Odronextamab: a bispecific antibody for follicular lymphoma

Follicular lymphoma (FL) is an indolent lymphoma characterized by repeated relapses and progressively shorter responses with successive lines of therapy, particularly in patients with early progression (POD24). Although chemoimmunotherapy has historically dominated treatment, the therapeutic landscape has shifted toward chemo-free approaches. T-cell-redirecting therapies, including bispecific antibodies, have demonstrated high efficacy in relapsed/refractory (R/R) FL.

This review discusses the role of odronextamab in FL, including its mechanism of action, pharmacokinetic properties, and key clinical efficacy and safety data from the ELM-1 and ELM-2 trials, which supported its approval by the European Medicines Agency (EMA). Future development strategies are also reviewed, including combinations with other agents and use in earlier lines of therapy, including the frontline setting, as investigated in the phase III OLYMPIA-1, OLYMPIA-2, and OLYMPIA-5 studies.

Odronextamab has shown highly promising single-agent activity in R/R FL. Although its efficacy and safety appear broadly comparable to those of mosunetuzumab and epcoritamab, differences in treatment duration, route of administration, dosing frequency, and cytokine release syndrome prophylaxis may influence treatment selection. Ongoing phase III studies may further define its role across the FL treatment continuum.