Detailed instructions and instructions for use of Icoritumab

Epcoritumab (Epcoritamab) is a highly innovative immunotherapy drug. Its mechanism of action is based on bispecific T cell engagement technology (BiTE), which can simultaneously target the CD20 antigen (widely expressed on the surface of B-cell lymphoma cells) and the CD3 receptor (present on T cells), thereby achieving immune clearance of tumor cells.

1. Indications:

Icorelatumumab is clinically positioned to treat relapsed or refractory B-cell non-Hodgkin lymphoma, especially patients with diffuse large B-cell lymphoma (DLBCL; non-Hodgkin lymphoma), high-gradeB-cell lymphoma (HGBL) and follicular lymphoma (FL). According to the latest guidelines updated by the FDA and EMA in 2024, icarelatumumab is suitable for adult patients who are relapsed or refractory after receiving two or more lines of systemic therapy. It has a wide range of indications and is another important treatment option after CAR-T and monoclonal antibody therapy.

2. Usage and dosage:

Ikorituzumab is administered by subcutaneous injection, and the dosage regimens for patients with different types of lymphoma are slightly different, reflecting the strategy of individualized treatment and safe progression. For patients with DLBCL or HGBL, a dose escalation regimen is used at the initial stage of treatment to reduce the risk of severe immune reactions. The first dose of 0.16 mg is injected on the 1st day of the first cycle, the second dose is 0.8 mg (day 8), the third dose is the first standard dose of 48 mg (day 15), and the fourth dose of 48 mg is continued on the 22nd day. In subsequent cycles 2 to 3, 48 mg will be injected every week. In cycles 4 to 9, the injection will be once every two weeks. From the 10th cycle onwards, the injection will be once every 28 days. Each cycle is based on 28 days, and the treatment rhythm is relatively regular, taking into account the patient's long-term compliance.

For patients with follicular lymphoma, since the disease progresses relatively slowly, the treatment plan is more conservative and gradual. The initial dose is also 0.16 mg, but is increased in four steps in the first cycle: 0.16 mg on day 1, 0.8 mg on day 8, 3 mg on day 15, and the first full 48 mg dose is injected on day 22. Thereafter, the standard phase was entered, with the dose and frequency consistent with the DLBCL treatment regimen. This incremental strategy can effectively reduce immune activation reactions and reduce the risk of adverse events in the early stages of treatment.

3. Adverse reactions:

During the use of icarelatumumab, clinicians need to pay close attention to two key types of adverse reactions: cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). CRS may manifest as fever, hypotension, dyspnea and other symptoms of immune overactivation. The risk is higher especially when the initial high dose (48 mg) is injected. Therefore, the first use of this dose must be carried out in a hospital environment with emergency rescue conditions and continued observation for at least 24 hours. For ICANS, although the incidence rate is relatively low, if neurological symptoms such as disturbance of consciousness, confusion of speech, or convulsions occur, treatment should be discontinued promptly and symptomatic treatment should be given.

4. Listing status:

At present, icarelatumumab has been launched in countries and regions such as the United States, the European Union, and Canada, but it has not yet been approved in mainland China, so it is temporarily unavailable through local hospitals or medical insurance channels. If there is a need for treatment, original drugs can be obtained under the guidance of doctors through international medical institutions or cross-border drug purchasing platforms. Due to the strict cold chain transportation requirements and high prices of drugs, patients are advised to operate through formal channels to ensure that the sources of drugs are legal and the storage is compliant.

Reference materials:https://www.drugs.com/epcoritamab.html