Expert Insights: Lunsumio VELO’s Fast Follicular Lymphoma Therapy

Dr. Ian Flinn explains in an interview with CURE how Lunsumio VELO (mosunetuzumab) works and its impact on patients with relapsed or refractory follicular lymphoma. He is chief scientific officer at Tennessee Oncology and One Oncology in Nashville, Tennessee.

Unlike traditional treatments, Lunsumio VELO uses a bispecific antibody to bring immune cells directly to lymphoma cells, helping the body fight the cancer naturally.

The subcutaneous version can be given in just one minute, shortening clinic visits and reducing side effects compared with intravenous therapy. This faster, easier approach provides patients with effective treatment while minimizing disruption to their daily lives.

CURE: Could you please explain what Lunsumio VELO is and how it works for patients with relapsed or refractory follicular lymphoma?

Flinn: Lunsumio VELO is a bispecific antibody that targets an antigen on the surface of lymphoma cells called CD20, as well as white blood cell lymphocytes. If I give you a flu shot, you will develop an antibody that protects you against influenza. In the laboratory, we can develop antibodies that target anything we want, including CD20, which is expressed on lymphoma cells. Those are traditionally called naked antibodies. They’re unmodified.

Here, a bispecific antibody targets not only the lymphoma cells, but it also targets white blood cells, in this case lymphocytes that circulate in our blood, and it brings the lymphocyte to the lymphoma cell, where the lymphocyte can then kill the lymphoma cells. This is a novel form of immunotherapy, using your own immune system to fight the cancer.

What makes the subcutaneous formulation different from the intravenous version?

The subcutaneous version of Lunsumio VELO is helpful because it’s a one-minute shot under the skin, similar to how a person with diabetes might receive an injection. It’s quicker, easier, and better tolerated than the IV formulation.

We’ve had Lunsumio VELO for patients with relapsed or refractory follicular lymphoma for a couple of years now, but it’s been given intravenously. That has worked well, but this new formulation makes it easier and safer to give.

Why was there a need for a one-minute injection option for these patients?

From both a patient convenience and safety standpoint, the IV version requires patients to sit in an infusion chair for a much longer period of time. By giving the drug subcutaneously, we can significantly shorten the amount of time patients need to stay in the office.

At the same time, it appears to reduce infusion-related reactions and decrease cytokine release syndrome, which includes symptoms like fever and low blood pressure. Overall, it makes treatment faster and safer for patients.

Could you summarize the key findings from the GO29781 study that led to FDA accelerated approval?

The subcutaneous version of Lunsumio VELO was tested in patients with relapsed or refractory follicular lymphoma who had received at least two prior lines of therapy. There were a little over 90 patients enrolled in this arm of the study.

The antibody was given in a step-up fashion during the first cycle, starting at a lower dose and increasing to the target dose for subsequent cycles. The findings showed that the majority of patients responded, with nearly 59% achieving a complete metabolic remission. These were patients who had already received several prior therapies, so these were very strong results.

The treatment showed high efficacy, ease of use, and a favorable safety profile. Patients did not experience the same toxicities associated with chemotherapy. About 30% of patients experienced cytokine release syndrome, but these were grade 1 or 2 events, meaning most were limited to symptoms like fever. Overall, it was a well-tolerated antibody with high efficacy, moving away from traditional cytotoxic chemotherapy.

How long do responses typically last, and what does a median benefit of 22.4 months mean for patients?

Many of the responses in this study were durable. The 22.4-month figure refers to patients who responded to treatment and how long that benefit lasted. For patients receiving this as a third-line or later therapy, a response lasting nearly two years is considered very durable compared with other available options.

This represents a meaningful benefit for patients, especially when combined with the favorable safety profile.

Are there particular patients who may benefit most from the subcutaneous formulation?

The subcutaneous formulation allows patients to avoid having an IV placed repeatedly and lets them get in and out of the office much more quickly. Treatment can last up to a year for some patients, so minimizing time in the clinic is important.

Both the IV and subcutaneous versions are given for a fixed duration, which is also beneficial. From a quality-of-life standpoint, avoiding a port, shortening clinic visits, and achieving durable remissions are all important. Many patients with follicular lymphoma could benefit from this approach, especially as it moves away from traditional chemotherapy.

Are there ongoing studies combining Lunsumio VELO with other treatments or using it earlier in therapy?

Yes, there are multiple ongoing studies combining Lunsumio VELO with other agents, including lenalidomide and antibody-drug conjugates such as polatuzumab. The combination with lenalidomide is particularly promising, with very high efficacy observed.

Other studies are evaluating Lunsumio VELO in earlier lines of therapy. Ultimately, the greatest impact of bispecific antibodies may come from using them earlier in the disease course, and those trials are ongoing.

How do you see this approval impacting the overall treatment landscape for follicular lymphoma?

Initially, use will likely be limited to later lines of therapy based on the current approval. However, as additional studies mature and guidelines evolve, I expect this treatment to move earlier in the course of disease.

Given its safety, ease of use and high efficacy, Lunsumio VELO has the potential to significantly change how follicular lymphoma is treated, allowing more patients to receive effective therapy earlier in their disease course.

Transcript has been edited for clarity and conciseness.

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.