mosunetuzumab-axgb (Lunsumio)

Indications

• refractory follicular lymphoma

Contraindications

• pregnancy

Dosage

• administer 8 cycles
  • unless complete response, an additional 9 cycles of treatment (17 cycles total)
• premedicate to reduce risk of cytokine release syndrome & infusion-related reaction
• cycle 1 day 1: 1 mg
• cycle 1 day 8: 2 mg
• cycle 1 day 15: 60 mg
• cycle 2 day 1: 60 mg
• cycle 3+ day 1: 30 mg

* a treatment cycle is 21 days

* cycle 1: administer over minimum of 4 hours

* subsequent cycles: administer over minimum of 2 hours if cycle 1 well tolerated

* premedicate with dexamethasone 20 mg or methylprednisolone 80 mg IV, diphenhydramine 50-100 mg, acetaminophen 500-1000 mg 30 minutes prior to infusion (all patients cycles 1 & 2), & subsequent cycles for patients who experienced cytokine release syndrome during cycles 1 & 2.

1 mg/mL: 1 mL, 30 mL

Adverse effects

• common (>= 20%)
  • cytokine release synndrome
  • fatigue, rash, pyrexia, headache
• laboratory abnormalities (>= 10%)
  • lymphopenia, leukopenia, neutropenia, anemia, thrombocytopenia
  • hypoglycemia, hypophosphatemia, increased serum uric acid
• tumor flare
• Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS)
• fetal-embryo toxicity

• drug adverse effects of pharmaceutical monoclonal antibodies

Mechanism of action

• bispecific CD20-directed CD3 T-cell engager

More general terms

• antineoplastic monoclonal antibody