ASH 2024 | Fixed duration epcoritamab with bendamustine and rituximab for first-line treatment of FL

So this is a very exciting data set I think that we got to present here at ASH this year really for the first time in its entirety. This is bringing what we know to be a wonderful immunotherapy for follicular lymphoma patients, epcoritimab. Already FDA approved as a third line therapy but as with all great agents we try to bring those agents to be earlier lines of therapy. In this case doing it in combination with the standard of care, one standard of care, rituximab and bendamastine, so chemo plus immunotherapy. And the results have been fantastic, I mean complete remission rates of above 85% in certain subgroups even a bit higher, and so far these remissions have been extremely durable patients have been in remission for at the longest beyond three years so very exciting. Overall this was pretty gentle therapy bendamustine pretty gentle chemo thankfully and the epcoritamab had just the same old side effects we’ve seen with it in the very first couple of doses or first few doses low levels of CRS, cytokine release syndrome, but the high grade CRS less than three percent. So still pretty well-tolerated and no other real surprising toxicities. I do have to be fair that all of this was done in the context of a pandemic. I don’t know if you heard there was a big pandemic around and so there were people that got infections primarily COVID infections, and there were a lot of them. Personally, I did see those same COVID infections on my patients who were not getting any therapy or getting other therapies. I don’t think it’s anything special about this study. Overall, it was impressive that the efficacy was that good and the tolerability was excellent. It’s a little bit in the context of another great abstract presented here at ASH by Tycel Phillips, another lymphoma expert who presented on whether bendamustine hurts T-cells so much that we’d be afraid to give bispecifics with it. And the punchline of Tycel’s abstract was that bendamustine does decrease CD4 T-cells, but overall is pretty much sparing CD8 T-cells. So for those patients that had bendamustine prior to epcoritimab, probably is true of other bispecifics as well, the response rate seemed to be just as high as patients that had not had bendamustine. So that was a bit of a concern before we started this. The results in Tycel’s study suggest that this should be a safe way to combine these good therapies. And the results from our study, the results were fantastic. So it seems like they’re quite combinable and hopefully it could be a new paradigm for this frontline therapy of follicular lymphoma.

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