• Columvi is an anti-CD20×CD3 T-cell engaging bispecific antibody that targets CD20 expressing B-cells.
• Lysis of B-cells by Columvi does not occur in the absence of CD20 expression.
• In the Columvi pivotal study, patients were not screened for CD20 expression.
• Patients were eligible if they had a diagnosis of a B-cell malignancy associated with CD20 expression.
• In a retrospective study amongst 42 patients with Columvi-refractory B-NHL, Grigg et al. found that only four of the patients were CD20-negative prior to start of Columvi. After treatment with Columvi, 23 patients had PD of which 13 were CD20-negative at the time of relapse.
• There is no recommendation for measuring levels of CD20 expressions prior to administration of Columvi.
• The potential risks and benefits of treating patients with CD20-negative DLBCL with Columvi should be considered.

Columvi is a bispecific monoclonal antibody that binds to [1]

• CD20 expressed on the surface of B cells, and
• CD3 in the T-cell receptor complex expressed on the surface of T cells.

By simultaneous binding to CD20 on the B cell and CD3 on the T cell, Columvi induces [1]

• lysis of CD20-expressing B cells,
• activation and proliferation of T‑cells, and
• release of cytokines.

Lysis of B cells mediated by Columvi is CD20‑specific and does not occur in the absence of [1]

• CD20 expression, or
• simultaneous binding of T cells to CD20‑expressing cells

Data from non-clinical studies show [2,3]

• Columvi efficiently killed cell lines expressing very low levels of CD20.
• Evidence of Columvi’s in vitro activity includes lysis of 50% of tumor cells with 0.5% of CD20 receptor occupancy.
• tumor cell killing can efficiently occur in the presence of saturating levels of obinutuzumab, thus supporting the hypothesis that Columvi works effectively under conditions of limited CD20 access.

Experience from clinical trials

There is limited data in patients with CD20‑negative DLBCL treated with Columvi.[4] CD20‑negative DLBCL is defined as less than 5% of CD20-positive cells in the tumor area.[4]

In the Columvi pivotal study, patients were not prescreened for CD20 expression because [5]

• data from non-clinical studies demonstrated anti-tumor activity of Columvi even with low CD20 expression, [2,3] and
• CD20 is expressed in the majority of B-cell-derived human malignancies.
• Published reports show that CD20-negative B-cell-derived malignancies are rare.[6]

In the pivotal clinical trial, patients were eligible if they had a diagnosis of a B-cell malignancy associated with CD20 expression. Fresh tumor biopsy or archival tumor tissue samples was mandatory for entry into the study to: 

• assess CD20 expression, retrospectively,
• determine prognostic or predictive factors, and
• investigate baseline immune status.[2]

Three patients had CD20-negative disease; all had progressive disease as their best response to Columvi and died during follow-up.[4] The efficacy of Columvi has not been established in patients with CD20-negative disease who have relapsed from prior anti-CD20 therapy.[4]

In the Columvi pivotal study, patients who had progressed after completing treatment with 12 cycles of Columvi were strongly recommended to provide a fresh tumor sample for exploratory assessment of CD20 expression, before receiving retreatment with Columvi.[7]

Case reports and published literature on the use of Columvi in patients with CD20‑negative DLBCL

Grigg et al. conducted a single-center retrospective study of 42 patients with aggressive B-NHL who were refractory or relapsed after Columvi therapy to assess post-Columvi treatment outcomes and CD20 status.[8]

Prior to treatment with Columvi, CD20 status was assessed in 32 patients, of which four had CD20-negative disease. In these four patients, two had a PR as their best response to Columvi and two had PD.

After treatment with Columvi, 23 patients had PD. CD20 status was assessed in 22 patients with available biopsies. Thirteen (59%) patients were found CD20-negative, of which

• ten had converted from CD20-positive to CD20 negative,

• two remained persistently CD20-negative, and

• the pretreatment CD20 status of the rest was unknown.

Those who were CD20-negative at relapse

• progressed earlier on Columvi (median PFS 2.5 months vs. 5.5 months; p = 0.4), and

• had shorter median OS from time of progression (4.4 months vs. 10.4 months; p = 0.06).

Of those who progressed after treatment with Columvi, two patients received re-treatment with Columvi. Of these two patients, the non-responder to re-treatment was CD20-negative prior to Columvi re-exposure.

There is no recommendation for assessment of CD20 expression prior to Columvi initiation.[1] However, the potential risks and benefits associated with treatment of patients with CD20-negative DLBCL with Columvi should be considered.[4] It is possible that patients with CD20-negative DLBCL may have less benefit compared to patients with CD20-positive DLBCL.[4] The decision to biopsy to assess the presence of CD20 prior to treatment with Columvi is left to the discretion of the healthcare provider. 

1. Roche Internal Regulatory Document (Columvi Core Data Sheet) (Accessed on 25 February 2024).
2. Dickinson MJ, Carlo-Stella C, Morschhauser F, et al. Glofitamab for Relapsed or Refractory Diffuse Large B-Cell Lymphoma. N Engl J Med 2022;387:2220-2231. https://www.ncbi.nlm.nih.gov/pubmed/36507690
3. Bacac M, Colombetti S, Herter S, et al. CD20-TCB with Obinutuzumab Pretreatment as Next-Generation Treatment of Hematologic Malignancies. Clin Cancer Res 2018;24:4785-4797. https://www.ncbi.nlm.nih.gov/pubmed/29716920
4. European Medicines Agency (EMA). Committee for Medicinal Products for Human Use (CHMP) Assessment Report (EMA/228393/2023). 2023;98-99. https://www.ema.europa.eu/en/documents/assessment-report/columvi-epar-public-assessment-report_en.pdf
5. Roche Internal Safety Report (Accessed on 04 March 2024).
6. Maeshima AM, Taniguchi H, Nomoto J, et al. Prognostic implications of histologic grade and intensity of Bcl-2 expression in follicular lymphomas undergoing rituximab-containing therapy. Hum Pathol 2013;44:2529-35. https://www.ncbi.nlm.nih.gov/pubmed/23916290
7. Roche Internal Clinical Study Report (Protocol of Study NP30179) (Accessed on 02 March 2024).
8. Grigg S, Minson A, Prins E, et al. Relapse after glofitamab has a poor prognosis and rates of CD20 loss are high. Br J Haematol 2024;https://www.ncbi.nlm.nih.gov/pubmed/38720530