Abstract
Introduction: Follicular lymphoma (FL) is an indolent, yet incurable subtype of non-Hodgkin lymphoma characterized by frequent relapses and risk of transformation to an aggressive disease such as diffuse large B-cell lymphoma. Treatment goals include prolonging overall survival, preserving health-related quality of life (QoL), and minimizing treatment-related toxicity. While lenalidomide plus rituximab (R²) is a recognized regimen for relapsed/refractory (R/R) FL that is perceived by clinicians to achieve these treatment goals, no definitive standard of care for R/R FL exists. Epcoritamab, a subcutaneous CD3xCD20 bispecific antibody, has demonstrated promising efficacy in this setting and is approved as monotherapy for R/R FL after ≥2 lines of therapy based on the EPCORE NHL-1 trial. The EPCORE NHL-2 regimen, phase II trial evaluated a fixed-duration (2-year) combination of epcoritamab + R² (ER2) in patients with R/R FL and trial results were presented at American Society of Hematology 2024 annual meeting. Our study assessed United States (US) oncologists' perceptions of treatment options and potential adoption of ER2 regimen in this setting.
Methods:During a live meeting in February 2025, U.S.-based oncologists and hematologists were surveyed regarding their current treatment practices and perceptions of bispecific antibody (BsAbs) therapies, including the ER2 regimen. Respondents who did not treat hematologic malignancies were excluded. Not all participants answered each question. Responses were collected before and after reviewing trial data and summarized using descriptive statistics.
Results: Among 67 participating oncologists (61% dual certified in hematology) the median (range) time in practice was 15 years (3-48), with representation across all U.S. regions. Prior to reviewing ER2 data, 40% of respondents reported administering bispecific antibodies (BsAbs) while 37% reported not currently administering them to patients with R/R FL. Additionally, respondents indicated that BsAbs were most commonly prescribed in the third-line (3L) setting (36%).
Before reviewing trial data, despite 40% reporting BsAb use, only 29% reported they would select BsAbs (i.e., mosunetuzumab, epcoritamab) as their preferred 3L regimen for a hypothetical patient with R/R FL (65-year-old male, stage III, and an ECOG PS of 1 who received R-CHOP in 1L and bendamustine + rituximab in 2L), and most respondents preferred CAR T therapy (42%) for this patient. After reviewing ER2 trial data, 59% of respondents selected epcoritamab + R2 as their preferred 3L treatment for the same hypothetical patient —an increase of 30 percentage points. Additionally, 87% were somewhat likely (46%) or very (41%) likely to use the regimen in the second-line (2L) setting.
The absence of a Risk Evaluation and Mitigation Strategy requirement for epcoritamab was viewed as an advantage by 93%, with 47% of respondents citing it as a major advantage and an equal proportion (47%) considering it a minor advantage. The most frequently cited reason for adopting the ER2 for R/R FL was its defined 2-year fixed duration (59%), followed by efficacy in earlier lines (40%), and subcutaneous administration (32%).
Conclusions: U.S. oncologists demonstrated increased interest in the fixed duration of ER2 following review of EPCORE NHL-2 data, with a notable shift in preference from CAR T to BsAbs in earlier lines of treatment for R/R FL. The regimen's defined treatment duration and potential for use in 2L settings were key drivers of interest. These findings suggest that ER2 may offer a clinically attractive alternative to existing therapies, particularly for patients' ineligible for CAR T or those seeking outpatient, time-limited options. Future studies will further elucidate its role in optimizing sequencing strategies and further clarify the positioning of ER2 in the evolving treatment paradigm for R/R FL.
