Screen for hepatitis B virus in all cancer patients starting systemic treatment. Find out more about hepatitis B virus screening and management.

Drug Formulary

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epcoritamab

( EP-koh-RIH-tah-mab )

Other Name(s): Epkinly™

Appearance: colourless to slightly yellow solution

epcoritamab patient.pdf

epcoritamab pour le patient.pdf

epcoritamab

Pronunciation:

EP-koh-RIH-tah-mab

Other Name(s):

Epkinly™

Appearance:

colourless to slightly yellow solution

This handout gives general information about this cancer medication.

You will learn:

who to contact for help
what the medication is
how it is given
what to expect while on medication

This handout was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.

This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.

Who do I contact if I have questions or need help?

My cancer health care provider is: _____________________________________________

During the day I should contact: _______________________________________________

Evenings, weekends and holidays: _____________________________________________

This page gives general information about this cancer medication.

You will learn:

who to contact for help
what the medication is
how it is given
what to expect while on this medication

This information was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.

This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.

What is this treatment for?

Epcoritamab is used to treat certain types of blood cancers called lymphomas (such as B-cell lymphomas and follicular lymphoma).
Epcoritamab is a T-cell engaging antibody. For more information on T-cell engaging antibodies, click here.

What should I do before I start this treatment?

Tell your health care team if you have or had significant medical condition(s), especially if you have / had:

heart, kidney or liver problems,
problems with your nervous system (brain and nerves),
an active infection, or
any allergies.

Remember To:

Tell your health care team about all of the other medications you are taking.
Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.

You will have a blood test to check for hepatitis B before starting treatment. See the Hepatitis B and Cancer Medications pamphlet for more information.

How is this treatment given?

This drug is given under your skin using a small needle (subcutaneous or Subcut).
You may be admitted to hospital when you get your first treatments so that your health care team can monitor how your body reacts. Your healthcare team will give you medications before your treatments to help prevent side effects.
Your epcoritamab injection will be given according to a step-up schedule (also known as ramp-up) for the first 3 doses. This means that your doses will start off smaller and will be increased over time so that your health care team can make sure you do not have any issues with the medication. Talk to your health care team about your treatment schedule.
If you missed your treatment appointment, talk to your health care team to find out what to do.

Other medications you may be given with this treatment

To Prevent Allergic Reaction

You will be given medications before your treatment to help prevent allergic reactions before they start and help prevent side effects

There are different types of medications to stop allergic reactions. They are called:
- antihistamines (such as diphenhydramine or Benadryl®)
- analgesics/antipyretics (such as acetaminophen or Tylenol®)
- corticosteroids (such as prednisone or dexamethasone)

To Prevent Infection from Herpes Zoster Virus (Shingles)

You may be given medication to take before your treatment to prevent infection from the Herpes Zoster virus.

These are called anti-virals (such as acyclovir or valacyclovir).

To Prevent Infection from Bacteria

You may be given a medication to take before your treatment to prevent infection.

These are called antibiotics (such as trimethoprim-sulfamethoxazole).

To Prevent Tumor Lysis Syndrome (TLS)

TLS can happen when a large number of cancer cells die quickly and your body cannot get rid of them fast enough. TLS can make you very sick. Ask your health care team if you are at risk for TLS.

If you are at risk for TLS, you may be given medications before your epcoritamab treatment to help prevent it.

These are called anti-uricemics (such as allopurinol), or others.

To Prevent Hepatitis B Flare Ups

If you have ever been infected with hepatitis B, there is a risk that this treatment can cause it to flare up (come back). Tell your health care team if you have had hepatitis B. You may need to take medication to prevent a hepatitis B flare-up.

Other important things for you to know about this treatment

Epcoritamab causes your immune system to work harder. Your immune system is what fights infections and your cancer.

When your immune system is working harder, it can also damage healthy cells. This can cause side effects that are different from other cancer medications, like chemotherapy.

Cytokine release syndrome (CRS) can happen when your immune system responds aggressively to epcoritamab. CRS usually happens during the ramp up schedule and with your first full dose. The symptoms can be mild but can also quickly become severe and life-threatening.

CRS can be treated. It is important to catch it early so that the treatment has the best chance of working well. Talk to your healthcare team right away if you have any of the following signs of CRS:

Fever higher than 38°C
Trouble breathing
Fast or irregular heartbeat
Flu-like symptoms (such as chills, body aches and fatigue)
Severe nausea, vomiting or diarrhea

Immune effector cell-associated neurotoxicity syndrome (ICANS) is a side effect from epcoritamab that affects your nervous system (brain and nerves). ICANS can happen on its own, or together with CRS. It can start during treatment, up to a week after treatment, or may start a few days after developing CRS.

ICANS is treatable, and it is very important to manage it as quickly as possible. You should talk to your health care team right away if you have any of the following signs of ICANS:

Headaches that are new or worse than usual
Drowsiness or weakness
Tremors
Chills or shaking
Change in handwriting
Trouble speaking or swallowing
Seizures

Ask your health care team for the Treating cancer with T-cell engaging antibodies: What you need to know pamphlet for more information.

You will be given a wallet card that has information and instructions for other health care providers about your treatment and possible side-effects. Show this card to all health care providers, especially if you need to go to the emergency room.

DO this while on treatment

DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures. You will need to wait 4 weeks after receiving a live vaccine before you can start epcoritamab treatement.

DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy, dizzy or confused after your treatment.

DO tell your health care team about any serious infections that you have now or have had in the past. This includes herpes virus (such as Shingles) or Hepatitis B infections.

DO NOT do this while on treatment

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DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.

DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products without checking with your health care team.

DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your health care team.

DO NOT drive, operate machinery or do any tasks that need you to be alert if you feel tired, dizzy, or confused.

DO this while on treatment

Check Mark Icon

DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures. You will need to wait 4 weeks after receiving a live vaccine before you can start epcoritamab treatement.

DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy, dizzy or confused after your treatment.

DO tell your health care team about any serious infections that you have now or have had in the past. This includes herpes virus (such as Shingles) or Hepatitis B infections.

DO NOT do this while on treatment

Stop Icon

DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.

DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products without checking with your health care team.

DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your health care team.

DO NOT drive, operate machinery or do any tasks that need you to be alert if you feel tired, dizzy, or confused.

Will this treatment interact with other medications or natural health products?

Yes, this medication can interact with other medications, vitamins, foods and natural health products. Interactions can make this medication not work as well or cause severe side effects.
- Tell your health care team about all of your:
  - prescription and over-the-counter (non-prescription) medications
  - natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements
- Check with your health care team before starting or stopping any of them.
If you are taking a blood thinner (such as warfarin), your health care team may need extra blood tests and may change your dose.

Talk to your health care team BEFORE taking or using these :

Anti-inflammatory medications such as ibuprofen (Advil^® or Motrin^®), naproxen (Aleve^®) or Aspirin^®.
Over-the-counter products such as dimenhydrinate (Gravol^®)
Natural health products such as St. John’s Wort
Supplements such as vitamin C
Grapefruit juice
Alcoholic drinks
Tobacco
All other drugs, such as marijuana or cannabis (medical or recreational)

What to do if you feel unwell, have pain, a headache or a fever

Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol^®) or ibuprofen (Advil^®)).
- Fever can be a sign of infection or CRS that may need treatment right away.
- If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection or CRS.

How to check for fever:

Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).

You have a fever if your temperature taken in your mouth (oral temperature) is:
- 38.0°C (100.4°F) or higher.

If you do have a fever:

Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
Ask your health care team for the Treating cancer with T-cell engaging antibodies: What you need to know pamphlet for more information.

If you do not have a fever but have mild symptoms such as headache or mild pain:

Ask your health care team about the right medication for you. Acetaminophen (Tylenol^®) is a safe choice for most people.

Talk to your health care team before you start taking ibuprofen (Advil^®, Motrin^®), naproxen (Aleve^®) or ASA (Aspirin^®), as they may increase your chance of bleeding or interact with your cancer treatment.

Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.

How will this treatment affect sex, pregnancy and breastfeeding?

Talk to your health care team about:

How this treatment may affect your sexual health
How this treatment may affect your ability to have a baby, if this applies to you

This treatment may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.

If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time until at least 4 months after your last treatment dose. Talk to your health care team about which birth control options are best for you.

Do not breastfeed while on this treatment and for at least 4 months after your last dose.

What are the side effects of this treatment?

The following table lists side effects that you may have when getting epcoritamab treatment. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.

Read over the side effect table so that you know what to look for and when to get help. Refer to this table if you experience any side effects while on epcoritamab treatment.

Some side effects can become serious or life-threatening very quickly. You must tell your health care team right away if:

You start to have any new side effects, especially if severe.
You notice any of your side effects getting worse.

Very Common Side Effects (50 or more out of 100 people)
Cytokine release syndrome (May be severe) Cytokine release syndrome (CRS) can happen when your immune system responds aggressively to epcoritamab. This can cause the release of a large amount of proteins called cytokines. CRS usually happens at the start of treatment, when your immune system is activated (during or after your first 3 doses). Symptoms of CRS can be mild but can also quickly become severe and life-threatening. Your health care team will monitor you more closely during your first doses and do blood tests as necessary. What to look for? Fever. Sometimes the fever can be high (more than 40ºC). And, you may also have: Trouble breathing Fast or irregular heartbeats Flu-like symptoms (such as chills, body aches and fatigue) Severe nausea, vomiting or diarrhea Signs of low blood pressure, such as dizziness Symptoms usually happen within hours to days of when treatment is given. What to do? Tell your nurse right away if you feel any signs of CRS during or just after your treatment. Symptoms may worsen quickly. Check your temperature to see if you have a fever. Read the above section “What should I do if I feel unwell, have pain, a headache or a fever?” If you have left the hospital and you have any signs of CRS, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away.	Talk to your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.

Very Common Side Effects (50 or more out of 100 people)

Side effects and what to do

When to contact health care team

Cytokine release syndrome

(May be severe)

Cytokine release syndrome (CRS) can happen when your immune system responds aggressively to epcoritamab. This can cause the release of a large amount of proteins called cytokines.

CRS usually happens at the start of treatment, when your immune system is activated (during or after your first 3 doses).

Symptoms of CRS can be mild but can also quickly become severe and life-threatening. Your health care team will monitor you more closely during your first doses and do blood tests as necessary.

What to look for?

Fever. Sometimes the fever can be high (more than 40ºC).
And, you may also have:
- Trouble breathing
- Fast or irregular heartbeats
- Flu-like symptoms (such as chills, body aches and fatigue)
- Severe nausea, vomiting or diarrhea
- Signs of low blood pressure, such as dizziness
Symptoms usually happen within hours to days of when treatment is given.

What to do?

Tell your nurse right away if you feel any signs of CRS during or just after your treatment. Symptoms may worsen quickly.
Check your temperature to see if you have a fever. Read the above section “What should I do if I feel unwell, have pain, a headache or a fever?”
If you have left the hospital and you have any signs of CRS, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away.

Talk to your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.

Common Side Effects (25 to 49 out of 100 people)
Side effects and what to do	When to contact health care team
Fatigue What to look for? Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep. What to do? Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days. Check with your health care team before starting any new exercise. Pace yourself, do not rush. Put off less important activities. Rest when you need to. Ask family or friends to help you with things like housework, shopping, and child or pet care. Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your health care team has told you to drink more or less). Avoid driving or using machinery if you are feeling tired. Ask your health care team for the Fatigue pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe.
Reactions at the injection site What to look for? Your skin may become red, itchy, bruised, and/or swollen where the injection was given. Site reactions are usually mild and go away within one to three days. What to do? You may need to apply hot compresses or ice/cold compresses if you have mild redness or discomfort. This depends on which medication caused the reaction. Talk to your health care team to find out which treatment is right for you.	Talk to your health care team if this bothers you.
Low neutrophils (white blood cells) in the blood (neutropenia) (May be severe) When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information. What to look for? If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever. Do not take medications that treat a fever before you take your temperature (for example, Tylenol® (acetaminophen), or Advil® (ibuprofen)). Do not eat or drink anything hot or cold right before taking your temperature. You have a fever if your temperature taken in your mouth (oral temperature) is: 38.0°C (100.4°F) or higher. What to do? If your health care team has told you that you have low neutrophils: Wash your hands often to prevent infection. Check with your health care team before getting any vaccines, surgeries, medical procedures or visiting your dentist. Keep a digital thermometer at home so you can easily check for a fever. If you have a fever: If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.	If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away.
Low platelets in the blood (May be severe) When your platelets are low, you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information. What to look for? Watch for signs of bleeding: bleeding from your gums unusual or heavy nosebleeds bruising easily or more than normal black coloured stools (poo) or blood in your stools (poo) coughing up red or brown coloured mucus dizziness, constant headache or changes in your vision heavy vaginal bleeding red or pink coloured urine (pee) What to do? If your health care team has told you that you have low platelets: Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication. Check with your healthcare team before you go to the dentist. Take care of your mouth and use a soft toothbrush. Try to prevent cuts and bruises. Ask your health care team what activities are safe for you. Your treatment may have to be delayed if you have low platelets. Your health care team may recommend a blood transfusion. If you have signs of bleeding: If you have a small bleed, clean the area with soap and water or a saline (saltwater) rinse. Apply pressure for at least 10 minutes. If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away.	Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop or is severe (very heavy), you MUST get emergency help right away.

Less Common Side Effects (10 to 24 out of 100 people)
Side effects and what to do	When to contact health care team
Diarrhea What to look for? Loose, watery, unformed stool (poo) that may happen days to weeks after you get your treatment. What to do? If you have diarrhea: Take anti-diarrhea medication if your health care team prescribed it or told you to take it. Do not eat foods or drinks with artificial sweetener (like chewing gum or ‘diet’ drinks), coffee and alcohol, until your diarrhea has stopped. Eat many small meals and snacks instead of 2 or 3 large meals. Drink at least 6 to 8 cups of liquids each day, unless your health care team has told you to drink more or less. Talk to your health care team if you can’t drink 6 to 8 cups of liquids each day when you have diarrhea. You may need to drink special liquids with salt and sugar, called Oral Rehydration Therapy. Talk to your health care team if your diarrhea does not improve after 24 hours of taking diarrhea medication or if you have diarrhea more than 7 times in one day. Ask your health care team for the Diarrhea pamphlet for more information.	Talk to your health care team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in one day).
Nausea and vomiting (Generally mild) What to look for? Nausea is feeling like you need to throw up. You may also feel light-headed. You may feel nausea within hours to days after your treatment. What to do? To help prevent nausea: It is easier to prevent nausea than to treat it once it happens. If you were given anti-nausea medication(s), take them as prescribed, even if you do not feel like throwing up. Drink clear liquids and have small meals. Get fresh air and rest. Do not eat spicy, fried foods or foods with a strong smell. Limit caffeine (like coffee, tea) and avoid alcohol. If you have nausea or vomiting: Take your rescue (as-needed) anti-nausea medication(s) as prescribed. Ask your health care team for the Nausea & Vomiting pamphlet for more information. Talk to your health care team if: nausea lasts more than 48 hours vomiting lasts more than 24 hours or if it is severe	Contact your healthcare team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours.
Rash; dry, itchy skin What to look for? You may have cracked, rough, flaking or peeling areas of the skin. Your skin may look red and feel warm, like a sunburn. Your skin may itch, burn, sting or feel very tender when touched. What to do? To prevent and treat dry skin: Use fragrance-free skin moisturizer. Protect your skin from the sun and the cold. Use sunscreen with UVA and UVB protection and a SPF of at least 30. Avoid perfumed products and lotions that contain alcohol. Drink 6 to 8 cups of non-alcoholic, non-caffeinated liquids each day, unless your health care team has told you to drink more or less. Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.	Talk to your health care team if it does not improve or if it is severe.
Mild swelling What to look for? You may have mild swelling or puffiness in your arms and/or legs. Rarely, this may be severe. What to do? To help prevent swelling: Eat a low-salt diet. If you have swelling: Wear loose-fitting clothing. For swollen legs or feet, keep your feet up when sitting.	Talk to your health care team if it does not improve or if it is severe.
Constipation What to look for? Having bowel movements (going poo) less often than normal. Small hard stools (poo) that look like pellets. The need to push hard and strain to have any stool (poo) come out. Stomach ache or cramps. A bloated belly, feeling of fullness, or discomfort. Leaking of watery stools (poo). Lots of gas or burping. Nausea or vomiting. What to do? To help prevent constipation: Try to eat more fiber rich foods like fruits with skin, leafy greens and whole grains. Drink at least 6 to 8 cups of liquids each day unless your health care team has told you to drink more or less. Be Active. Exercise can help to keep you regular. If you take opioid pain medication, ask your health care team if eating more fibre is right for you. To help treat constipation: If you have not had a bowel movement in 2 to 3 days you may need to take a laxative (medication to help you poo) to help you have regular bowel movements. Ask your health care team what to do. Ask your health care team for the Constipation Pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe.
Mild headache, joint, muscle pain or cramps What to look for? Mild headache New pain in your muscles or joints, muscle cramps, or feeling achy What to do? Take pain medication (such as acetaminophen) as needed or as prescribed (opioids such as codeine, morphine, hydromorphone, oxycodone). Read the above section: "What should I do if I feel unwell, have pain, a headache or a fever?" before taking acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or Aspirin. These medications may hide an infection that needs treatment or they may increase your risk of bleeding. Ask your health care team for the Pain pamphlet for more information. If you have a sudden, severe headache get emergency medical help right away.	Talk to your health care team if it does not improve or if it is severe.
Low appetite What to look for? Loss of interest in food or not feeling hungry Weight loss What to do? Try to eat your favourite foods. Eat small meals throughout the day. You may need to take meal supplements to help keep your weight up. Talk to your health care team if you have no appetite. Ask your health care team for the Loss of Appetite pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe.
Heart problems (May be severe) What to look for? You may have an irregular heartbeat, shortness of breath, chest pain or fainting spells. Swelling in your legs, ankles and belly. Sharp pain in the centre or left side of the chest (often worsens when taking a deep breath). Extreme tiredness that prevents you from exercising or doing normal activities. What to do? Get emergency medical help right away.	Get emergency medical help right away.

Other rare, but serious side effects are possible with this treatment.

If you have any of the following, talk to your cancer health care team or get emergency medical help right away:

Yellowing of the skin or eyes
Unusually dark pee or pain on the right side of your belly
Changes in urination (peeing) such as less urine than usual
Muscle twitches and cramps or itchiness that won't go away
Tremors, weakness or trouble walking
Trouble with swallowing or speaking
Confusion or trouble with memory
Seizures
Pain or swelling in your joints or swelling in your hands, ankles, feet or other areas of your body
Pain, swelling and hardening of a vein in your body or limbs
New cough, problems breathing, or coughing up blood

For more information on how to manage your symptoms ask your health care provider, or visit: https://www.cancercareontario.ca/symptoms.

Notes

January 2025 Updated patient information sheet

The information set out in the medication information sheets, regimen information sheets, and symptom management information (for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.

A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.

epcoritamab

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