Epcoritamab
Epcoritamab-bysp, sold under the brand name EPKINLY in the US and Japan and TEPKINLY in the EU, is a subcutaneously administered, humanized IgG1-bispecific monoclonal antibody that simultaneously binds to CD20 on the surface of B cells, including malignant cells, and CD3 on T cells, thereby facilitating T-cell activation and directed cytotoxicity against CD20-positive lymphoma cells.[1] Developed by Genmab using their proprietary DuoBody® technology in collaboration with AbbVie, it represents a novel class of bispecific T-cell engagers (BiTEs) designed for targeted immunotherapy in B-cell malignancies.[1][2] The U.S. Food and Drug Administration (FDA) first granted accelerated approval to epcoritamab-bysp on May 19, 2023, for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) not otherwise specified, primary mediastinal large B-cell lymphoma, or high-grade B-cell lymphoma after at least two prior lines of systemic therapy.[3] This approval was based on clinical trial data demonstrating an overall response rate of 61% in the pivotal EPCORE NHL-1 study, with 38% achieving complete responses.[3] On June 26, 2024, the FDA expanded accelerated approval to include adult patients with relapsed or refractory follicular lymphoma (FL) after two or more prior lines of systemic therapy, supported by an 82% overall response rate and 60% complete response rate from the same trial cohort.[4][4] It has also received approvals from the European Medicines Agency (EMA) and Japan's Ministry of Health, Labour and Welfare (MHLW) for similar indications in relapsed or refractory B-cell lymphomas.[5][6] Epcoritamab's dosing regimen involves weekly subcutaneous injections in 28-day cycles, with step-up dosing in cycle 1 to mitigate cytokine release syndrome (CRS), a key boxed warning alongside immune effector cell-associated neurotoxicity syndrome (ICANS).[7] Clinical studies have shown durable responses in heavily pretreated patients, positioning it as a chemotherapy-free option in third-line and later settings for aggressive non-Hodgkin lymphomas such as DLBCL and high-grade B-cell lymphoma, as well as indolent follicular lymphoma.[8] Ongoing research explores its potential in earlier lines of therapy and combination regimens to further improve outcomes in B-cell malignancies, including positive results from the Phase 3 EPCORE FL-1 trial of epcoritamab plus rituximab and lenalidomide in relapsed/refractory FL as of August 2025, with an FDA target action date of November 30, 2025.[9][10]Medical uses
Indications
Epcoritamab is indicated for the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS), including DLBCL arising from indolent lymphoma and high-grade B-cell lymphoma, after two or more lines of systemic therapy.[11] This approval, granted under accelerated approval by the FDA in May 2023, is based on response rates and durability of response from the EPCORE NHL-1 trial, where the overall response rate (ORR) was 61% and the complete response (CR) rate was 38% among 148 evaluable patients.[11] The indication was expanded in June 2024 to include adult patients with relapsed or refractory follicular lymphoma (FL) after two or more lines of systemic therapy.[7] In the FL cohort of the EPCORE NHL-1 trial, epcoritamab monotherapy yielded an ORR of 82% and a CR rate of 60% in 127 patients, supporting this accelerated approval.[7] Epcoritamab is under investigation for earlier-line treatment in DLBCL, including frontline combinations with regimens like R-CHOP,[12] as well as in combination with rituximab and lenalidomide for relapsed or refractory FL.[13] Ongoing trials are also evaluating its use in other B-cell malignancies, such as chronic lymphocytic leukemia (CLL), particularly in relapsed or refractory settings with high-risk features.[14] In August 2025, the phase 3 EPCORE FL-1 trial met its dual primary endpoints of progression-free survival for epcoritamab plus rituximab and lenalidomide versus rituximab and lenalidomide alone in relapsed or refractory FL; a supplemental new drug application has been submitted to the FDA, with a target action date of November 30, 2025.[10] These investigational applications leverage epcoritamab's mechanism of targeting CD20-positive B cells to potentially broaden its role in B-cell non-Hodgkin lymphoma management.Dosage and administration
Epcoritamab is administered exclusively via subcutaneous injection by a qualified healthcare professional in a setting equipped to manage severe reactions such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).[7] Patients should be well-hydrated prior to each dose, and certain lower doses (0.16 mg and 0.8 mg) require dilution using either the vial or syringe method with 0.9% sodium chloride injection to achieve the appropriate concentration, while 3 mg and 48 mg doses are administered undiluted.[7] Injection sites should be rotated weekly during cycles 1 through 3, typically in the lower abdomen or thigh, avoiding areas with tattoos, scars, or inflammation.[7] The recommended dosing regimen follows a step-up schedule in 28-day cycles to minimize CRS risk, continuing until disease progression or unacceptable toxicity. For relapsed or refractory diffuse large B-cell lymphoma (DLBCL) or high-grade B-cell lymphoma after at least two prior systemic therapies, a two-step up approach is used in cycle 1: 0.16 mg on day 1, 0.8 mg on day 8, and 48 mg on days 15 and 22.[7] This is followed by 48 mg weekly (days 1, 8, 15, and 22) in cycles 2 and 3, biweekly (days 1 and 15) in cycles 4 through 9, and monthly (day 1) starting from cycle 10.[7] For relapsed or refractory follicular lymphoma (FL) after at least two prior systemic therapies, a three-step up schedule applies in cycle 1: 0.16 mg on day 1, 0.8 mg on day 8, 3 mg on day 15, and 48 mg on day 22, with subsequent cycles mirroring the DLBCL maintenance schedule.[7]| Cycle | Day 1 | Day 8 | Day 15 | Day 22 |
|---|---|---|---|---|
| DLBCL/High-grade B-cell Lymphoma (2-Step Up) | ||||
| Cycle 1 | 0.16 mg | 0.8 mg | 48 mg | 48 mg |
| Cycles 2–3 | 48 mg | 48 mg | 48 mg | 48 mg |
| Cycles 4–9 | 48 mg | - | 48 mg | - |
| Cycle 10+ | 48 mg | - | - | - |
| FL (3-Step Up) | ||||
| Cycle 1 | 0.16 mg | 0.8 mg | 3 mg | 48 mg |
| Cycles 2–3 | 48 mg | 48 mg | 48 mg | 48 mg |
| Cycles 4–9 | 48 mg | - | 48 mg | - |
| Cycle 10+ | 48 mg | - | - | - |