Dr Nowakowski on Monitoring Epcoritamab-Associated ICANS and CRS in Follicular Lymphoma

Grzegorz S. Nowakowski, MD, consultant, Division of Hematology; enterprise deputy director, Clinical Research, Mayo Clinic Comprehensive Cancer Center, discusses monitoring strategies for immune effector cell-associated neurotoxicity syndrome (ICANS) and cytokine release syndrome (CRS) associated with epcoritamab-bysp (Epkinly) in patients with relapsed/refractory follicular lymphoma.

The package insert for epcoritamab thoroughly outlines the potential complications associated with its use, and physicians are encouraged to review it closely, Nowakowski begins. A key concern is CRS, which is commonly reported with other bispecific antibodies or CAR T-cell therapies and must be monitored vigilantly, Nowakowski says. Although the incidence and severity of CRS with epcoritamab are lower than with CAR T-cell therapies, it is critical for physicians to monitor for signs of fever and constitutional changes related to this toxicity using established protocols like steroids, fluids, and therapy interruptions, he states.

This reflects a pivotal moment in hematological malignancy treatment, as the use of bispecific antibodies is expanding across multiple indications, including multiple myeloma and potentially solid tumors, Nowakowski continues. Medical teams are becoming increasingly adept at recognizing and managing CRS and related complications, which is crucial as these therapies become more common in clinical practice, he adds.

Patient education also plays an important role, Nowakowski continues. Booklets and educational materials are available to inform patients about the symptoms of CRS and neurotoxicity, such as mental status changes or confusion, which require immediate medical attention, he explains. Although neurotoxicity occurs in only a small percentage of patients and is generally low grade, prompt monitoring and management are essential to mitigate risks and ensure the best possible outcomes for patients undergoing treatment with bispecific antibodies, Nowakowski concludes.