ClinicalTrials.gg
RecruitingNCT06563596Updated Sep 25, 2026

Epco, Zanu, Ritux for R/R FL or MZL

A Phase 2 interventional study of Zanubrutinib and Rituximab in Follicular Lymphoma, Lymphoma and Non-Hodgkin Lymphoma, sponsored by Reid Merryman, MD. Recruiting at 3 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-09-25.

Sponsored by Reid Merryman, MD · Phase 2, Interventional, and Treatment

From the registry’s dates

  • Started Jan 2025; still recruiting 1 year 9 months later.
Updated Sep 25, 2026Primary completion movedStudy completion moved+2 moreGo to Updates ↓
Phase
Phase 2
Study type
Interventional
Enrollment
71
Allocation
Non-randomized
Ages
18 Years and older
Sex
All
01

Where this study stands

Counted across the records on this site · 2026-11-12

Among 13 studies testing zanubrutinib in Lymphoma, Follicular — 9 open to participants now, 11 under way, 1 of them phase 3. zanubrutinib · Lymphoma, Follicular.

Planned enrollment
3rd of 13
71 · median 43
Started
2025
with 2 others
Phase 2
11 of 13
9 open now
Primary completion
2030-03
later than 9 of 10 live
Registered
9th of 13
by date
Lead sponsor
1 of 13
Reid Merryman, MD

Among the 13 studies testing zanubrutinib in Lymphoma, Follicular, this one is the 3rd largest by planned enrollment, is one of 3 that started in 2025, is one of 11 in phase 2, reaches primary completion later than 9 of the 10 other live ones, and was the 9th registered.

Lymphoma, Follicular

1,891 studies on the registry are indexed under Lymphoma, Follicular; 290 are open to participants now.

Browse Lymphoma, Follicular studies →

Open to participants now

9 of the 13 studies testing zanubrutinib in Lymphoma, Follicular are open now, in 2 countries. Recruiting first, the newest first:

3 more — sign in →

By country, each count listing its studies:

All 9 open studies →

About zanubrutinib

zanubrutinib: first FDA approval 2019 (BRUKINSA), first EMA approval 2021. What it is approved for, and how studies give it, is on its page →

Who these studies take

Of the 226 Lymphoma, Follicular studies recruiting now, 159 (70%) set no upper age limit and 39 (17%) stop at 75 or younger; 33 take children under 18; 24 take healthy volunteers.

This study: 18 Years and older · all sexes · no healthy volunteers.

The full table on the hub →

This tab as a report to print or save as PDF → With an account.

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Watch this landscapeDownload CSVNarrow it in search →With an account: a weekly mail of what changed among 13 studies testing zanubrutinib in Lymphoma, Follicular, or all of them as a file.
02

Study summary

The purpose of this study is to determine how effective and safe the combination of epcoritamab, zanubrutinib, and rituximab is in treating participants with relapse or refractory Follicular Lymphoma (FL) or marginal zone lymphoma (MZL).

  • The names of the study drugs involved in this research study are:
  • Epcoritamab (a type of antibody)
  • Zanubrutinib (a type of Bruton tyrosine kinase inhibitor)
  • Rituximab (a type of monoclonal antibody)
Read the detailed description

This is an open-label, multicenter, phase II study to evaluate the efficacy and safety of epcoritamab, zanubrutinib, and rituximab (EZR) for participants with relapsed or refractory follicular lymphoma (FL) or marginal zone lymphoma (MZL). The trial will commence with a six participant lead-in cohort for each disease type.

The U.S. Food and Drug Administration (FDA) has approved epcoritamab for people who have received at least 2 prior treatments for follicular lymphoma. Epcoritamab is not approved for patients with marginal zone lymphoma.

The U.S. FDA has approved zanubrutinib (in combination with a drug called obinutuzumab) for people who have received at least 2 prior treatments for follicular lymphoma. Zanubrutinib is approved for patients with marginal zone lymphoma who have received at lest 1 prior treatment.

The FDA has also approved rituximab as a treatment option for follicular lymphoma and marginal zone lymphoma.

The research study procedures include screening for eligibility, in-clinic visits, urine tests, blood tests, stool samples, saliva samples, electrocardiograms (ECGs), bone marrow biopsies, Computerized Tomography (CT) scans, Positron Emission Tomography (PET) scans, and questionnaires.

Participants will receive study treatment for approximately 12 months and will be followed every 6 months thereafter for up to 10 years.

It is expected that about 71 people will take part in this research study (50 FL participants and 21 MZL participants).

Genmab is supporting this research study by providing the study drug, epcoritamab, and funding for the study. BeOne Medicines, Inc. is supporting this research study by providing the study drug, zanubrutinib, and funding for the study.

03

Conditions studied

  • Follicular Lymphoma
  • Lymphoma
  • Non-Hodgkin Lymphoma
  • Relapsed Lymphoma
  • Refractory Lymphoma
  • Marginal Zone Lymphoma

Keywords

  • Follicular Lymphoma
  • Lymphoma
  • Non-Hodgkin Lymphoma
  • Relapsed Lymphoma
  • Refractory Lymphoma
  • Marginal Zone Lymphoma
04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • confirmed diagnosis of CD20+ FL (grade 1-3A) or CD20+ MZL (any subtype) (at time of trial entry) with review of the diagnostic pathology specimen at one of the participating institutions. Patients with current histologic transformation are excluded.
  • Receipt of at least one for FL or MZL (with prior treatment including a CD20 monoclonal antibody).
  • , defined as ≥1 measurable nodal lesion (long axis >1.5 cm or short axis >1.0 cm), or ≥1 measurable extra-nodal lesion (long axis >1.0 cm), or spleen >13 cm on PET, CT, or magnetic resonance imaging (MRI). For patients with FL, disease should be FDG-avid based on PET. FDG-avid disease is NOT a requirement for patients with MZL.
  • Meets at least one criterion to begin treatment based on the modified GELF (Groupe d'Etude des Lymphomes Folliculaires) criteria:

    • Symptomatic adenopathy
    • Organ function impairment due to disease involvement, including cytopenias due to marrow involvement (WBC \<1.5x109/L; [ANC] \<1.0x109/L, \<10g/dL; or \<100x109/L)
    • Constitutional symptoms (defined as persistent fevers >100.4 F, shaking chills, drenching night sweats, or loss of >10% of body weight within 6 months)
    • Any nodal or extranodal tumor mass >7 cm in maximum diameter
    • >3 nodal sites of involvement >3 cm
    • Local compressive symptoms or imminent risk thereof
    • Splenomegaly (craniocaudal diameter > 16cm on CT imaging)
    • pleural or peritoneal effusion
    • Leukemic phase (>5x109/L circulating malignant cells)
    • Rapid generalized disease progression
    • Renal infiltration
    • Bone lesions
  • (ECOG) performance status of 0-2. (Appendix A)
  • Age ≥18 years.
  • Adequate hematologic and organ function:

    1. Absolute neutrophil count > 1.0x109/L unless due to marrow involvement by lymphoma in which case ANC must be >0.5x109/L
    2. Platelets > 75 x109/L, unless due to marrow involvement by lymphoma, in which case platelets must be >50 x109/L
    3. Estimated (based on Cockcroft Gault or ) ≥ 45ml/min or ≥ 45ml/min/1.73m2
    4. Total \< 1.5 X , unless Gilbert syndrome, in which case direct bilirubin must be \< 1.5 x ULN
    5. /ALT \< 2.5 X ULN, unless documented liver involvement by lymphoma, in which case AST/ALT must be \<5 x ULN
  • Ability to understand and the willingness to sign a written document.
  • Willingness to provide a pre-treatment tumor sample by core needle or excisional surgical . A fresh biopsy is strongly encouraged, but an archival sample is acceptable if it is collected within 90 days and without intervening treatment and the following provisions are met: 1) availability of a tumor-containing formalin-fixed, paraffin-embedded (FFPE) tissue block, 2) if the tumor containing FFPE tissue block cannot be provided in total, sections from this block should be provided that are freshly cut and mounted on positively-charged glass slides. Preferably, 25 slides should be provided; if not possible, a minimum of 15 slides is required. Exceptions to this criterion may be made with approval of the Sponsor-Investigator.
  • Willingness to remain abstinent (1) or to use two effective methods that result in a failure rate of \<1% per year from screening until: (a) at least 12 months after pre-treatment with rituximab, 12 months after the last dose of epcoritamab, or 3 months after the last dose of zanubrutinib, whichever is longer, if the patient is a male or (b) until at least 12 months after pre-treatment with rituximab, 12 months after the last dose of epcoritamab, or 3 months after the last dose of zanubrutinib, whichever is longer, if patient is a female. Examples of contraceptive methods with a failure rate of \<1% per year include:

    • Tubal ligation, male sterilization, hormonal implants, established proper use of hormonal contraceptives that inhibit ovulation, hormone-releasing intrauterine devices, and copper intrauterine devices.
    • Alternatively, two methods (e.g., two barrier methods such as a condom and a cervical cap) may be combined to achieve a failure rate of \<1% per year. Barrier methods must always be supplemented with the use of a spermicide.

      1. True abstinence is acceptable when this is in line with the preferred and usual lifestyle of the subject. In contrast, periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception.

Exclusion criteria

Exclusion Criteria:

  • Patients who require systemic therapy for an ongoing medical condition will be excluded. For , patients receiving a prednisone dose of >10 mg daily (or equivalent) will not be eligible. A short course of steroids (up to 14 days) for lymphoma-related symptom palliation or for prophylaxis (i.e., IV contrast allergy) is allowed, in which case patients should be off steroids prior to treatment start.
  • Patients with bulky cervical adenopathy that is compressing the upper airway or could result in significant airway compression during a tumor flare event.
  • Patients, who have had a major surgery or significant traumatic injury within 4 weeks of start of study drug, patients who have not recovered from the side effects of any major surgery (defined as requiring general anesthesia).
  • Presence of antibody. Patients with presence of HCV antibody are eligible if HCV RNA is undetectable (NOTE: the limit of detection for HCV RNA must have a sensitivity of \< 15 IU/mL). Subjects who received treatment for HCV that was intended to eradicate the virus and who have an undetectable HCV RNA may participate without serial HCV RNA screening. Other patients may participate if they are willing to undergo every 3-month monitoring for HCV reactivation.
  • Presence of surface antigen (HBsAg) or hepatitis B core antibody (HBcAb). Patients with positive hepatitis B serologies with undetectable HBV DNA (NOTE: the limit of detection for HBV DNA must have a sensitivity of \< 20 IU/mL) are permitted in the trial but should receive prophylactic antiviral therapy (i.e. entecavir) and undergo every 3 month HBV DNA monitoring.
  • Known active bacterial, viral, fungal, mycobacterial, parasitic, or other infection (excluding fungal infections of nail beds) requiring antimicrobial therapy at trial enrolment or significant infections within 2 weeks of study treatment initiation.
  • Subject has a known active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. If a subject has signs/symptoms suggestive of SARS-CoV-2 infection or has had recent known exposure to someone with SARS-CoV-2 infection, the subject must have a negative molecular (e.g., PCR) test, or 2 negative antigen test results at least 24 hours apart, to rule out SARS-CoV-2 infection. Subjects who do not meet SARS-CoV-2 infection eligibility criteria must be screen failed and may only rescreen after they meet the following SARS-CoV-2 infection viral clearance criteria:

    • No signs/symptoms suggestive of active SARS-CoV-2 infection
    • Negative molecular (e.g., PCR) result or 2 negative antigen test results at least 24 hours apart
  • Prior history of another (except for non-melanoma skin cancer, in situ cervical or breast cancer, or Gleason 6 prostate cancer managed with observation) unless disease free for at least 2 years OR unless the likelihood of relapse is very low in the opinion of the treating physician.
  • Patients should not have received immunization with attenuated within one week of study entry or during study period. Vaccination with live vaccines within 28 days of the first dose of study treatment is prohibited.
  • Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study or limit adherence to study requirements.
  • Patients with any one of the following currently on or in the previous 6 months will be excluded: myocardial infarction, congenital long syndrome, torsade de pointes, unstable angina, coronary/peripheral artery bypass graft, cardiac arrhythmia ( grade 3 or higher), or cerebrovascular accident. History of Mobitz II second-degree or third-degree heart block without a permanent pacemaker in place. Uncontrolled hypertension as indicated by ≥ 2 consecutive blood pressure measurements showing systolic blood pressure > 170 mm Hg and diastolic blood pressure > 105 mm Hg at screening.
  • Patients with 1) Class III or IV heart failure or known of \<45%, 2) MI within 6 months prior to screening, 3) unstable angina within 3 months before screening, or 4) history of arrhythmias within 6 months of screening (eg sustained Vtach, Vfib, torsades de pointes).
  • Inability to comply with protocol mandated restrictions.
  • Patients who are pregnant, breast-feeding, or intending to become pregnant during the study.
  • Prior solid organ or stem cell transplantation.
  • History of known or suspected hemophagocytic lymphohistiocytosis (HLH).
  • History of clinically significant disease, including but not limited to myocarditis, pneumonitis, myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis.

    • Patients with a remote history of, or well controlled, autoimmune disease who meet above criteria may be eligible to enroll after consultation with the Sponsor-Investigator.
  • Inability to tolerate anti-CD20 mAb therapy or known allergy or intolerance to any component or of epcoritamab.
  • Known central nervous system involvement
  • Neuropathy > grade 1(based on CTCAE grading)
  • Treatment with CAR-T therapy within 100 days prior to first dose of epcoritamab.
  • Treatment with an drug within 4 weeks prior to the first dose of study treatment.
  • Chemotherapy and other non-investigational anti-neoplastic agents (except CD20 mAbs) within 4 weeks prior to the first dose of study treatment.
  • Participants who require warfarin or other vitamin K antagonists for anticoagulation. Other anticoagulants including direct oral anticoagulants (i.e. apixaban, rivaroxaban) and low-molecular weight heparin are allowed.
  • Participants who are known at the time of study entry to require concomitant treatment with any medications or substances that are strong inducers. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently updated medical reference. As part of the enrollment/ procedures, the participant will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the participant is considering a new over-the-counter medicine or herbal product.
  • Unable to swallow capsules or disease significantly affecting gastrointestinal function, such as malabsorption syndrome.
  • History of severe bleeding disorder such as hemophilia A, hemophilia B, von Willebrand disease, or history of spontaneous bleeding requiring blood transfusions or other medical interventions. Requires ongoing treatment with warfarin or warfarin derivatives.
  • Prior exposure to a BTK inhibitor
  • A limited number of patients with BsAb- disease will be permitted to enroll in each cohort (see section 2.5.3). After this limit is reached, patients with BsAb-refractory disease will be excluded. BsAb-refractory disease will be defined as failing to achieve an objective response to a prior CD3xCD20 BsAb or relapse/progression within 6 months of last dose of CD3xCD20 BsAb.
  • Screening 12-lead showing a baseline QTcF (Fridericia's correction) > 480 msec.
  • History of stroke or intracranial hemorrhage within 6 months before first dose of study drug.
  • Major surgery ≤ 4 weeks before the first dose of study treatment or planned during study.
Terms in these criteria, in plain language(33)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Histologically or cytologically confirmed

The diagnosis was confirmed by looking at a sample under a microscope: tissue from a biopsy or surgery (histology), or cells from a fluid or needle sample (cytology).

Your pathology report is the document that shows this.

Line of therapy

A line of therapy is one course of treatment, which may combine several drugs. First-line is the first course given; second-line follows when that stops working or is not tolerated.

“Two prior lines” means two courses that count separately under the study’s rules — not simply two drugs. Ask the study team if you are unsure how yours are counted.

Measurable disease

The amount of disease can be tracked with a defined measurement, so the study can see whether it shrinks or grows. It might be a tumour measured on a scan or, in some blood cancers such as myeloma, a marker measured in blood or urine.

The criteria or the study team say which measurement counts — having no tumour visible on a scan does not by itself rule you out.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Clinically significant

Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

GFR and eGFR (kidney filtering)

GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².

Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Biopsy and archival tissue

A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.

Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Live vaccines

Vaccines made with a weakened form of the germ, such as measles–mumps–rubella (MMR), chickenpox and yellow fever. They can be risky when the immune system is weakened. Flu injections are not live; the nasal flu spray is.

QT and QTc

On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.

The study may name a correction formula and a limit in milliseconds, often around 450–480.

CTCAE grade

The US National Cancer Institute’s scale of how severe an adverse event is — any unwanted medical event during a study, such as a symptom, an illness or an abnormal test result, whether or not a treatment caused it. Whether it did is judged separately.

1
Mild.
2
Moderate.
3
Severe.
4
Life-threatening.
5
Death due to the event.

“Side effects of earlier treatment resolved to grade 1 or less” means they have settled to mild or gone.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

LVEF (left ventricular ejection fraction)

The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.

Allogeneic and autologous transplant

Stem cell (bone marrow) transplants. Allogeneic uses cells from a donor; autologous uses your own cells, collected earlier and given back.

Autoimmune disease

A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.

Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.

Excipients

The other ingredients in a medicine besides the active drug, such as fillers, colours or preservatives.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

CYP3A (CYP3A4) inhibitors and inducers

CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.

Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.

Relapsed and refractory

Relapsed: the illness came back after treatment had worked. Refractory: it did not respond to treatment, or stopped responding while still on it.

ECG (electrocardiogram)

A recording of the heart’s electrical activity, taken with stickers on the chest, arms and legs. It takes a few minutes and does not hurt.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
71 participants (estimated)

Study arms

  • Experimental
    Rituxan + Zanubrutinib + Epcoritamab for FL

    Enrolled participants will complete: * Baseline visit with imaging and bone marrow biopsy * Imaging on cycles 3, 6, 9 * Up to 1 year of treatment with study drugs * End of Treatment visit with imaging and bone marrow biopsy * Follow up visits every 6 months for up to 10 years

    Drug: Zanubrutinib · Drug: Rituximab · Drug: Epcoritamab

  • Experimental
    Rituxan + Zanubrutinib + Epcoritamab for MZL

    Enrolled participants will complete: * Baseline visit with imaging and bone marrow biopsy * Imaging on cycles 3, 6, 9 * Up to 1 year of treatment with study drugs * End of Treatment visit with imaging and bone marrow biopsy * Follow up visits every 6 months for up to 10 years

    Drug: Zanubrutinib · Drug: Rituximab · Drug: Epcoritamab

Interventions

  • Bruton tyrosine kinase inhibitor, 80 mg immediate-release capsule, taken orally per protocol.

    Also known as: BDB-3111, Brukinsa

  • Chimeric anti-CD20 monoclonal antibody, 10 or 50 mL single-use vials, via intravenous infusion per institutional standard.

    Also known as: MabThera, Riabni, Ruxience, Truxima, ABP 798, IDEC-C2B8

  • Bispecific antibody, 5 or 60 mg/mL vials, via subcutaneous (under the skin) injection per protocol.

    Also known as: GEN3013

06

What researchers measure

Primary outcomes

  1. Complete Metabolic Response (CMR) Rate among patients with R/R FL

    CMR rate is defined as the proportion of participants who achieved CMR during study. CMR assessed by PET/CT is defined using Lugano criteria.

    Time frame: 6 months

  2. Complete Response (CR) Rate among patients with R/R MZL

    CMR rate is defined as the proportion of participants who achieved CMR during study. CMR assessed by PET/CT or CT is defined using Lugano criteria.

    Time frame: 6 months

Secondary outcomes

  1. Objective Response Rate (ORR)

    ORR is defined as the participants who achieved complete response (CR) and partial response (PR) during study. Response is defined using Lugano criteria.

    Time frame: 12 months

  2. Partial Response Rate (PRR)

    PRR is defined as the participants who achieved partial response during study. Response is defined using Lugano criteria.

    Time frame: 12 months

  3. End-of-treatment Objective Response Rate (EOT ORR)

    EOT ORR is defined as the proportion of participants who achieved complete response (CR) or partial response (PR) at the end of treatment visit. Response is assessed by PET/CT using Lugano criteria.

    Time frame: Up to 12 months - End-of treatment visit occurs 4 weeks after cycle 12 day 1. Each cycle is 4 weeks. Participants who discontinue therapy due to toxicity would also undergo an EOT evaluation approximately 4 weeks after the last dose of study treatment.

  4. End-of-treatment Partial Response Rate (EOT PRR)

    EOT PRR is defined as the proportion of participants who achieved partial response (PR) at the end of treatment visit. Response is assessed by PET/CT using Lugano criteria.

    Time frame: Up to 12 months - End-of treatment visit occurs 4 weeks after cycle 12 day 1. Each cycle is 4 weeks. Participants who discontinue therapy due to toxicity would also undergo an EOT evaluation approximately 4 weeks after the last dose of study treatment.

  5. End-of-treatment Complete Response Rate (EOT CRR)

    EOT CRR is defined as the proportion of participants who achieved complete response (CR) at the end of treatment visit. Response is assessed by PET/CT using Lugano criteria.

    Time frame: Up to 12 months - End-of treatment visit occurs 4 weeks after cycle 12 day 1. Each cycle is 4 weeks. Participants who discontinue therapy due to toxicity would also undergo an EOT evaluation approximately 4 weeks after the last dose of study treatment.

  6. Duration of Response (DOR)

    The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started, or death due to any cause). Participants without events reported are censored at the last disease evaluation.

    Time frame: 5 years

  7. Duration of Complete Response (DOCR)

    The duration of overall CR is measured from the time measurement criteria are first met for CR until the first date that progressive disease is objectively documented, or death due to any cause. Participants without events reported are censored at the last disease evaluation.

    Time frame: 5 years

  8. 2-Year Progression Free Survival (PFS2)

    2-year PFS is the percent probability estimate at 2 years based on the Kaplan-Meier method. PFS is defined as the duration of time from study entry to documented disease progression (PD) requiring removal from the study or death. Participants alive without PD are censored at the earliest of the date of the last disease evaluation or start of new anti-cancer therapy.

    Time frame: 2 years

  9. Median Progression Free Survival

    PFS based on the Kaplan-Meier method is defined as the duration of time from study entry to documented disease progression (PD) requiring removal from the study or death. Participants alive without PD are censored at the earliest of the date of the last disease evaluation or start of new anti-cancer therapy.

    Time frame: 5 years

  10. Median Time-to-next treatment (TTNT)

    Time to next treatment (TTNT) based on Kaplan-Meier methodology will be calculated as time from the start of treatment to the date of initiation of the next line of treatment. Participants who have not progressed to a subsequent line of therapy, will be censored at the date of last follow up or at death.

    Time frame: 5 years

  11. Median Overall Survival (OS)

    OS based on Kaplan-Meier methodology is defined as the time from registration to death due to any cause, or censored at date last known alive.

    Time frame: 12 years

  12. Incidence of Histological Transformation

    Incidence of Histological Transformation (HT) based on Kaplan-Meier methodology defined as as the number of cases of HT divided by the total number of individuals in the population at risk at that specific time interval.

    Time frame: 5 years

  13. Cytokine Release Syndrome (CRS) Rate

    CRS Rate is defined as the proportion of participants who experience CRS. CRS is graded according to the American Society for Transplantation and Cellular Therapy (ASTCT) grading.

    Time frame: 12 months

  14. Immune Effector Cell-associated Neurotoxicity Syndrome (ICANS) Rate

    ICANS Rate is defined as the proportion of participants who experienced ICANS during the study. ICANS graded according to the American Society for Transplantation and Cellular Therapy (ASTCT) grading.

    Time frame: 12 months

  15. Rate of Grade 3 or Higher Toxicity Regardless of Attribution

    The percentage of participants who experience a maximum grade 3 or higher adverse event based on the Common Toxicity Criteria for Adverse events Version 5.0 (CTCAEv5) as reported on case report forms.

    Time frame: 12 months

  16. Rate of Grade 2 or Higher Toxicity at Least Possibly Related to Study Treatment

    The percentage of participants who experience a maximum grade 2 or higher at least possibly related to study treatment adverse event based on the Common Toxicity Criteria for Adverse events Version 5.0 (CTCAEv5) as reported on case report forms.

    Time frame: 12 months

07

Study locations

3 of 3 sites recruiting
08

References and documents

Individual participant data

Plan to share: Yes — The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.

Supporting information: Study protocol, Statistical analysis plan

Time frame: Data can be shared no earlier than 1 year following the date of publication

Access criteria: Contact the Belfer Office for Dana-Farber Innovations (BODFI) at innovation@dfci.harvard.edu

Data sharing details ↗ · www.dfhcc.harvard.edu

No publications or documents are linked to this record.

09

Timeline

1 registry update since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedDate before it movedWhere the date was before it movedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Started Jan 2025 (actual). Primary completion is estimated for Mar 2030, 61 months after the start.

Of 151 non-industry phase 2 interventional studies under Lymphoma, Follicular, half reached primary completion within 67 months of starting (the median), counting those still running; a quarter within 40 and three quarters within 110. This study's planned 61 months is close to that.

Counting every sponsor, half of 199 studies reached it within 57 months; a quarter within 31 and three quarters within 97.

Since we started tracking on Sep 25, 2026, the dates moved once, on Sep 25, 2026: primary completion Mar 2028 → Mar 2030 and completion Mar 2030 → Mar 2032.

Earlier changes are on the record history on ClinicalTrials.gov ↗

How these figures are worked out, and which studies are left out of them.

Registered
Aug 19, 2024
First posted
Aug 21, 2024
StartActual
Jan 21, 2025
Primary completionEst.
Mar 1, 2030was Mar 2028
CompletionEst.
Mar 1, 2032was Mar 2030
Last update
Sep 25, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
Primary completion
Mar 1, 2028→Mar 1, 2030
Sep 25, 2026
Study completion
Mar 1, 2030→Mar 1, 2032
Sep 25, 2026
Enrollment
45→71
Sep 25, 2026
Primary outcomes
1 edited
What changed in the outcomes
  • EditedComplete Metabolic Response (CMRCR) Rate among patients with R/R MZLTime frame: 6 months
Sep 25, 2026
Show all 1 update
  1. Sep 25, 2026
    Primary completion Mar 1, 2028→Mar 1, 2030
    Study completion Mar 1, 2030→Mar 1, 2032
    Enrollment 45→71
    Primary outcomes 1 edited
    What changed in the outcomes
    • EditedComplete Metabolic Response (CMRCR) Rate among patients with R/R MZLTime frame: 6 months
    + 2 other changes: verification date and description

From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗

10

Registry details

Key details

Study ID
NCT06563596
Lead sponsor
Reid Merryman, MD
Collaborators
BeiGene, Genmab
Responsible party
Reid Merryman, MD (Sponsor Investigator, Dana-Farber Cancer Institute) — Sponsor-investigator
First posted
Aug 21, 2024
Start date
Jan 21, 2025
Primary completion
Mar 1, 2030 (estimated)
Completion
Mar 1, 2032 (estimated)
Last update
Sep 25, 2026

Study contacts

Reid Merryman, MD
Contact
Reid_merryman@dfci.harvard.edu
617-632-6844
Heather A Walker, MPH
Contact
heathera_walker@dfci.harvard.edu
857-215-1833
Reid Merryman, MD
principal investigator · Dana-Farber Cancer Institute

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drugs tested here: Zanubrutinib · Rituximab · Epcoritamab

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