest beyond cycle two and onwards the treatment really can be delivered in the community itself as long as there’s an easy link back to the hospital should there be any complications so I think it’s the message for the bispecs certainly is you know embrace it it’s very much achievable in the community these are therapies that are here to stay and make sure that you know they’ve got the training and the infrastructure to deliver those treatments. So I think that’s a really important lesson for the bispecs. I think, you know, the other lesson is, you know, that the treatment landscape is evolving really very rapidly. You know, we, in our session, we talked a lot about CAR T-cell therapy and bispecifics, but there’s obinutuzumab, zanabrutinib, there’s loncastuximab tesirine, you know, there’s still chemotherapy. There are so many options out there for our patients, and I think we need to start thinking very, very carefully about treatment sequencing so that, you know, we are not burning our bridges by giving all of our best drugs in the first-line treatment setting, bearing in mind that obviously our goal is to try and achieve the longest first remission. But actually, we could probably still do that very well with immunochemotherapy for the vast majority of our patients and reserve some of those novel therapies, the combinations for later lines of therapy when risk is highest. But we don’t yet have the framework for choosing those people. And I think that’s one of our biggest research challenges, actually, is to develop predictive biomarkers that will allow us to select the patients who are most likely to benefit from any given treatment.

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