From the Research
CAR-T cell therapy after epcoritamab treatment is not recommended without careful consideration due to potential cumulative toxicity risks, but according to the most recent study 1, epcoritamab demonstrated significantly better response rates and overall survival rates than other therapies, with no statistically significant differences in response rates or survival compared to CAR T in R/R LBCL.
Key Considerations
- The mechanism of action of epcoritamab involves T-cell engagement and B-cell depletion, which could potentially affect CAR-T cell expansion and increase the risk of cytokine release syndrome or neurotoxicity when followed by CAR-T therapy 2.
- Patients may experience prolonged cytopenias and increased infection risk with sequential therapy 3.
- Treatment decisions should be individualized based on the patient's disease status, prior response to epcoritamab, performance status, and comorbidities.
- Close monitoring for toxicities including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, and infections is essential if sequential therapy is pursued 4.
Recommendations
- If CAR-T therapy is being considered following epcoritamab, a washout period of at least 2-3 months is typically advised to allow for B-cell recovery and clearance of epcoritamab from the system.
- Prior to proceeding with CAR-T, patients should undergo comprehensive evaluation including assessment of B-cell counts, immunoglobulin levels, and screening for infections.
- The use of enhanced CAR T-cell products, such as huCART19-IL18, may offer improved efficacy and safety in patients with relapsed or refractory lymphoma after previous anti-CD19 CAR T-cell therapy 4.
- Intratumoral T-cell composition may predict epcoritamab-based treatment efficacy in B-cell non-Hodgkin lymphomas, with distinct tumor-resident T-cell profiles associated with response or resistance to bispecific antibody therapy 5.