Chapters Transcript Video Reid W. Merryman, MD discusses results of a multicenter phase II trial Rituximab and epcoritamab as first-line therapy for patients with high-tumor burden follicular lymphoma Chemoimmunotherapy is the most common standard of care for patients with newly diagnosed high tumor burden follicular lymphoma, but CD3 CD20 bi-specific antibodies are challenging the role of chemo immunotherapy and could delay or even obviate the need for chemotherapy in this disease in the future. Epcritumab is a CD3 CD20 bi-specific antibody that is already approved for patients with relapsed or refractory follicular lymphoma. And at Ash this year, we presented data from a phase 2 trial that is combining rituximab and equitumab for patients with newly diagnosed high tumor burden follicular lymphoma. In the trial, patients received 4 weekly doses of rituximab before the first full dose of ecritumab is given, and critumab is continued as a monotherapy for a total duration of treatment of about 9 months. We hypothesize that pre-treatment with rituximab could both lower the risk of cytokine release syndrome and also deepen responses. 35 patients were enrolled on the trial at 3 different US cancer centers, and these patients had frequent high-risk features, including approximately 60% of patients with a high-risk flippy score. So far, 30 of these patients have completed treatment. We've observed very high response rates with the best overall response rate of 97% and a best complete metabolic response rate of 94%. And with approximately 1 year of follow-up, only 1 patient has progressed, yielding a 1-year progression-free survival of 97%. In addition, the toxicity profile for this combination was manageable. Cytokine release syndrome, or CRS was the most common side effect, occurring in about 45% of patients, but was almost entirely grade one, with only 2 cases of grade 2 CRS, suggesting that pre-treatment with rituximab may lower the risk of CRS. Infections of any type were observed in about 60% of patients and were generally low grade, although two patients did discontinue treatment prematurely because of recurrent low grade infections. Our results suggest that bi-specific antibody-based frontline therapy is highly effective, and follow-up for these patients is ongoing. Based on these encouraging results, we have expanded the trial to include an additional 65 patients, and in this expansion cohort, we're making two changes to improve the tolerability and convenience of the regimen for patients. First, decreasing the frequency of epicridumab dosing to every 4 weeks for the last 6 months of therapy. And second, reducing the steroids that are used to prevent CRS during ecritumab dose ramp up. We're excited to continue enrollment for this trial and look forward to sharing initial results from the expansion cohort soon. Published December 18, 2025 Created by Related Presenters Reid Merryman, MD Medical Oncology View Full profile
