{"entity":{"id":"lymphoma-tx-bispecific-step-up","kind":"term","name":"CD20 bispecific antibodies: step-up dosing, fixed duration and what it is like to take one","aka":["Step-up dosing","T-cell engager lymphoma","Glofitamab schedule","Epcoritamab schedule","Mosunetuzumab schedule"],"tldr":"Bispecific antibodies grab a lymphoma cell with one arm and a T cell with the other. The first doses are deliberately tiny because the first full dose is what causes fever and low blood pressure; after that most people take them as an outpatient.","summary":"Four are in use in lymphoma. Glofitamab (intravenous, for large B-cell lymphoma after two lines) is given for a fixed twelve cycles and then stopped, after a dose of obinutuzumab seven days before the first dose to reduce cytokine release syndrome, and step-up doses of 2.5 mg and 10 mg before the 30 mg target. Epcoritamab (subcutaneous) is given weekly then fortnightly then monthly until progression, with a priming dose and an intermediate dose in cycle 1. Mosunetuzumab (intravenous) is given in 21-day cycles with cycle-1 step-up of 1 mg, 2 mg then 60 mg, for eight cycles if a complete response is reached and up to seventeen otherwise. Odronextamab (intravenous) uses a 0.7/4/20 mg split step-up that reduced grade 3 or worse cytokine release syndrome to 1.7 per cent in the follicular cohort of ELM-2.\n\nWhat it is like. The first cycle usually needs an overnight stay or close observation; fever, chills and a fall in blood pressure in the 24 hours after a step-up dose are common and are managed with paracetamol, fluids, steroids and, if needed, tocilizumab. Neurological events are less frequent than with CAR-T but are looked for at every visit. After cycle 1 to 2 most people attend as outpatients. Infections, and low immunoglobulin levels that persist for months, are the main long-term problem.\n\nWhy fixed duration matters. Glofitamab and mosunetuzumab stop at a set point, which is unusual in lymphoma and means a person can finish. Epcoritamab is given until progression. That difference, not the response rate, is often what decides which one someone wants.","asOf":"2026-09-29","links":[{"label":"Epcoritamab dose expansion in relapsed large B-cell lymphoma, Journal of Clinical Oncology 2023","url":"https://doi.org/10.1200/JCO.22.01725"},{"label":"Mosunetuzumab in relapsed or refractory follicular lymphoma, Lancet Oncology 2022 (complete response 60.0 per cent)","url":"https://doi.org/10.1016/S1470-2045(22)00335-7"},{"label":"Odronextamab in relapsed or refractory follicular lymphoma, ELM-2, Annals of Oncology 2024","url":"https://doi.org/10.1016/j.annonc.2024.08.2239"}],"tags":[],"related":[],"cancers":["dlbcl","follicular-lymphoma","non-hodgkin-lymphoma","marginal-zone-lymphoma"],"sections":[],"technologies":["bispecific-antibody"],"targets":[],"drugs":["glofitamab","epcoritamab","mosunetuzumab","odronextamab","obinutuzumab","tocilizumab"],"companies":[],"institutions":[],"pathways":[],"terms":["crs","icans","lymphoma-tx-crs-icans","lymphoma-tx-immunoglobulin-replacement"],"trials":["epcore-nhl-1","epcore-dlbcl-1","starglo","sunmo"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Treatment jargon"},"route":"/terms/lymphoma-tx-bispecific-step-up/","neighbours":{"cancer":[{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"marginal-zone-lymphoma","kind":"cancer","name":"Marginal zone lymphoma","route":"/cancers/marginal-zone-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"}],"technology":[{"id":"bispecific-antibody","kind":"technology","name":"Bispecific antibodies","route":"/technologies/bispecific-antibody/"}],"drug":[{"id":"epcoritamab","kind":"drug","name":"Epcoritamab","route":"/drugs/epcoritamab/"},{"id":"glofitamab","kind":"drug","name":"Glofitamab","route":"/drugs/glofitamab/"},{"id":"mosunetuzumab","kind":"drug","name":"Mosunetuzumab","route":"/drugs/mosunetuzumab/"},{"id":"obinutuzumab","kind":"drug","name":"Obinutuzumab","route":"/drugs/obinutuzumab/"},{"id":"odronextamab","kind":"drug","name":"Odronextamab","route":"/drugs/odronextamab/"},{"id":"tocilizumab","kind":"drug","name":"Tocilizumab","route":"/drugs/tocilizumab/"}],"term":[{"id":"crs","kind":"term","name":"Cytokine release syndrome (CRS)","route":"/terms/crs/"},{"id":"lymphoma-tx-crs-icans","kind":"term","name":"Cytokine release syndrome and ICANS: grading and management","route":"/terms/lymphoma-tx-crs-icans/"},{"id":"icans","kind":"term","name":"ICANS (neurotoxicity)","route":"/terms/icans/"},{"id":"lymphoma-tx-immunoglobulin-replacement","kind":"term","name":"Immunoglobulin replacement after CAR-T, bispecifics and long anti-CD20 treatment","route":"/terms/lymphoma-tx-immunoglobulin-replacement/"}],"trial":[{"id":"epcore-dlbcl-1","kind":"trial","name":"EPCORE DLBCL-1","route":"/trials/epcore-dlbcl-1/"},{"id":"epcore-nhl-1","kind":"trial","name":"EPCORE NHL-1","route":"/trials/epcore-nhl-1/"},{"id":"starglo","kind":"trial","name":"STARGLO","route":"/trials/starglo/"},{"id":"sunmo","kind":"trial","name":"SUNMO","route":"/trials/sunmo/"}]}}