Time Toxicity in Lymphoma: Study Reveals Stark Differences in Treatment Burden Among Bispecific Antibodies
Key Insights
A patient survey of 120 lymphoma patients found that epcoritamab imposed 88 hours of monthly time demands for DLBCL patients versus 43 hours for glofitamab, and 62 versus 31 hours for FL patients on mosunetuzumab.
Recovery time was the biggest driver of the disparity, with patients on continuous epcoritamab reporting longer recovery periods compared to fixed-duration regimens.
At least 92% of surveyed patients said they would prefer a fixed-duration treatment with lower time burden when efficacy and safety are equivalent.
When evaluating cancer therapies, the conversation has traditionally centered on safety and efficacy. But a new study led by researchers at the University of Colorado Anschutz Medical Campus brings a third dimension into sharp focus: the time patients must sacrifice to receive treatment. Published online in May by The Oncologist and slated for its July 2026 print issue, the study quantifies "time toxicity" — the cumulative burden of clinic visits, infusions, travel, and recovery — across three bispecific antibody therapies for relapsed lymphoma.
"Time toxicity is associated with less time for patients to do things outside of their cancer care, and with inferior quality of life," said lead author Ajay Major, MD, MBA, a lymphoma specialist and assistant professor in the CU Anschutz Department of Medicine's Division of Hematology. Major is also co-lead of the imPROve Patient-Reported Outcomes Working Group at the CU Anschutz Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS).
The study surveyed 120 patients nationwide — 60 with follicular lymphoma (search) (FL), a slower-growing form, and 60 with diffuse large B-cell lymphoma (search) (DLBCL), a more aggressive subtype — all of whom were already receiving one of three bispecific antibodies as part of their regular cancer care.
Bispecific Antibodies: Off-the-Shelf Immunotherapy
Bispecific antibodies represent a new class of engineered immunotherapy proteins that link disease-fighting T cells directly to cancer cells, enabling the immune system to identify and destroy malignant lymphocytes. Unlike CAR T-cell therapies, which require weeks of manufacturing after collecting a patient's own T cells, these drugs are available immediately.
"Unlike CAR T-cell therapies, where we have to collect a patient's T cells and they have to be manufactured for several weeks before we can give them, these are off-the-shelf therapies," Major explained. "I can just get them from the pharmacy and treat the patients immediately, which is very exciting for us, especially for patients with lymphoma who need treatment urgently."
The three drugs examined — mosunetuzumab (for FL), glofitamab (for DLBCL), and epcoritamab (for either FL or DLBCL) — have similar efficacy and safety profiles but differ markedly in their dosing schedules. Epcoritamab is administered via weekly subcutaneous injections, initially once weekly and then every other week, continuing until disease progression — potentially indefinitely. In contrast, mosunetuzumab and glofitamab are fixed-duration regimens given once every three weeks, with treatment stopping after approximately 6 to 12 months.
Stark Time Differences Emerge
Patients were asked to report all cancer-related time demands over a 30-day period, including scheduling appointments, time at the clinic or infusion center, travel to and from visits, and — critically — recovery time needed before feeling able to return to normal life.
The disparities were striking. DLBCL patients taking epcoritamab reported an average of 88 hours of cancer-related time demands per month, compared to 43 hours for those on glofitamab. Among FL patients, epcoritamab imposed 62 hours per month versus 31 hours for mosunetuzumab.
The single largest driver of the time gap was recovery time. Patients on epcoritamab consistently reported needing longer to feel back to normal after each treatment visit. Additionally, patients on the fixed-duration drugs reported significantly fewer treatment visits per month.
When asked a hypothetical question — if two treatments were equally effective and safe, but one was a fixed-duration drug requiring less time and fewer clinic visits — at least 92% of patients chose the lower time-burden option.
Rural Patients Face Amplified Burdens
Geographic disparities compounded the problem. Rural patients reported traveling up to 105 minutes each way for DLBCL treatment, compared to approximately 31 minutes for urban and suburban patients. In a previous study, Major and colleagues documented the case of a rural lymphoma patient who had to be away from home for up to three days for each bispecific antibody treatment at a distant facility, forcing the patient to find a flexible job that accommodated the treatment schedule.
Major noted that while academic medical centers like the CU Anschutz Cancer Center routinely administer bispecific antibodies, "in local communities, the uptake has not been as extensive, partly because these are new medications. We have to make sure that community oncologists, pharmacists, and infusion nurses are more comfortable with providing them so patients don't have as much travel time."
Informing Shared Decision-Making
The study concludes that recognizing time toxicity "can enable more informed, patient-physician treatment decision-making that considers clinical outcomes as well as patient convenience and overall time burden." Major emphasized that the growing array of therapeutic options makes such patient-centered discussions both possible and necessary.
"In some ways, this is a product of our own success in developing new therapies," Major said. "Before, we weren't able to have these discussions with patients because we didn't have a choice on treatments. Now that we have choices, we need to be able to better support patients to make choices in their care that are better aligned with what they want out of life."