Patient-reported time toxicity with bispecific antibody therapies in relapsed/refractory follicular lymphoma and diffuse large B-cell lymphoma.

This study highlights that patients with relapsed/refractory follicular lymphoma and diffuse large B-cell lymphoma experience different amounts of “time toxicity” (ie, the time spent receiving cancer care), depending on which type of bispecific antibody they receive. Some bispecific antibodies require more frequent visits and longer treatment duration than others, leading to more time spent on attending clinics, receiving care, travelling, and recovery, even if efficacy and safety are similar. Recognizing these differences can enable more informed, patient–physician treatment decision-making that considers clinical outcomes as well as patient convenience and overall time burden.

Introduction

Bispecific antibody (BsAb) therapies have revolutionized the management of non-Hodgkin lymphoma (NHL), with Food & Drug Administration (FDA) approvals of mosunetuzumab and epcoritamab in relapsed/refractory (R/R) follicular lymphoma (FL) 1 , 2 and glofitamab and epcoritamab in diffuse large B-cell lymphoma (DLBCL) 2 , 3 after two or more prior systemic therapies, as well as several ongoing clinical trials in various settings. 4 Treatment approaches (ie, treatment duration and dosing frequency) differ between these BsAbs. Mosunetuzumab and glofitamab are administered for a fixed duration: after the initial step-up dosing phase with three administrations in cycle 1, mosunetuzumab is administered every 3 weeks for eight cycles if a complete response is achieved, or up to 17 cycles, 1 and glofitamab is administered every 3 weeks for 12 cycles. 3 In contrast, epcoritamab, when given as monotherapy, is administered more frequently, with weekly dosing for the first 3 months and every 2 weeks thereafter until progression. 2 Without head-to-head clinical trials, BsAb selection is based upon considerations of safety, efficacy, and patient priorities, including quality of life, costs of care, and time burden of therapy.

Differences in treatment approaches may significantly influence the cumulative time spent receiving cancer care, often referred to as “time toxicity”. 5 Time toxicity refers to the burden of days spent physically interacting with the healthcare system, including time spent receiving anti-cancer treatments in an infusion center, clinic visits, procedures, laboratory testing, imaging studies, urgent care and emergency room visits, hospitalizations, traveling to/from appointments, parking, waiting time, and scheduling and coordinating appointments. 6 , 7 Altogether, these factors support the assertion that any in-person, physical healthcare contact day may be considered a “lost day” by patients and their care partners. 7 Time toxicity is particularly relevant when the durability of response (disease curability) from treatments is not yet established and patients may need to consider how much time they want to spend with and without healthcare contact during their limited lifetime, a particular concern among patients with advanced or metastatic solid tumor malignancies, where treatment goals are palliative and aim to improve quality of life. 5 Due to the considerable implications of time toxicity, including emotional, financial, and social impacts on the wellbeing of patients with cancer and their care partners, 6 it is critical to assess time toxicity when making treatment decisions.

Patients with R/R FL or DLBCL face substantial disease burden and may require multiple additional lines of therapy and workup, including labs and imaging, which can lead to increased healthcare resource utilization (HRU) and costs. 8–10 The time toxicity of BsAbs has previously been evaluated based on registrational trial protocols: mosunetuzumab and glofitamab were associated with lower time toxicity of approximately 2 weeks over the first year of treatment compared with epcoritamab in R/R FL and DLBCL. 11 , 12 However, relying on registrational trial protocols is insufficient to fully understand time toxicity, as this does not account for unexpected healthcare visits (eg, for adverse events) nor additional aspects of time toxicity (eg, travel, home care coordination, recovery). There is a need for time toxicity to be investigated using real-world data reported by patients treated in routine clinical practice, as clinical trials have a highly selective patient population (eg, fitness, comorbidities), which may not be representative of the general population.

We designed this patient-centered, real-world study to comprehensively measure time toxicity from the perspective of patients who have received different BsAbs for R/R FL or R/R DLBCL. This study also sought to evaluate patient preferences and perceived convenience between distinct BsAb treatment schedules.

Methods

An online survey was conducted between April and July 2025 to collect de-identified, self-reported data from patients with R/R FL or R/R DLBCL currently receiving BsAbs in the real-world setting. Participants were recruited by convenience sampling and were referred to the online survey through a network of United States (U.S.)-based hematologists and an objective third-party data vendor, Global Perspective (IQVIA). Eligibility criteria were: ≥18 years, FL/DLBCL diagnosis, residing in the U.S., able to read and understand English, currently receiving BsAb monotherapy for ≥1 month (FL: mosunetuzumab or epcoritamab; DLBCL: glofitamab or epcoritamab), received ≥1 prior treatment for FL/DLBCL, and no enrollment in any BsAb clinical trials. A screener in the online survey excluded individuals who did not meet these inclusion criteria. The full survey is available in the Supplement .

Details on the survey design are provided in the Supplement and Table S1 . The final survey was 20–25 minutes in length and included four key sections: (1) participant characteristics and caregiver status; (2) all-cause healthcare visits and time spent on cancer-related HRU; (3) impact of treatment visits on daily activity, volunteering, and work productivity; and (4) treatment preferences and convenience of different treatment approaches and time required. The survey was administered through an online link coordinated by Global Perspective. This study received an exemption from the Pearl Institutional Review Board.

All data collected in the survey was self-reported by participants. Participant characteristics and caregiver status were measured as of the date of survey completion. All-cause healthcare visits were measured by participants recalling the visits and/or services received in the past 30 days related to BsAb treatment, disease management, or any other reason. Participants also recalled the time spent on visits related to BsAb treatment and disease management, including attending visits, traveling to and from visits, scheduling and coordinating visits, and recovering at home after visits. Participants were asked to rate the impact of BsAb treatment-related visits on regular, non-work daily activities on a 5-point scale: no effect, little effect, moderate effect, large effect, and completely prevented daily activities.

Additionally, participant preferences and convenience were assessed through direct elicitation of choice between two hypothetical treatment profiles, assuming the same efficacy and safety: fixed-duration, less frequently dosed, and less time required (option 1) versus treat-to-progression, more frequently dosed, and more time required (option 2). No treatment names or types were presented to participants ( Supplementary Methods and Figure S1 ).

Participant-reported characteristics, all-cause healthcare visits in the past 30 days, total time spent on cancer-related HRU (defined as a combination of BsAb treatment-related and disease management-related visits; including clinic and infusion visit time, travel time, scheduling and coordinating time, and recovery time) per participant per month (PPPM), and the proportion of participants preferring the convenience of different hypothetical treatment profiles were all descriptively summarized. Recovery time reflects the duration until resumption of normal activities and did not capture specific recovery-related activities.

For each BsAb (within each disease indication), continuous variables were compared using independent t-tests and categorical variables using Pearson’s chi-squared tests. For each indication, mean differences between BsAb cohorts were calculated and compared using independent t -tests at a significance level of 0.05. All analyses were conducted using SAS® Enterprise Guide 7.1.

Results

Of 132 patients who accessed the survey, 120 (91%) participants with R/R NHL receiving BsAbs completed the survey, including 60 with FL and 60 with DLBCL.

Participants with FL

Participant characteristics and caregiver status

Among participants with FL ( N = 60), self-reported characteristics were comparable between those receiving mosunetuzumab ( N = 30) and epcoritamab ( N = 30) ( Table 1 and Table S2 ). Mean age was similar (57 vs 58 years), most participants were female (60% vs 73%), there were similar proportions of people of color (23% vs 37%), most were based in Western states (87% vs 83%) and urban/suburban areas (77% and 93%), and most were privately insured (67% vs 63%), for participants receiving mosunetuzumab and epcoritamab, respectively. Among all participants, common comorbidities included anxiety, depression, and diabetes. Additionally, most participants receiving mosunetuzumab and epcoritamab had a college education or higher (57% for both), were predominantly in a relationship (73% vs 67%), and had a change in employment status since diagnosis (53% vs 57%), respectively. Common employment changes included disability leave, early retirement, and unemployment. All participants had unpaid caregivers ( Table S3 ).

BsAb treatment experience

Among all participants with FL, most received mosunetuzumab and epcoritamab in academic settings (70% and 60%, respectively) ( Table 2 ). Mean (standard deviation [SD]) duration of treatment was different between mosunetuzumab (6.2 [1.7] months) and epcoritamab (5.2 [1.8] months). Most participants had been receiving their current BsAb for 4–12 months (mosunetuzumab: 100%; epcoritamab: 83% [17% had been receiving epcoritamab for 1–3 months]), and in the third-line setting or later (3L+) (mosunetuzumab: 73%; epcoritamab: 80%). All participants had received prior chemotherapy, with a minority having received stem cell transplant and chimeric antigen receptor (CAR) T-cell therapy.

All-cause healthcare visits and time spent on cancer-related HRU

Among all participants with FL, mean (SD) number of all-cause healthcare visits in the past 30 days was 2.5 (1.5). Mean (SD) number of all-cause healthcare visits in the past 30 days was significantly lower with mosunetuzumab versus epcoritamab (1.7 [0.8] vs 3.3 [1.7], respectively; P < .01) ( Figure 1 ).

Mean (SD) time spent per visit on BsAb treatment-related visits was 5.1 (1.3) and 4.3 (1.7) hours for mosunetuzumab and epcoritamab, respectively ( Table 3 ). One-way travel time for BsAb treatment-related visits was shorter for participants living in urban/suburban vs rural areas ( N = 53 vs N = 7; 27.7 [0.3] vs 60.3 [27.6] minutes, respectively). Mean (SD) time spent per visit on disease-related visits (FL disease management) was 1.7 (0.5) and 1.5 (0.6) hours with mosunetuzumab and epcoritamab, respectively. One-way travel time, services received, time spent on coordination and scheduling visits, and recovery time are shown in Table 3 and Table S4 for BsAb treatment-related visits and Table 4 and Table S5 for disease-related visits.

Among all participants with FL, mean (SD) time spent on cancer-related HRU (combination of BsAb treatment-related and disease management-related visits) PPPM was 46.5 (41.2) hours. Participants reported statistically significant lower mean (SD) time spent on cancer-related HRU PPPM for fixed-duration and less frequently dosed mosunetuzumab versus treat-to-progression and more frequently dosed epcoritamab (31.2 [16.9] vs 61.9 [51.7] hours, respectively; reduction of 49.7%; P < .05). These differences were largely driven by recovery time, followed by time spent attending BsAb treatment-related visits and disease-related visits. When excluding recovery time, the lower time toxicity with fixed-duration and less frequently dosed mosunetuzumab remained (mean [SD]: 7.9 [3.5] vs 11.5 [6.0] hours; reduction of 31.2%; P < .05) ( Figure 2 ).

Participants with DLBCL

Participant characteristics and caregiver status

Among participants with DLBCL ( N = 60), self-reported characteristics were comparable between those receiving glofitamab ( N = 32) and epcoritamab ( N = 28) ( Table 1 and Table S2 ). Mean age was similar (67 vs 66 years), around half of participants were female (53% vs 46%), there were similar proportions of people of color (31% vs 25%), most lived in urban/suburban areas (88% vs 89%), and most had public insurance coverage (75% vs 71%) for participants receiving glofitamab and epcoritamab, respectively. A significant proportion of participants receiving glofitamab lived in Southern states compared with those receiving epcoritamab (22% vs 0%, respectively). Most common comorbidities included anxiety, depression, diabetes, chronic lung disease/respiratory conditions, and rheumatologic diseases. Additionally, 38% versus 61% had a college education or higher, most were in a relationship (59% vs 68%), and few had a change in employment status since diagnosis (19% vs 21%) for participants receiving glofitamab and epcoritamab, respectively. Most common reasons for employment changes were disability leave, early retirement, and unemployment. Most (98.3%) participants had caregivers, most of whom were unpaid ( Table S3 ).

BsAb treatment experience

Among all participants with DLBCL, most received glofitamab and epcoritamab in academic settings (66% and 68%, respectively) ( Table 2 ). Mean (SD) duration of treatment was comparable between glofitamab (6.1 [2.0] months) and epcoritamab (6.0 [1.8] months).

Most participants had been receiving their current BsAb for 4–12 months (glofitamab: 88%; epcoritamab: 97%), few had been receiving their current BsAb for 1–3 months (glofitamab: 13%; epcoritamab: 4%). Most participants received BsAbs in the 3L+ setting (75% for both). All participants received prior chemotherapy. History of stem cell transplant and CAR T-cell therapy was more common in participants receiving glofitamab than epcoritamab ( Table 2 ).

All-cause healthcare visits and time spent on cancer-related HRU

Among all participants with DLBCL, mean (SD) number of all-cause healthcare visits in the past 30 days was 2.6 (1.3). Mean (SD) number of all-cause healthcare visits in the past 30 days was significantly lower with glofitamab versus epcoritamab (2.2 [1.3] vs 3.0 [1.2], respectively; P = .01) ( Figure 1 ).

Mean (SD) time spent per visit on BsAb treatment-related visits was 5.1 (1.6) and 5.7 (1.2) hours for glofitamab and epcoritamab, respectively ( Table 3 ). One-way travel time was shorter for participants living in urban/suburban versus rural areas ( N = 53 vs N = 7; 31.1 [0.3] vs 105.7 [18.8] minutes, respectively). Mean (SD) time spent per visit on disease-related visits (DLBCL disease management) was 1.5 (0.7) and 2.4 (3.0) hours with glofitamab and epcoritamab, respectively. One-way travel time, services received, time spent on coordination and scheduling visits, and recovery time are shown in Table 3 and Table S4 for BsAb treatment-related visits and Table 4 and Table S5 for disease-related visits.

Among all participants with DLBCL, mean (SD) time spent on cancer-related HRU (combination of BsAb treatment-related and disease management-related visits) PPPM was 63.8 (42.5) hours. Participants reported statistically significant lower mean (SD) time spent on cancer-related HRU PPPM for fixed-duration and less frequently dosed glofitamab versus treat-to-progression and more frequently dosed epcoritamab (43.0 [25.9] vs 87.7 [45.5] hours, respectively; reduction of 51.0%; P < .05). These differences were largely driven by recovery time, followed by time spent attending BsAb treatment-related visits and disease-related visits. When excluding recovery time, the lower time toxicity with fixed-duration and less frequently dosed glofitamab remained (mean [SD]: 8.5 [3.7] vs 15.6 [6.4] hours; reduction of 45.2%; P < .05) ( Figure 2 ).

Impact of BsAb treatment-related visits on daily activity, volunteering, and work productivity

Most participants with R/R FL and DLBCL reported little to moderate impact on regular, non-work daily activities, and few reported no impact ( Table S6 ). Only one participant with FL (epcoritamab) reported a large impact, and five participants with DLBCL reported a large impact (glofitamab, N = 2; epcoritamab, N = 3). Two participants with FL reported being employed ( N = 1 each): one participant receiving mosunetuzumab had no work scheduled during BsAb treatment-related visits, and the other participant receiving epcoritamab reported not being able to go to work due to BsAb treatment and had reported 20% of a 20-hour working week missed due to BsAb treatment. No participants with DLBCL were employed, and no participants with FL or DLBCL volunteered regularly.

Patient preferences and convenience

Among two treatment options (assuming the same efficacy and safety) presented to participants as part of a hypothetical scenario, the majority (≥92% of participants with FL or DLBCL, separately) preferred the convenience of a fixed-duration treatment option with less frequent doses and less time required, regardless of their disease indication or the BsAb that they were currently receiving ( Figure S1 and Table S7 ).

Discussion

This is the first study to directly measure patient-reported time toxicity from a diverse population of patients with R/R FL and R/R DLBCL receiving BsAbs in the real-world setting, with a broad range of clinical, demographic, and care setting characteristics. The overall mean number of all-cause healthcare visits in the past 30 days for patients actively receiving BsAbs was 2.5 for FL and 2.6 for DLBCL. When comparing BsAbs, the mean number of visits for fixed-duration and less frequently dosed BsAbs was statistically significantly lower compared with a treat-to-progression and more frequently dosed BsAb in both FL (mosunetuzumab [1.7] vs epcoritamab [3.3]; P < .01) and DLBCL (glofitamab [2.2] vs epcoritamab [3.0]; P = .01). Overall, mean time spent for cancer-related HRU was 46.5 and 63.8 hours PPPM for FL and DLBCL, respectively. Mean time spent on cancer-related HRU was statistically significantly lower by approximately 50% with fixed-duration and less frequently dosed BsAbs versus a treat-to-progression and more frequently dosed BsAb in both FL (mosunetuzumab [31.2 hours] vs epcoritamab [61.9 hours]; P < .05) and DLBCL (glofitamab [43.0 hours] vs epcoritamab [87.7 hours]; P < .05). Across both indications, differences in time spent on cancer-related HRU were primarily driven by recovery time (when patients felt they were able to resume normal activities after cancer-related visits for BsAb treatment and disease management). However, even when excluding recovery time, time spent on visit-related activities (attending visits, traveling, and scheduling and coordinating) remained consistently lower for fixed-duration and less frequently dosed BsAb options.

When asked to choose between two hypothetical treatment profiles with similar efficacy and safety but different duration, dosing frequency, and time required, the majority of patients preferred option 1 (fixed-duration, less frequent dosing, and a lower time burden). Option 2 (treat-to-progression, more frequent dosing, and a higher time burden) was reported as inconvenient.

Our study contributes to the medical literature as we collected more comprehensive real-world data compared with existing studies, which focused on the travel burden of BsAb treatment in R/R FL or R/R DLBCL, 13 or estimated healthcare contact days based on pre-specified clinical trial protocols, 11 , 12 using the framework developed by Gupta et al. 5 We collected detailed real-world information on the frequency of all-cause healthcare visits and time spent on cancer-related HRU, including novel aspects that have not previously been reported, such as scheduling and coordinating visits and recovery at home. We found that the frequency of BsAb treatment-related visits was aligned with the dosing schedule specified in the U.S. Prescribing Information for each respective BsAb. 1–3

In addition, our study found that patients with DLBCL were older and had more comorbidities compared with patients with FL. We observed a higher magnitude of time toxicity in patients with DLBCL versus FL, and this is aligned with findings by Banerjee et al. in patients with multiple myeloma (another incurable hematologic malignancy), where patients’ disease status may predict their time toxicity. 14 We also provided insights on the impact of patients’ residence on time toxicity, with longer travel times for patients residing in rural versus urban/suburban areas. This further reinforces the findings by Banerjee et al., where far-residing status was a significant predictor of time toxicity. 14 Future analyses should evaluate the relief of time burden for patients and care partners in rural, frontier, and/or urban healthcare deserts.

The differences in time toxicity by BsAbs observed in this study were consistent with findings from our prior time toxicity analyses, where lower time toxicity with lower travel burden was observed 13 and fewer healthcare contact days 11 , 12 were associated with fixed-duration and less frequently dosed BsAbs (mosunetuzumab and glofitamab) versus a treat-to-progression and more frequently dosed BsAb (epcoritamab).

Recent studies from a health system perspective have shown that patient chair time spent in clinics can be reduced by treatments with different routes of administration. 15 , 16 In our study, we provided additional findings on time spent for BsAb treatment-related visits from a patient perspective. Regardless of the route of administration, the overall mean time spent per BsAb treatment visit was comparable (4.3–5.7 hours) across disease indications. This reflects the reality of each treatment visit, which includes services beyond BsAb treatment administration, including pre-medication administration, interactions with clinicians, and laboratory or imaging testing.

Our findings from the hypothetical scenario on treatment choice underscore the importance of time to patients, who preferred to spend less time on healthcare visits. This was consistent with findings in multiple myeloma, where patients reported improved convenience with less frequent dosing to prioritize quality of life. 17 With the changing therapeutic landscape, fixed-duration treatment strategies with less frequent dosing are being increasingly investigated to become the more common approach in earlier lines of lymphoma treatment; however, differences in dosing requirements across treatment options mean that differences in time toxicity remain. Additionally, differences in combination regimens may also impact differences in time toxicity due to the number of agents used. In the absence of head-to-head trials, clinicians may assume comparable safety and efficacy across BsAbs based on clinical experience to date. Therefore, patient priorities, including the importance of time, should be considered during patient–physician shared decision-making on treatment choices.

Several limitations exist in our study. Firstly, given the small sample size and use of convenience sampling, the potential for imbalances between cohorts cannot be excluded; therefore, our findings should be interpreted as descriptive with limited generalizability. Additionally, survey results were based on self-reported data from a convenience sample and were subject to potential biases, including recall and sampling bias and misclassification. In addition, the survey was only conducted in English and may not be generalizable to all patients receiving BsAbs in the U.S. The mean one-way travel time reported by patients in our survey was more conservative than the findings from a real-world study of Medicare beneficiaries receiving BsAbs for R/R FL and R/R DLBCL (61.5 minutes). 18 However, as BsAbs become increasingly available at local/community sites, more recent studies will likely report shorter travel times. Furthermore, there was a higher-than-expected proportion of patients with R/R FL who reported prior transplants and a lower-than-expected percentage of patients with R/R DLBCL who reported prior second-line CAR T-cell therapy. 19 , 20 These differences in the study population may be due to convenience sampling or recall bias, and these findings should be validated in future studies where treatment history can be verified through medical records. In addition, over 75% of patients had completed the initial ramp-up phase of treatment, so most patients had been receiving BsAbs for 4–12 months. However, per the U.S. Prescribing Information, 1–3 we would expect more time to be spent receiving treatment during the ramp-up stage (initial three cycles), particularly for epcoritamab monotherapy which requires 12 administrations compared with five for mosunetuzumab and glofitamab. The low proportion of patients in this study who had been receiving BsAbs within the first 3 months was insufficient to provide robust estimates on time toxicity in early treatment cycles. Future studies are warranted to discern if additional time toxicity is associated with the dose ramp-up phase across different BsAbs. Finally, as the recommended dose and frequency of dosing of BsAbs and their combinations is quickly evolving, such as the recent approval of fixed-duration epcoritamab in combination with lenalidomide and rituximab in FL, 2 , 21 further studies will be needed to ensure that our understanding of treatment-related time burden and patient preference remains up to date.

As the survey length was designed to avoid patient fatigue, we did not explore all factors in detail, including recovery time, which was not fully characterized in this study. Future investigation into specific activities of recovery time, the primary driver of patient-reported cancer-related HRU, may help improve discussions on time toxicity. In addition, most patients reported little to moderate impact of BsAb treatment-related visits on non-work daily activities, with additional research needed to better understand the patient trade-off between time spent for BsAb treatment versus obligations in daily life. Lastly, it is important to study the perspective of care partners in the patient journey, as nearly all patients reported having at least one care partner. Therefore, future patient-centered studies, supported by early community engagement, should also seek to understand time toxicity and opportunity costs to care partners.

Conclusions

Patients with R/R FL and R/R DLBCL reported differences in time toxicity between fixed-duration, less frequently dosed BsAbs (mosunetuzumab and glofitamab) versus a treat-to-progression, more frequently dosed BsAb (epcoritamab). The majority of patients (≥92%) preferred the convenience of a hypothetical fixed-duration treatment with less frequent administration and time commitment. As the use of BsAbs continues to expand in the U.S., several ongoing initiatives are focused on building system capacity, optimizing care coordination, and enhancing education for healthcare professionals. 22–25 It is necessary to determine if these initiatives effectively bridge the gap in time toxicity among patients and the downstream economic implications across patients, care partners, health systems, and society. These patient-centered data are vital in empowering oncologists to counsel patients on time considerations of BsAbs and support informed, shared treatment decision-making in R/R FL and R/R DLBCL.

Supplementary Material

Acknowledgments

We thank the patients for participating in this study. The authors thank Wenny Lin, an employee of Genentech, Inc., for the concept development of this study. Data analysis and quality checks were provided by Kana Yokoji at Analysis Group. Third party medical writing assistance, under the direction of Esprit Ma, was provided by Vanessa Poon, MRes, and Rachel Dobb, PhD, of Ashfield MedComms, an Inizio company, and was funded by Genentech, Inc. A subset of data from this manuscript were presented in poster form at the ASH 2025 Annual Meeting.

Contributor Information

Ajay Major, Division of Hematology, University of Colorado School of Medicine, Aurora, CO 80045, United States.

Esprit Ma, Genentech, Inc., South San Francisco, CA 94080, United States.

Anthony Masaquel, Genentech, Inc., South San Francisco, CA 94080, United States.

Mazie Tsang, Division of Hematology/Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ 85054, United States.

Mengyang Di, Department of Medicine, Divison of Hematology and Oncology, Fred Hutchinson Cancer Center and University of Washington, Seattle, WA 98109, United States.

Supreet Kaur, Department of Hematology and Oncology, UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX 78229, United States.

Priyanka Pophali, Department of Medicine, Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin, Carbone Cancer Center, Madison, WI 53792, United States.

Sally Werner, Cancer Support Community, Washington, DC 20020, United States.

Rebecca Bungay, Analysis Group ULC, Toronto, ON M5X 1A9, Canada.

Dominick Latrémouille-Viau, Analysis Group ULC, Montreal, QC H3B 0G7, Canada.

Annie Guerin, Analysis Group ULC, Montreal, QC H3B 0G7, Canada.

Carolina Reyes, Genentech, Inc., South San Francisco, CA 94080, United States.

Mei Wu, Genentech, Inc., South San Francisco, CA 94080, United States.

Lourenia Cassoli, Genentech, Inc., South San Francisco, CA 94080, United States.

Pallawi Torka, Department of Medicine, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.

Author contributions

Ajay Major (Conceptualization, Formal analysis, Methodology, Visualization, Writing—original draft, Writing—review & editing), Esprit Ma (Conceptualization, Formal analysis, Funding acquisition, Methodology, Project administration, Supervision, Visualization, Writing—original draft, Writing—review & editing), Anthony Masaquel (Conceptualization, Formal analysis, Methodology, Project administration, Visualization, Writing—original draft, Writing—review & editing), Mazie Tsang (Conceptualization, Formal analysis, Methodology, Visualization, Writing—original draft, Writing—review & editing), Mengyang Di (Conceptualization, Formal analysis, Methodology, Visualization, Writing—original draft, Writing—review & editing), Supreet Kaur (Conceptualization, Formal analysis, Methodology, Visualization, Writing—original draft, Writing—review & editing), Priyanka Pophali (Conceptualization, Formal analysis, Methodology, Visualization, Writing—original draft, Writing—review & editing), Sally Werner (Conceptualization, Formal analysis, Methodology, Visualization, Writing—original draft, Writing—review & editing), Rebecca Bungay (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing—original draft, Writing—review & editing), Dominick Latrémouille-Viau (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing—original draft, Writing—review & editing), Annie Guerin (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing—original draft, Writing—review & editing), Carolina Reyes (Conceptualization, Formal analysis, Methodology, Visualization, Writing—original draft, Writing—review & editing), Mei Wu (Conceptualization, Formal analysis, Methodology, Visualization, Writing—original draft, Writing—review & editing), Lourenia Cassoli (Conceptualization, Formal analysis, Methodology, Visualization, Writing—original draft, Writing—review & editing), and Pallawi Torka (Conceptualization, Formal analysis, Methodology, Visualization, Writing—original draft, Writing—review & editing)

Supplementary material

Supplementary material is available at The Oncologist online.

Funding

This study was sponsored by Genentech, Inc.

Conflicts of interest

A.Major: Consultancy (includes expert testimony): Kite, Genentech, BMS; Research Funding: Incyte, GSK. E.M.: Current employment: Genentech, Inc.; Current equity holder in publicly-traded company: Roche. A.Masaquel: Current employment: Genentech, Inc.; Current holder of stock options in a publicly-traded company: Roche. M.T.: Consultancy (includes expert testimony): Genentech (funding goes to Mayo Clinic); Research Funding: ONO, Lilly; Current equity holder in publicly-traded company: Poseida Therapeutics; Honoraria: TerSera, AstraZeneca, Novartis, Genentech (funding goes to Mayo Clinic); BioAscend. M.D.: Consultancy (includes expert testimony): AbbVie, BeOne, Genentech, Inc., Incyte; Research Funding: AbbVie, BeOne, Dren Bio, Lilly, Regeneron, Schrodinger; Honoraria: Merck. S.K.: Consultancy (includes expert testimony): Genentech, Inc.; Honoraria: Novartis—Advisory board 5/2025. P.P.: Consultancy (includes expert testimony); Advisory Board: AbbVie, ADC Therapeutics, BMS, Genentech, Inc., SeaGen; Research Funding: SeaGen, Marker Therapeutics, Fate Therapeutics. S.W.: no conflict of interests to disclose. R.B.: Other: I am an employee of Analysis Group, ULC., which received consulting fees from Genentech, Inc. for the conduct of this study. D.L.-V.: Other: I am an employee of Analysis Group, ULC., which received consulting fees from Genentech, Inc. for the conduct of this study. A.G.: Other: I am an employee of Analysis Group, ULC., which received consulting fees from Genentech, Inc. for the conduct of this study. C.R.: Current employment: Roche/Genentech; Current equity holder in publicly-traded company: Roche; Current holder of stock options in a publicly-held company: Roche. M.W.: Current employment: Genentech, Inc.; Current equity holder in publicly-traded company: Roche. Divested equity in a private or publicly-traded company in the past 24 months: Roche. L.C.: Current employment: Genentech, Inc.; Current holder of stock options in a publicly-traded company: Roche. P.T.: Consultancy (includes expert testimony): AbbVie, Bristol Myers Squibb, Genentech, Inc., Genmab, Lilly Oncology, Pfizer; SeaGen; Research Funding: AbbVie, Genentech, Inc., Genmab, Incyte.

Data availability

The data that support the findings of this study have originated from a study sponsored by Genentech, Inc. Requests for data sharing by license or by permission for the specific purpose of replicating results in this manuscript can be submitted to ma.esprit@gene.com .

Ethical statement

All participants provided informed consent. This study received an exemption from the Pearl Institutional Review Board on October 17, 2024, and also had approval for protocol amendment on April 17, 2025. The IRB ID is 2024-0437.

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Associated Data

Supplementary Materials

Data Availability Statement

The data that support the findings of this study have originated from a study sponsored by Genentech, Inc. Requests for data sharing by license or by permission for the specific purpose of replicating results in this manuscript can be submitted to ma.esprit@gene.com .