Epcoritamab Is Associated With Higher Travel Burden/Costs in R/R DLBCL and Follicular Lymphoma

Zachary Frosch, MD, MSHP

Findings from an analysis of real-world patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma being treated with bispecific antibodies showed that epcoritamab-bysp (Epkinly) was associated with higher travel burden and costs compared with glofitamab (Columvi) or mosunetuzumab-axgb (Lunsumio), reflective of the agent's more frequent dosing schedule, according to data shared at the 2024 ASH Annual Meeting.

Study author, Zachary Frosch, MD, MSHP, noted that having a better understanding of these burdens and costs will help health care providers and patients make more informed therapy decisions that reflect their personal goals of treatment.

“Travel burden to receive bispecific antibody therapies can be significant for patients,” Frosch said in an the interview with OncLive^®.

In the interview, Frosch delved into details on the investigation of travel burden and costs related to bispecific antibody treatment in relapsed/refractory DLBCL or follicular lymphoma; highlighted the primary challenges faced by patients when receiving bispecific antibodies; and shed light on steps health care providers can take to minimize the travel burden for patients receiving these agents.

Frosch is an assistant professor in the Department of Hematology/Oncology at Fox Chase Cancer Center, Temple Health, in Philadelphia, Pennsylvania.

OncLive: What were the goals of investigating travel burden and costs associated with bispecific antibodies in patients with relapsed/refractory DLBCL or follicular lymphoma?

Frosch: Our [investigation] provided early data regarding the travel burden faced by patients with DLBCL or follicular lymphoma [who were] being treated with 1 of the 3 recently [FDA-approved] bispecific antibodies. Dosing schedules and treatment durations are different between the approved bispecific antibodies, which are glofitamab and epcoritamab for DLBCL, and epcoritamab and mosunetuzumab for follicular lymphoma. These schedule and duration differences could potentially lead to differences in travel burden for patients receiving these approved therapies.

What findings from this investigation were presented at the 2024 ASH Annual Meeting?

We used Medicare claims to estimate the travel burden for each treatment over a 12-month initial time frame. Accounting for all bispecific antibodies in our dataset, [we found that] patients traveled an average distance of 80.1 miles [and a median of 23.7 miles] each way to receive their therapy. Although [56%] of patients traveled less than 30 miles, [24%] traveled over 60 miles each way for treatment.

When extrapolated to the treatment schedules [for each agent] over 12 months, we estimated patients with DLBCL would travel an average of 2243 miles in total to receive glofitamab and 4486 miles to receive epcoritamab. This amounted to an average [difference in] travel time of 40 hours for patients with DLBCL.

Over a 12-month period, those with follicular lymphoma would travel 1602 miles to receive short-course mosunetuzumab [for those in a complete response after 8 cycles], 3044 miles for full-course mosunetuzumab, and 4486 miles for epcoritamab. This amounted to a time difference of 51 hours [for short-course mosunetuzumab vs epcoritamab] and 25 hours [for full-course mosunetuzumab vs epcoritamab].

What are the primary challenges faced by patients with relapsed/refractory DLBCL and follicular lymphoma in terms of travel burden when receiving bispecific antibodies?

The time spent seeking, receiving, and coordinating care can be significant for patients, and this has been termed “time toxicity.” This is time that [patients] can’t spend doing other things that may be important to them. In addition to the time itself, a number of factors may make it harder for patients to travel to receive treatment. These include illness due to their lymphoma or other medical conditions; access to transportation; social support; and financial considerations.

How do factors such as urban vs rural residence and treatment frequency exacerbate or mitigate these challenges?

We saw in our data that travel burden for patients receiving bispecific antibodies can be significant across therapies; however, when extrapolated across a treatment course, dosing frequency and duration can play a role in determining patients’ total travel burden.

From a clinical perspective, how do these financial burdens influence treatment adherence and patient outcomes?

We know that financial toxicity can be significant for patients receiving cancer treatment. Other studies have shown that patients experiencing financial hardship have reduced treatment adherence. Patients with fewer resources are particularly vulnerable, although we also know that financial toxicity can affect even well-insured patients.

One important thing when deciding on treatment is to talk with patients and their caregivers about their priorities, then make treatment decisions together based on [these considerations]. Some patients may prioritize travel burden and time toxicity highly, [whereas these] may be a lower priority for others. Asking about these issues can start an important discussion.

In addition, providing support to overcome some of the other associated barriers, such as financial cost, can help patients, as can potentially seeing what portions of their care could be delivered closer to home.

Reference

Huntington SF, Masaquel A, Esprit M, et al. Travel burden and travel costs of bispecific antibodies in patients with relapsed/refractory diffuse large B-cell lymphoma and relapsed/refractory follicular lymphoma. Blood. 2024;144(suppl 1):782. doi:10.1182/blood-2024-198414