# Step-up dosing (T-cell engagers)

Source: https://onco.cc/terms/step-up-dosing/  
OnCo record `step-up-dosing` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Starting a bispecific T-cell engager (teclistamab, glofitamab, epcoritamab, tarlatamab) at a tiny dose and increasing it over the first week, so T cells are switched on gradually and the fever-and-low-blood-pressure reaction (cytokine release syndrome) stays mild. The hospital stay it needs has slowed community adoption.

## Summary

Bispecific T-cell engagers (teclistamab, glofitamab, epcoritamab, tarlatamab) are given in step-up doses over the first week, often with steroid or tocilizumab premedication and inpatient monitoring, after which CRS risk falls sharply and dosing can continue in clinic. The requirement for hospital beds during step-up has slowed community adoption and motivates subcutaneous formulations, prophylactic tocilizumab and outpatient protocols. Venetoclax uses a similar five-week ramp-up in CLL to prevent tumour lysis syndrome.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: step-up; step-up dose; step-up doses; priming dose; ramp-up; ramp-up dosing; venetoclax ramp-up; dose ramp; inpatient monitoring; outpatient administration; outpatient step-up

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Bispecific_T-cell_engager
- Wikipedia: https://en.wikipedia.org/wiki/Bispecific_T-cell_engager

## Connected records

- terms: [Cytokine release syndrome (CRS)](https://onco.cc/terms/crs/), [ICANS (neurotoxicity)](https://onco.cc/terms/icans/)
- technologies: [Bispecific antibodies](https://onco.cc/technologies/bispecific-antibody/), [Community oncology and site networks](https://onco.cc/technologies/community-oncology-networks/), [T-cell engagers (bispecific)](https://onco.cc/technologies/t-cell-engager/)
- fronts: [Immunotherapy](https://onco.cc/fronts/immunotherapy/)
- drugs: [Elranatamab](https://onco.cc/drugs/elranatamab/), [Epcoritamab](https://onco.cc/drugs/epcoritamab/), [Glofitamab](https://onco.cc/drugs/glofitamab/), [Tarlatamab](https://onco.cc/drugs/tarlatamab/), [Tebentafusp](https://onco.cc/drugs/tebentafusp/), [Teclistamab](https://onco.cc/drugs/teclistamab/), [Venetoclax](https://onco.cc/drugs/venetoclax/)
- cancers: [Extensive-stage small-cell lung cancer](https://onco.cc/cancers/extensive-stage-sclc/), [Relapsed or refractory multiple myeloma](https://onco.cc/cancers/myeloma-relapsed-refractory/)

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