Glofitamab (Columvi)

Glofitamab is a type of targeted cancer drug. You pronounce it as glow-fiyh-tah-mab. It is also called Columvi.

It's a treatment for diffuse large B cell lymphoma (DLBCL) that has had at least 2 or more systemic treatments and has either:

• come back (relapsed DLBCL)

• not gone away (refractory DLBCL)

You might have glofitamab as part of a clinical trial .

How does glofitamab work?

Glofitamab is a type of monoclonal antibody called a bispecific T-cell engager (BiTE) .

Glofitamab works by binding to your body’s immune cells and the cancerous cells. When they meet it creates a link. This link helps stimulate the immune system to attack and produce chemicals to kill the cancer cells.

How do you have glofitamab?

You have glofitamab as a drip into your bloodstream (intravenously).

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

How often do you have glofitamab?

You have glofitamab as cycles of treatment. This means you have the drug and then a rest to allow your body to recover.

Each cycle lasts 3 weeks (21 days). You usually have up to 12 cycles.

Before your first treatment with glofitamab you have another drug called obinutuzumab. You have this drug to help lower the risk of getting a side effect called cytokine release syndrome. Cytokines are a group of proteins in the body that play an important part in boosting the immune system. Glofitamab stimulates the immune system to make large amounts of cytokines. 

The following is an example of how you have glofitamab.

You have cycle 1 in the following way:

You then start cycle 2 of treatment.

You have cycle 2 and 3 in the following way:

You then start cycle 4 of treatment.

You have cycle 4 to 12 in the following way:

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV . This is called a viral screen.

It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your immune system and can cause the virus to become active again (reactivation). 

What are the side effects of glofitamab?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Tumour flare

This is an immune system reaction to the drug. It can cause symptoms and make your cancer worsen for a short time. This usually happens in the first cycle of treatment. 

Your healthcare team monitor you closely while having your first treatment. Some of the symptoms can include sore and swollen lymph nodes, chest pain, difficulty breathing and pain at the site of the tumour.

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when weeing, or generally feeling unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Cytokine release syndrome (CRS)

Cytokines are a group of proteins in the body that play an important part in boosting the immune system. This treatment stimulates the immune system to make large amounts of cytokines. This can cause symptoms which can be severe. Some of the symptoms include fever, chills, a headache, difficulty breathing, and dizziness.

Your doctors and nurses monitor you closely. Depending on how severe your symptoms are you might need treatment with a monoclonal antibody called tocilizumab to control it. You might also have steroids .

Low levels of minerals and salts in the blood

Your blood tests might show you have low levels of phosphate, magnesium, calcium and potassium.

Less commonly your sodium level might drop. You have regular blood tests to check your levels of minerals and salts.

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Skin rash 

This treatment can cause a skin rash. This usually goes back to normal when your treatment finishes. Your healthcare team can tell you what products you can use on your skin to help.

High temperature (fever)

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• sepsis - a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, slurred speech or confusion, breathlessness, mottled or discoloured skin, extreme shivering or muscle pain. Call 999 or go to accident and emergency (A&E) immediately if you have any of these symptoms
• brain changes (neurological side effects) - symptoms can include shaking (tremor), disorientation, fits (seizures) difficulties with your writing or speech
• changes to the levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this
• feeling confused
• feeling very sleepy (somnolence) - do not drive or operate machinery
• feeling shaky or trembling (tremor)
• bleeding from the stomach or gut – symptoms might include black poo or vomiting up blood
• changes to how well your liver is working – symptoms can include yellowing of the skin and whites of the eyes

Rare side effects

This treatment can cause swelling or inflammation of the spinal cord . This is called myelitis. Symptoms can include feeling numb or muscle weakness.

This side effect happens in fewer than 1 in 100 people (less than 1%).

Possible rare and long term side effects

This is a new drug in cancer treatment. So there is limited information available at the moment about possible rare and longer term effects that it may cause. Tell your doctor if you notice anything that is not normal for you.

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, food and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Pregnancy and contraception

It is unknown whether this treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment and for 2 months afterwards. Let your team know straight away if you become pregnant while having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Breastfeeding

It is not known whether these drugs come through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment and for 2 months afterwards.

Treatment for other conditions 

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.