In an interview with Pharmacy Times®, Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA, a clinical pharmacy manager at the University of Kansas Health System, discussed the clinical significance of epcoritamab (Epkinly; Genmab, AbbVie) in combination with rituximab (Rituxan; Genentech) and lenalidomide (Revlimid; Bristol Myers Squibb) (R²) following its 2025 approval for patients with relapsed or refractory follicular lymphoma (RR FL).
What Pharmacists Should Know
- Epcoritamab’s bispecific mechanism redirects patient T cells to target CD20-positive lymphoma cells, offering a chemo-free, off-the-shelf immunotherapy option for relapsed or refractory follicular lymphoma.
- Pharmacists play a central role in coordinating step-up dosing, implementing CRS mitigation protocols, selecting premedications, and managing infection prophylaxis and cytopenias, particularly related to lenalidomide.
- The epcoritamab-based triplet regimen may represent a new second-line benchmark, making pharmacist-led patient education and access navigation critical to successful implementation.
Mahmoudjafari emphasized the unique mechanism of action of epcoritamab as a CD3xCD20 bispecific T-cell engager, which simultaneously binds malignant B cells and patient T cells, redirecting the immune system to directly eliminate lymphoma cells. This approach differs fundamentally from traditional chemotherapy or passive immunotherapies by enabling antigen-specific cytotoxicity without the need for ex vivo cellular manipulation, such as chimeric antigen receptor (CAR) T-cell therapy.
Within the current treatment paradigm, Mahmoudjafari described the triplet regimen as a potential new benchmark for second-line therapy. The magnitude of progression-free survival (PFS) benefit, depth of complete responses (CR), and durability observed in clinical trials suggest meaningful improvements over standard R². She noted that this regimen may be particularly appealing for patients seeking to avoid chemotherapy-related toxicities, those who are not ideal candidates for CAR T-cell therapy, or those who prefer an off-the-shelf outpatient immunotherapy option.
“What I see here is the magnitude of that PFS advantage,” Mahmoudjafari said in the interview. “Deep CR rates and durability suggest that this could be a new benchmark in second-line therapy.”
From a pharmacy perspective, Mahmoudjafari underscored the central role pharmacists play in safely implementing this regimen. Key responsibilities include coordinating step-up dosing schedules across inpatient and outpatient settings, ensuring adherence to cytokine release syndrome mitigation protocols, and leading patient and caregiver education. Pharmacists are also integral to selecting appropriate premedications and managing prophylaxis, as immunosuppression increases infection risk. Additional monitoring for cytopenias, particularly related to lenalidomide, and immune-mediated toxicities is essential.
Beyond clinical management, pharmacists often support financial navigation by assisting with insurance approvals and access programs, ensuring patients can obtain therapy. Collectively, these responsibilities highlight the multifaceted role pharmacists play in optimizing outcomes for patients receiving epcoritamab-based therapy.
