Rutgers Cancer Institute of New Jersey and RWJBarnabas Health, New Brunswick, NJ.
Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO.
Clin Lymphoma Myeloma Leuk. 2024 Apr;24(4):240-253. doi: 10.1016/j.clml.2023.12.005. Epub 2023 Dec 12.
BACKGROUND: Mosunetuzumab is a CD20xCD3 T-cell engaging bispecific antibody approved in Europe and the United States for relapsed/refractory (R/R) follicular lymphoma (FL) after ≥ 2 prior therapies. MATERIALS AND METHODS: We present interim safety data from the mosunetuzumab GO29781 (NCT02500407) phase I/II dose-escalation study in R/R non-Hodgkin lymphoma (NHL), focusing on FL. RESULTS: Overall, 218 patients with R/R NHL, including 90 with R/R FL, received a median of eight 21-day cycles of intravenous mosunetuzumab with step-up dosing in Cycle (C) 1 (C1 Day [D] 1, 1 mg; C1D8, 2 mg; C1D15/C2D1, 60 mg; C3D1 and onwards, 30 mg). Cytokine release syndrome (CRS) was the most common adverse event (AE), occurring in 39.4% (NHL) and 44.4% (FL) of patients. Events occurred predominantly during C1 at the first loading dose; the majority were grade 1/2. CRS events were managed at the investigator's discretion with supportive care, steroids, and tocilizumab, based on protocol management guidelines. Immune effector cell-associated neurotoxicity syndrome was uncommon, reported in 0.9% (NHL) and 1.1% (FL) of patients. Neutropenia occurred in 27.5% (NHL) and 28.9% (FL) of patients (mostly grade 3/4) and could be effectively managed using granulocyte colony-stimulating factor. Tumor lysis syndrome occurred in 0.9% (NHL) and 1.1% (FL) of patients (all grade 3/4 with CRS; all resolved). CONCLUSION: Mosunetuzumab monotherapy as treatment for R/R B-cell NHL, including FL, was associated with low rates of severe AEs (including CRS) and is suitable for outpatient administration in the community setting. Adapted protocol guidance for the management of select AEs during mosunetuzumab treatment is included.
背景:Mosunetuzumab 是一种 CD20xCD3 T 细胞结合双特异性抗体,在欧洲和美国被批准用于治疗复发/难治性(R/R)滤泡性淋巴瘤(FL),这些患者此前接受过≥2 种治疗。
材料和方法:我们报告了 mosunetuzumab GO29781(NCT02500407)在复发/难治性非霍奇金淋巴瘤(NHL)中的 I/II 期剂量递增研究的中期安全性数据,重点是 FL。
结果:总体而言,218 例 R/R NHL 患者,包括 90 例 R/R FL 患者,接受了静脉 mosunetuzumab 的中位数为 8 个 21 天周期,在第 1 周期(C1)进行逐步加量(C1D1,1mg;C1D8,2mg;C1D15/C2D1,60mg;C3D1 及以后,30mg)。细胞因子释放综合征(CRS)是最常见的不良事件(AE),在 NHL 和 FL 患者中分别有 39.4%和 44.4%发生。事件主要发生在第一次负荷剂量的 C1 期间;大多数为 1/2 级。根据方案管理指南,CRS 事件由研究者自行决定,采用支持性护理、类固醇和托珠单抗进行管理。免疫效应细胞相关神经毒性综合征罕见,在 NHL 和 FL 患者中分别有 0.9%和 1.1%报告。中性粒细胞减少症在 NHL 和 FL 患者中分别发生了 27.5%和 28.9%(大多数为 3/4 级),可通过使用粒细胞集落刺激因子有效管理。肿瘤溶解综合征在 NHL 和 FL 患者中分别有 0.9%和 1.1%发生(均为 3/4 级伴 CRS;均已解决)。
结论:Mosunetuzumab 单药治疗复发/难治性 B 细胞 NHL,包括 FL,与严重不良事件(包括 CRS)发生率低相关,适合在社区环境下进行门诊管理。还包括了在 mosunetuzumab 治疗期间管理特定不良事件的适应方案指导。
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