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Fixed-duration subcutaneous mosunetuzumab shows favorable efficacy and safety versus IV in relapsed follicular lymphomaSubcutaneous Mosunetuzumab Shows Promise for Follicular Lymphoma Patients

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Key Takeaway
Consider fixed-duration subcutaneous mosunetuzumab for relapsed follicular lymphoma after two prior therapies.

This Phase 2 primary analysis assessed fixed-duration subcutaneous mosunetuzumab compared with mosunetuzumab IV in patients with relapsed or refractory follicular lymphoma who had received at least two prior therapies. The study population comprised 94 patients in the subcutaneous group and 90 patients in the IV comparator group. Median follow-up was 26.1 months for the subcutaneous group and 22.5 months for the IV group.

Primary outcomes included pharmacokinetic endpoints, while secondary outcomes covered overall response rate, complete response rate, median duration of complete response, median progression-free survival, and cytokine release syndrome events. Overall response rate was 76.6% (95% CI: 66.7-84.7) for subcutaneous administration and 61.7% (95% CI: 51.1-71.5) for complete response. Median duration of complete response was 34.6 months (95% CI: 20.7-not evaluable) for subcutaneous administration and 23.7 months (95% CI: 14.6-not evaluable) for progression-free survival.

Safety analysis showed cytokine release syndrome events occurred in 29.8% of subcutaneous patients versus 44.4% of IV patients. Grade 2 or higher severity events were 9.6% (SC) versus 18.9% (IV). Pharmacokinetic exposure showed a geometric mean ratio of 1.39 (90% CI: 1.20-1.61) for concentration and 1.06 (90% CI: 0.92-1.21) for AUC, both non-inferior. The study reported a favorable safety profile versus mosunetuzumab IV. Limitations include the Phase 2 design and lack of reported absolute numbers for outcomes.

This Phase 2 trial looked at a new way to give the drug mosunetuzumab for follicular lymphoma. Ninety-four patients received the drug under the skin, while ninety others received the same drug through an IV line. Both groups had already tried at least two other treatments.

The study measured how well the drug worked and how patients tolerated it. Results showed that the subcutaneous version led to an overall response rate of 76.6 percent and a complete response rate of 61.7 percent. The median duration of complete response was 34.6 months, and median progression-free survival was 23.7 months.

Safety was a major focus. The subcutaneous form caused cytokine release syndrome events in 29.8 percent of patients, compared to 44.4 percent with the IV form. Severe events, defined as grade 2 or higher, occurred in 9.6 percent of the subcutaneous group versus 18.9 percent of the IV group. The primary analysis focused on pharmacokinetic endpoints, which confirmed non-inferiority between the two methods.

Because this is a Phase 2 study, the findings are early and need more confirmation. The subcutaneous route offers a potentially easier administration option with a favorable safety profile compared to the IV comparator.

What this means for you:
Subcutaneous mosunetuzumab showed similar effectiveness to IV with fewer severe side effects in this early trial.

Study Details

Study typePhase2
EvidenceLevel 3
PublishedMay 2026
View Original Abstract ↓
Mosunetuzumab is approved as an intravenous (IV) formulation for relapsed/refractory (R/R) follicular lymphoma (FL) after ≥ 2 prior therapies. A subcutaneous (SC) formulation, aiming to improve patient safety and convenience, has been developed. We report the primary analysis of pharmacokinetics (PK), efficacy, and safety of mosunetuzumab SC (N = 94; median follow-up: 26.1 months) at the recommended Phase 2 dose (Cycle [C]1 Day [D]1: 5 mg; C1D8 and D15, and C2D1 onwards: 45 mg) in patients with R/R FL after ≥ 2 prior therapies, alongside data from a within-study comparator cohort of mosunetuzumab IV in a similar patient population (N = 90; median follow-up: 22.5 months). The co-primary PK endpoints (C and AUC) were met, demonstrating non-inferior exposure of mosunetuzumab SC versus IV (observed C: geometric mean ratio [GMR] 1.39 [90% confidence interval (CI): 1.20-1.61]; AUC: GMR 1.06 [90% CI: 0.92-1.21]). Mosunetuzumab SC efficacy was consistent with IV: overall response rate, 76.6% (95% CI: 66.7-84.7); complete response rate, 61.7% (95% CI: 51.1-71.5); median duration of complete response, 34.6 months (95% CI: 20.7-not evaluable [NE]); and median progression-free survival, 23.7 months (95% CI: 14.6-NE). Mosunetuzumab SC demonstrated a favorable safety profile versus mosunetuzumab IV with a numerically lower rate (29.8% vs. 44.4%) and severity (grade ≥ 2: 9.6% vs. 18.9%) of cytokine release syndrome (CRS) events. Mosunetuzumab SC combines the benefits of short administration time, fixed-duration treatment, outpatient accessibility, and low CRS rate, offering clinically meaningful improvements in patient convenience and safety. Trial Registration: www.clinicaltrials.gov: NCT02500407.
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