Expert: Epcoritamab-Based Therapy Reduces Progression Risk in Follicular Lymphoma

In an interview with Pharmacy Times®, Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA, a clinical pharmacy manager at the University of Kansas Health System, discussed key findings from the global phase 3 EPCORE FL-1 trial (NCT05409066) evaluating epcoritamab (Epkinly; Genmab, AbbVie) in combination with rituximab (Rituxan; Genentech) and lenalidomide (Revlimid; Bristol Myers Squibb) (R²) for patients with relapsed or refractory follicular lymphoma (RR FL). The open-label, randomized study compared the triplet regimen against R² alone in patients with grade 1 to 3A disease who had received at least 1 prior systemic therapy, including anti-CD20–based chemotherapy.

Patients were randomized 1:1 to receive either epcoritamab plus R² or R² alone. Epcoritamab was administered using standard subcutaneous step-up dosing to 48 mg during cycle 1, followed by weekly dosing in cycles 2 and 3 and then every 4 weeks for up to 12 cycles. Primary endpoints included overall response rate (ORR) and progression-free survival (PFS), with secondary endpoints assessing complete response (CR), duration of response, and overall survival.

Results demonstrated a significant improvement in efficacy with the addition of epcoritamab. The ORR reached 95% in the triplet arm compared with 79% in the R²-only arm. Importantly, the risk of disease progression or death was reduced by 79% among patients receiving epcoritamab. Improvements were also observed in complete response rates and durability of response, with median duration of response not yet reached, highlighting the potential for sustained benefit.

“R² has a really good response on its own, but epcoritamab with R² has an even better [response],” Mahmoudjafari said during the interview.

From a safety perspective, cytokine release syndrome (CRS) was observed, consistent with the known profile of epcoritamab. However, most CRS events were grade 1 or 2 and occurred early in treatment. These events were manageable using established mitigation strategies, and no new safety signals emerged.

For pharmacists, these findings underscore the expanding role of chemo-free immunotherapy regimens in earlier lines of follicular lymphoma treatment. Pharmacists will play a critical role in dosing coordination, CRS monitoring, patient education, and toxicity management as use of epcoritamab continues to grow in practice.