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This article is from the NEJM Journal Watch Bispecific Antibody Therapy for Relapsed Lymphoma Bispecific Antibody Therapy for Relapsed Lymphoma.
Author: PMichael E.
Williams, MD, ScM Diffuse Large B-Cell Lymphoma and Follicular Lymphoma Tumor patients received subcutaneous injection of epcoritamab and achieved remission without dose-limiting toxicity
.
Therapeutic bispecific monoclonal antibody is an emerging treatment option for acute lymphoblastic leukemia, non-Hodgkin's lymphoma and multiple myeloma, which links tumor cell surface antigens with redirecting effector T cells to exert immunotherapy effects
.
The researchers published a multicenter Phase 1/2 trial on epcoritamab (targeting CD20 expressed by B cells and CD3 antigen on T cells) funded by the industry
.
In order to alleviate cytokine release syndrome (CRS), patients with relapsed or refractory mature B-cell lymphoma received subcutaneous injection of epcoritamab with an ascending dose schedule
.
There is a treatment cycle every 4 weeks, cycle 1 and cycle 2 are administered once a week, cycles 3 to 6 are administered once every two weeks, and starting from cycle 7, once every 4 weeks, until the disease progresses or toxicity occurs
.
The dose range is 12-60 mg; the recommended phase 2 dose is 48 mg
.
Of the 68 patients treated, 59% developed CRS (all grades 1 to 2, and mostly occurred in cycle 1), and 6% developed neurological complications
.
Fever and injection site reactions are common; no treatment-related deaths have been reported, but one patient died of COVID-19 during epcoritamab treatment
.
In 46 patients with diffuse large B-cell lymphoma, the overall response rate was 68%, and the complete response rate was 45% (the 48 mg and 60 mg cohorts had higher response rates); 75% of the patients in response were at 6 months Still maintain remission
.
Among the 5 patients with follicular lymphoma who received 12 mg or 48 mg doses, 4 cases achieved remission and 3 cases achieved complete remission
.
Comment In this early clinical trial, epcoritamab achieved a high remission rate for patients, so there is an additional bispecific antibody under investigation for the treatment of relapsed/refractory B-cell lymphoma
.
It is worth noting that all 4 patients who failed the previous chimeric antigen receptor T cell (CAR-T) treatment have achieved remission, and epcoritamab has also become a transitional treatment for several other patients before receiving consolidation stem cell transplantation
.
The advantage of bispecific antibodies is "off the shelf", so in the case of rapid disease progression, it can be used more quickly than CAR-T
.
We need to follow CAR-T and bispecific antibodies for a longer period of time to determine the preferred therapy for the subgroup of patients with aggressive and follicular lymphoma
.
Commented article[1] Hutchings M et al.
Dose escalation of subcutaneous epcoritamab in patients with relapsed or refractory B-cell non-Hodgkin lymphoma: An open-label, phase 1/2 study.
Lancet 2021 Sep 25; 398:1157.
(https://doi.
org/10.
1016/S0140-6736(21)00889-8)[2] Ghobadi A and Bartlett NL.
CD3xCD20 bispecific T-cell redirectors for relapsed or refractory B-cell lymphoma.
Lancet 2021 Sep 25; 398:1109.
(https://doi.
org/10.
1016/S0140-6736(21)01070-9) Related readings Important papers to help doctors understand and use the latest developments
.
"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat
.
Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM)
.
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group
.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities
.
Author: PMichael E.
Williams, MD, ScM Diffuse Large B-Cell Lymphoma and Follicular Lymphoma Tumor patients received subcutaneous injection of epcoritamab and achieved remission without dose-limiting toxicity
.
Therapeutic bispecific monoclonal antibody is an emerging treatment option for acute lymphoblastic leukemia, non-Hodgkin's lymphoma and multiple myeloma, which links tumor cell surface antigens with redirecting effector T cells to exert immunotherapy effects
.
The researchers published a multicenter Phase 1/2 trial on epcoritamab (targeting CD20 expressed by B cells and CD3 antigen on T cells) funded by the industry
.
In order to alleviate cytokine release syndrome (CRS), patients with relapsed or refractory mature B-cell lymphoma received subcutaneous injection of epcoritamab with an ascending dose schedule
.
There is a treatment cycle every 4 weeks, cycle 1 and cycle 2 are administered once a week, cycles 3 to 6 are administered once every two weeks, and starting from cycle 7, once every 4 weeks, until the disease progresses or toxicity occurs
.
The dose range is 12-60 mg; the recommended phase 2 dose is 48 mg
.
Of the 68 patients treated, 59% developed CRS (all grades 1 to 2, and mostly occurred in cycle 1), and 6% developed neurological complications
.
Fever and injection site reactions are common; no treatment-related deaths have been reported, but one patient died of COVID-19 during epcoritamab treatment
.
In 46 patients with diffuse large B-cell lymphoma, the overall response rate was 68%, and the complete response rate was 45% (the 48 mg and 60 mg cohorts had higher response rates); 75% of the patients in response were at 6 months Still maintain remission
.
Among the 5 patients with follicular lymphoma who received 12 mg or 48 mg doses, 4 cases achieved remission and 3 cases achieved complete remission
.
Comment In this early clinical trial, epcoritamab achieved a high remission rate for patients, so there is an additional bispecific antibody under investigation for the treatment of relapsed/refractory B-cell lymphoma
.
It is worth noting that all 4 patients who failed the previous chimeric antigen receptor T cell (CAR-T) treatment have achieved remission, and epcoritamab has also become a transitional treatment for several other patients before receiving consolidation stem cell transplantation
.
The advantage of bispecific antibodies is "off the shelf", so in the case of rapid disease progression, it can be used more quickly than CAR-T
.
We need to follow CAR-T and bispecific antibodies for a longer period of time to determine the preferred therapy for the subgroup of patients with aggressive and follicular lymphoma
.
Commented article[1] Hutchings M et al.
Dose escalation of subcutaneous epcoritamab in patients with relapsed or refractory B-cell non-Hodgkin lymphoma: An open-label, phase 1/2 study.
Lancet 2021 Sep 25; 398:1157.
(https://doi.
org/10.
1016/S0140-6736(21)00889-8)[2] Ghobadi A and Bartlett NL.
CD3xCD20 bispecific T-cell redirectors for relapsed or refractory B-cell lymphoma.
Lancet 2021 Sep 25; 398:1109.
(https://doi.
org/10.
1016/S0140-6736(21)01070-9) Related readings Important papers to help doctors understand and use the latest developments
.
"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat
.
Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM)
.
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group
.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities
.
