On May 19, 2023, the U.S. Food and Drug Administration (FDA) granted accelerated approval to epcoritamab-bysp (Epkinly®) for relapsed or refractory diffuse large B-cell lymphoma (DLBCL) not otherwise specified, including DLBCL arising from indolent lymphoma, and high-grade B-cell lymphoma after two or more lines of systemic therapy.
Researchers evaluated epcoritamab-bysp, a bispecific, CD20-directed, CD3 T-cell engager, in EPCORE NHL-1 (NCT03625037), an open-label, multicohort, multicenter, single-arm trial in patients with relapsed or refractory B-cell lymphoma. The efficacy population consisted of 148 patients with relapsed or refractory DLBCL, not otherwise specified, including DLBCL arising from indolent lymphoma, or high-grade B-cell lymphoma after two or more lines of systemic therapy, including at least one anti-CD20 monoclonal antibody–containing therapy.
The main efficacy outcome measure was overall response rate (ORR), determined by Lugano 2014 criteria as assessed by an independent review committee. The ORR was 61% (95% CI = 53, 69) with 38% of patients achieving complete responses. After a median follow-up of 9.8 months among responders, the estimated median duration of response was 15.6 months (95% CI = 9.7, not reached).
The prescribing information has a boxed warning for serious or life-threatening cytokine release syndrome (CRS) and life-threatening or fatal immune effector cell-associated neurotoxicity syndrome (ICANS). Warnings and precautions include infections and cytopenias. Among the 157 patients with relapsed or refractory large B-cell lymphoma who received epcoritamab-bysp at the recommended dose, CRS occurred in 51% of patients, serious infections occurred in 15%, and ICANS occurred in 6%. For CRS, grade 1 occurred in 37% of patients, grade 2 in 17%, and grade 3 in 2.5%. For ICANS, grade 1 occurred in 4.5%, grade 2 in 1.3%, and grade 5 in 0.6%.
Epcoritamab-bysp should be administered only by qualified healthcare professionals with appropriate medical support to manage severe reactions such as CRS and ICANS. Because of the risk for CRS and ICANS, patients should be hospitalized for 24 hours after the cycle 1, day 15 dosage of 48 mg.
The most common adverse reactions reported in at least 20% of patients treated with epcoritamab-bysp were CRS, fatigue, musculoskeletal pain, injection site reactions, pyrexia, abdominal pain, nausea, and diarrhea. The most common grade 3 or 4 laboratory abnormalities reported in at least 10% of patients were decreased lymphocyte count, decreased neutrophil count, decreased white blood cell count, decreased hemoglobin, and decreased platelets.
The recommended regimen consists of epcoritamab-bysp administered subcutaneously in 28-day cycles until patient experiences disease progression or unacceptable toxicity. The recommended dose is step-up dosing in cycle 1 (0.16 mg on day 1; 0.8 mg on day 8; and 48 mg on day 15 and day 22), followed by fixed dosing of 48 mg weekly dosing during cycles 2–3, every other week during cycles 4–9, and then every four weeks on day 1 of subsequent cycles.
The review used the Assessment Aid, a voluntary submission from the applicant to facilitate the FDA’s assessment.
The application was granted priority review. FDA expedited programs are described in the Guidance for Industry: Expedited Programs for Serious Conditions—Drugs and Biologics.
Healthcare professionals should report all serious adverse events suspected to be associated with the use of any medicine and device to FDA’s MedWatch Reporting System or by calling 800-FDA-1088.