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Treatment with fixed-duration epcoritamab-bysp (Epkinly) plus dose-attenuated rituximab (Rituxan) plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-mini-CHOP) appeared to be well tolerated and elicited responses in elderly patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL), according to data from arm 8 of the phase 1/2 EPCORE NHL-2 trial (NCT04663347).¹

The data, which were presented at the 2025 ASH Annual Meeting, showed that at a median follow-up of 33.4 months (range, 2.8-41.1), the overall response rate (ORR) in all patients (n = 28) was 93%, which was comprised of a complete response (CR) rate of 86% and a partial response (PR) rate of 7%. The median time to response was 1.4 months (range, 1.1-2.7) and the median time to CR was 1.6 months (range, 1.2-8.1).

At 2 years, 79% (95% CI, 57%-91%) of patients remained in response to treatment with the regimen, and 79% (95% CI, 57%-91%) remained in CR. Of the 22 patients who completed therapy, 20 experienced a CR at the end of treatment (91%). At a median follow-up of 22.6 months after the end of treatment, 90% of the 20 patients remained in CR. Moreover, the 2-year progression-free (PFS) and overall survival (OS) rates were 76% (95% CI, 54%-89%) and 82% (95% CI, 62%-92%), respectively. The median PFS and OS were not reached, irrespective of International Prognostic Index score.

Of the 21 patients evaluable for minimal residual disease (MRD), 20 (95%) were negative at the time of the data cutoff date of September 21, 2025. At the first assessment, which was done on day 1 of cycle 3, 80% (n = 16) of patients achieved MRD negativity. Of the 4 MRD-positive patients at this assessment, 3 converted to MRD negativity by the second assessment, which was done on day 1 of cycle 6; 2 patients experienced subsequent progressive disease. Notably, MRD negativity was observed across all patient subgroups, including bulky disease (89%) and those with an IPI score ranging from 3 to 5 (93%).

“We can conclude that in combination with dose-attenuated chemotherapy, [epcoritamab] may have a role in the treatment of patients with historically poor outcomes,” Chan Cheah, MD, of the Sir Charles Gairdner Hospital and the University of Western Australia, in Nedlands, Australia, said during a presentation of the data.

Why add epcoritamab to R-mini-CHOP?

Although R-mini-CHOP is the standard of care (SOC) for patients with newly diagnosed DLBCL who are not able to receive the full dose, outcomes with the regimen remain suboptimal, Cheah explained. “It’s clear that better options for these patients are required,” he added. Previously, the CD3xCD20 bispecific antibody epcoritamab was found to be efficacious when administered as a monotherapy or paired with SOC in those with newly diagnosed DLBCL.

For example, findings from the phase 2 EPCORE DLBCL-3 trial (NCT05660967 ) indicated that single-agent epcoritamab induced durable responses in patients with newly diagnosed large B-cell lymphoma and comorbidities.² Other findings from EPCORE NHL-2 showed that the combination of epcoritamab and R-mini-CHOP elicited an ORR of 89% and a CR rate of 82% in elderly patients with newly diagnosed DLBCL who could not receive the full dose of R-CHOP.³ At the meeting, Cheah shared follow-up data from EPCORE NHL-2.¹

What did EPCORE NHL-2 evaluate?

The open-label, phase 1b/2 trial enrolled patients with newly diagnosed DLBCL, which could have been DLBCL not otherwise specified, T-cell or histocyte-rich DLBCL, high-grade B-cell lymphoma, or grade 3B follicular lymphoma. Patients had an ECOG performance status ranging from 0 to 2 and could not be eligible to receive full-dose R-CHOP because they were 75 years of age or older or 65 years of age or older with a comorbidity.

Twenty-eight patients received a fixed duration of subcutaneous epcoritamab at a dose of 48 mg once weekly for cycles 1 and 2 and every 3 weeks for cycles 3 to 6 and intravenous R-mini-CHOP, which comprised 375 mg/m² of rituximab, 400 mg/m² of cyclophosphamide, 25 mg/m² of doxorubicin, 1 mg/m² of vincristine—all given every 3 weeks—and 100 mg/day of prednisone, given on days 1 to 5 of each cycle from cycles 1 to 6. Epcoritamab was then given at 48 mg every 4 weeks for cycles 7 to 8.

ORR by investigator assessment served as the primary end point of the trial. Secondary end points included CR rate, duration of response, duration of CR, PFS, OS, MRD negativity, and safety.

In terms of baseline characteristics, the median patient age was 81 years (range, 74-90). Patients were not eligible to receive a full dose of anthracycline because of age older than 75 years (96%), hypertension requiring treatment (54%), diabetes mellitus (11%), or history of myocardial infarction (4%). Moreover, 43% of patients had an IPI score of 4 to 5 at screening, 39% had a bulky tumor of 7 cm or larger, and the majority had elevated lactate dehydrogenase (64%).

What was the safety profile of epcoritamab in this population?

Cheah noted that most adverse effects (AEs) were mild to moderate in severity, and no new safety concerns associated with the addition of epcoritamab to R-mini-CHOP presented with longer follow-up. The most frequent grade 3 or higher treatment-emergent adverse effects (TEAEs) were neutropenia (43%), serious infections (32%), and anemia 14%). Most grade 3 or higher serious infections were reported within the first 6 cycles of treatment, when R-mini-CHOP was being coadministered.

The most common TEAE was cytokine release syndrome (CRS), which occurred in 61% of patients; this effect was grade 1 for 32% of patients and grade 2 for 29% of patients. Time to first onset of CRS occurred at a median of 16 days (range, 8-17). Patients were treated with either tocilizumab (Actemra; 29%) or corticosteroids (14%), leading to CRS resolution across all patients affected. The median time to resolution was 2 days (range, 1-7). CRS led to treatment discontinuation in 1 patient. Cheah noted that almost all (90%) CRS events occurred in cycle 1 of treatment.

Additional common TEAEs occurring in 20% or more patients were neutropenia, serious infections, anemia, constipation, fatigue, hypokalemia, and fall. No patients experienced immune effector cell–associated neurotoxicity syndrome (ICANS) or tumor lysis syndrome (TLS).

TEAEs led to discontinuation of epcoritamab in 3 patients (11%), including 1 fatal event, and discontinuation of R-mini-CHOP in 6 patients (21%).

What is the significance of the updated EPCORE NHL-2 data?

“Despite an older population of newly diagnosed diffuse large B-cell lymphoma, the outcomes observed in arm 8 of the EPCORE NHL-2 evaluating fixed-duration epcoritamab plus R-mini-CHOP are encouraging,” Cheah stated in a news release issued by Genmab.⁴ “These results, along with those from other arms of the trial, support the potential for combinations of epcoritamab with standard of care treatment across a range of disease settings and patient populations.”

References

1. Cheah C, Ďuraš J, Belada D, et al. Epcoritamab + R-mini-CHOP results in 2-year remissions and high MRD negativity rates in elderly patients with newly diagnosed DLBCL: Results from the EPCORE NHL-2 trial. Presented at: 2025 ASH Annual Meeting; December 6-9, 2025; Orlando, FL. Abstract 64.
2. Vitolo U, Duell J, Burgues JMB, et al. Fixed-duration epcoritamab monotherapy induces high response and MRD-negativity rates in elderly patients with newly diagnosed large B-cell lymphoma (LBCL) and comorbidities: Results from EPCORE DLBCL-3. Presented at: 2025 ASH Annual Meeting; December 6-9, 2025; Orlando, FL. Abstract 63.
3. Leslie LA, Cheah CY, Morschhauser F, et al. Fixed-duration epcoritamab + R-mini-CHOP in patients with previously untreated diffuse large B-cell lymphoma ineligible for full-dose R-CHOP: Updated results from arm 8 of the Epcore NHL-2 trial. Blood. 2024;144(suppl 1):3106. doi: 10.1182/blood-2024-199652
4. Genmab press release. Genmab announces data from multiple clinical trials showing treatment with fixed-duration epcoritamab led to remissions in first-line diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). News release. Genmab. December 6, 2025. Accessed December 6, 2025. https://ir.genmab.com/news-releases/news-release-details/genmab-announces-data-multiple-clinical-trials-showing-treatment