Epcoritamab-bysp (Epkinly ™)
Classification: Targeted Therapy
About: Epcoritamab-bysp (Epkinly ™)
A targeted therapy works by targeting receptors specific to cancer cells. Epcoritamab-bysp is a bispecific CD20-directed CD3 T-cell engager. This medication binds to the CD3 receptor found on the surface of some T-cells and CD20 which is found on some lymphoma cells.
How to Take Epcoritamab-bysp
This medication is given as a subcutaneous injection. That means it is given as a shot into the fatty layer right underneath your skin. It is given in the lower belly or thigh and the injection should be given in a new spot each time it is given. Your dose and how often you receive the medication depends on which cycle day it is in your chemotherapy regimen. Your provider or pharmacist will talk to you about your schedule. Keep in mind you may have to stay in the hospital for 24 hours after some doses.
You may be given pre-medications before each dose. These medications are given to help prevent or manage an allergic reaction or side effects of the medication. These may include a steroid (prednisone or dexamethasone), a histamine-1 (H1) receptor antagonist (such as diphenhydramine/Benadryl), and an antipyretic (such as acetaminophen/Tylenol). You may need to take the steroids for a few days after your dose is given.
Possible Side Effects of Epcoritamab-bysp
There are a number of things you can do to manage the side effects of epcoritamab-bysp. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:
Cytokine Release Syndrome (CRS)
CRS can occur. T cells are activated by this medication, causing them to release many cytokines. The cytokines cause an inflammatory response in the body. This reaction, if left untreated, can be very dangerous. Signs and symptoms may be fever, having a hard time breathing, chills, low blood pressure, fast heart rate, headache, and higher levels of liver enzymes in your blood. Your care team will monitor you closely for CRS while you are receiving this medication. You should call your provider right away if you have any signs or symptoms of CRS so that treatment can be started.
Neurologic Toxicity including ICANS
This medication can cause neurologic toxicity and immune effector cell-associated neurotoxicity. Aphasia (being unable to understand speech or speak normally), being more tired than usual, tremors, confusion, and seizures have happened in patients who received this medication. Your care team will be monitoring you very closely for any changes in your mental status. If you notice any changes, contact your care team right away.
Infection and Low White Blood Cell Count (Leukopenia/Neutropenia)
This medication can cause life-threatening infections, with or without a decrease in white blood cell counts.
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4 °F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
- Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (i.e.: those who have a cold, fever, or cough or live with someone with these symptoms).
- When working in your yard, wear protective clothing including long pants and gloves.
- Do not handle pet waste.
- Keep all cuts or scratches clean.
- Shower or bathe daily and perform frequent mouth care.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your oncology care team before scheduling dental appointments or procedures.
- Ask your oncology care team before you, or someone you live with has any vaccinations.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals, and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
Injection Site Reactions
You may have pain, redness, or swelling at the site of the injection. There is also a chance of allergic reaction with this medication. During the injection and afterward, if you have a hard time breathing or swallowing, facial swelling, have chest pain, "racing" heart, cough or wheezing, develop flushing, hives or rash, nausea or vomiting, lightheadedness, headache, fever, chills, or shakes, let your nurse or care team know right away. Additional medications may be given to help you feel better.
Muscle or Joint Pain/Aches
Your healthcare provider can recommend medications and other strategies to help relieve pain.
Nausea and/or Vomiting
Talk to your oncology care team so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy, or acidic foods (lemons, tomatoes, oranges). Try saltines, or ginger ale to lessen symptoms. Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
Low Red Blood Cell Count (Anemia)
Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your oncology care team know if you experience any shortness of breath, difficulty breathing, or pain in your chest. If the count gets too low, you may receive a blood transfusion.
Low Platelet Count (Thrombocytopenia)
Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your oncology care team know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.
- Do not use a razor (an electric razor is fine).
- Avoid contact sports and activities that can result in injury or bleeding.
- Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib) etc. as these can all increase the risk of bleeding. Please consult with your healthcare team regarding use of these agents and all over the counter medications/supplements while on therapy.
- Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.
This medication can cause kidney problems, including an increased creatinine level, which your oncology care team may monitor for using blood tests. Notify your healthcare provider if you notice decreased urine output, blood in the urine, swelling in the ankles, or loss of appetite.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant while on this medication. Effective birth control is necessary during treatment and for at least 4 months after the last dose. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed during treatment and for at least 4 months after the last dose.