Epcoritamab (Tepkinly)

Epcoritamab is a targeted cancer drug. You pronounce it as ep-cor-ee-tah-mab. It is also called Tepkinly.

It is a treatment for some people with certain types of high grade B cell lymphoma that have had at least 2 or more systemic treatments and the lymphoma has either:

• come back (relapsed)

• not gone away (refractory)

You may have it as part of a clinical trial .

How does epcoritamab work?

Epcoritamab is a type of monoclonal antibody called a bispecific T-cell engager (BiTE) .

Epcoritamab works by bringing your body’s immune cells and the lymphoma cells together. When they meet it creates a link. This link helps stimulate the immune system to attack and kill the cancer cells.  

How do you have epcoritamab?

Your nurse gives you an injection under the skin (subcutaneous injection) into the stomach or thigh. They alternate between these sites each time you have an injection.

You might have stinging or a dull ache for a short time after this type of injection, but it doesn't usually hurt much. The skin in the area may go red and itchy for a while.

How often do you have epcoritamab?

You have epcoritamab as cycles of treatment. This means you have the drug and then a rest to allow your body to recover.

Each cycle lasts 4 weeks (28 days). You have epcoritamab for as long as the treatment is working, and you are not experiencing too many side effects.

For cycles 1 to 3 you have epcoritamab on days 1, 8, 15 and 22 of each cycle.

For cycles 4 to 9 you have epcoritamab on day 1 and day 15 of each cycle only.

From cycle 10 onwards you have epcoritamab only on day 1 of each cycle.

Epcoritamab can cause a reaction called cytokine release syndrome. Cytokines are a group of proteins in the body that play an important part in boosting the immune system. Epcoritamab stimulates the immune system to make large amounts of cytokines. Before each dose in cycle 1 you have paracetamol, a steroid and an antihistamine drug such as chlorphenamine (Piriton). This is to try and prevent cytokine release syndrome.

During your first cycle of epcoritamab, the dose of epcoritamab you have is increased over time. This is to try and prevent you having an allergic reaction. You receive the full amount of epcoritamab on day 15 of your first cycle. You stay in hospital for 24 hours after this injection.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV . This is called a viral screen.

It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your immune system and can cause the virus to become active again (reactivation). 

What are the side effects of epcoritamab?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs. This is known as petechiae.

Cytokine release syndrome

Cytokines are a group of proteins in the body that play an important part in boosting the immune system. This treatment stimulates the immune system to make large amounts of cytokines. This can cause symptoms which can be severe. Some of the symptoms include fever, chills, a headache, difficulty breathing, and dizziness.

Your doctors and nurses monitor you closely. Depending on how severe your symptoms are you might need treatment with a monoclonal antibody called tocilizumab to control it. You might also have steroids.

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Tummy (abdominal) pain 

Tell your doctor or nurse if you have this. They can check for the cause of the pain and give you medicine to help. 

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Tiredness and weakness (fatigue)

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Inflammation around the injection site

Tell your nurse if you notice any signs of redness or irritation around the injection site.

High temperature (fever)

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

General swelling (oedema)

A build up of fluid (oedema) that may cause swelling in your arms, hands, ankles, legs, face and other parts of the body. Contact your doctor if this happens to you.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• an immune system reaction called a tumour flare, it can make your cancer worsen for a short time - symptoms can include pain, sore and swollen lymph nodes , chest pain, and difficulty breathing
• low levels of phosphate, potassium and magnesium – these are seen on blood tests
• changes to the levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this
• an immune system reaction affecting your central nervous system called immune effector cell associated neurotoxicity syndrome (ICANS) - symptoms can include difficulty speaking or writing, drowsiness, confusion, muscle weakness, memory loss or fits (seizures). Let your healthcare team know straight away if you notice any of these changes
• skin rash
• itching
• changes to how well your liver is working – you have blood tests to check for this

Possible rare and long term side effects

This is a new drug in cancer treatment. So there is limited information available at the moment about possible rare and longer term effects that it may cause. Tell your doctor if you notice anything that is not normal for you.

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant while you are having this treatment and for at least 4 months afterwards.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed for 4 months after your last treatment.

Treatment for other conditions 

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having.

Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, and yellow fever.

You can usually have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine

Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.

Contact with others who have had immunisations 

You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your immune system is weakened.

Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.