A Phase Ib/II, Open-Label Trial to Assess the Safety and Preliminary Efficacy of Epcoritamab (GEN3013; DuoBody-CD3xCD20) in Combination With Other Agents in Subjects With B-cell Non-Hodgkin Lymphoma.
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Study Summary
Safety Run In Phase: To evaluate the safety and tolerability of epcoritamab in combination with other agents Expansion Phase: To Assess the preliminary anti-tumor activity of epcoritamab in combination with other agents To evaluate the safety, tolerability, PK, pharmacodynamics/biomarkers, immunogenicity, and preliminary efficacy of epcoritamab in combination with other standard of care (SOC) agents in subjects with B-NHL. Step-up dosing and corticosteroids during cycle 1 were used to mitigate cytokine release syndrome (CRS). Responses were evaluated by position emission tomography–computed tomography per the 2014 Lugano classification criteria To present preliminary results from arm 2 of this trial, which is evaluating epcoritamab in combination with R2 in pts with R/R FL. To present data from arm 1 of this trial, in which epcoritamab in combination with R-CHOP is evaluated in pts with previously untreated high-risk DLBCL. PET-CT was used to assess response To present results for a larger cohort with longer follow-up. To evaluate epcoritamab SC + R-mini-CHOP in 1L DLBCL. A safety run-in was conducted to confirm acceptability of the safety profile. To report initial data from arm 8 of the phase 1/2 EPCORE™ NHL-2 study evaluating epcoritamab SC + R-mini-CHOP in 1L DLBCL. To report updated data from epcoritamab in combination with rituximab, dexamethasone, cytarabine, and oxaliplatin or carboplatin (R-DHAX/C) in pts with R/R DLBCL eligible for HDT-ASCT, including high-risk pts (progressed within 12 mo of initial tx or primary refractory), from EPCORE™ NHL-2 To present data from EPCORE™ NHL-2 (phase 1/2; NCT04663347), with longer follow-up for epcoritamab + R2 in 1L FL (arm 6) and the first disclosure for epcoritamab maintenance in patients (pts) with FL in CR or partial response (PR) after 1–2 lines of standard of care (SOC) tx (arm 7). To report additional efficacy and safety results of epcoritamab + GemOx in difficult-to-treat R/R DLBCL (EPCORE™ NHL-2 phase 1/2 trial, NCT04663347). Methods: Adults with R/R CD20+ DLBCL who failed or were ineligible for autologous stem cell transplant (ASCT) enrolled to To present long-term follow-up beyond 2 y and minimal residual disease (MRD) analysis for the first time. MRD analysis was performed on peripheral blood mononuclear cell samples collected at prespecified time points (clonoSEQ® assay, Adaptive Biotechnologies) and quantified as tumor clones detected per 1 x 106 nucleated cells. To report updated results with longer follow-up from arm 8 of the EPCORE® NHL-2 trial evaluating epcoritamab + R-mini-CHOP in this population. To present long-term follow-up beyond 2 y, including in subgroups, and minimal residual disease (MRD) analyses for the first time To present initial results from arm 3 of the ongoing phase 1b/2 EPCORE NHL-2 trial evaluating fixed-duration epcoritamab + BR in 1L FL, including T-cell pharmacodynamics with this novel combination. To evaluate the safety and tolerability of epcoritamab in combination with other agents Expansion Phase: Arms 1-6 and 8-10: Assess the preliminary anti-tumor activity of epcoritamab in combination with other agents Arm 7: Evaluate the safety and tolerability of epcoritamab following standard of care (SOC) Efficacy by baseline (BL) bulky disease (BD) status (≥ 7 cm [n = 6] vs. < 7 cm [n = 19]) was evaluated. To report the first disclosure of circulating tumor DNA (ctDNA) over time to provide insights into MRD kinetics for pts treated with epcor + GemOx. MRD was assessed using the Avenio ctDNA assay with a cutoff of negativity defined as < 1 mutant molecule/ml. MRD-evaluable pts required a baseline and ≥ 1 on-tx MRD result and MRD positivity at C1D1. Best overall response and progression-free survival (PFS), were assessed by independent review committee per Lugano criteria. To report efficacy and safety from a 3-year follow-up of patients who received epcoritamab + R-CHOP in the EPCORE NHL-2 trial. To report long term durability data from this cohort after >2 y of follow-up
- Measurable disease defined as ≥1 measurable nodal lesion (long axis >1.5 cm and short axis >1.0 cm) or ≥1 measurable extra-nodal lesion (long axis >1.0 cm) on computed tomography (CT) or magnetic resonance imaging (MRI). Applies to all arms except arm 7.
- Eastern Cooperative Oncology Group (ECOG) PS score of 0, 1 or 2
- Acceptable organ function at screening
- CD20-positive non-Hodgkin lymphoma (NHL) at most recent representative tumor biopsy
- If of childbearing potential participant must practicing a highly effective method of birth control
- A man who is sexually active with a woman of childbearing potential must agree to use a barrier method of birth control
- Arm 1:
- Newly Diagnosed Documented diffuse large B-cell lymphoma (DLBCL)
- DLBCL, NOS
- “double-hit“ or “triple-hit“ DLBCL
- FL Grade 3B
- Arm 2: R/R FL
- Arm 3: Newly diagnosed, previously untreated FL grade 1-3A
- Arm 4:
- Documented DLBCL and eligible for HDT-ASCT
- DLBCL, NOS
- “double-hit“ or “triple-hit“ DLBCL
- FL Grade 3B
- Arm 5:
- Relapsed or refractory documented DLBCL and ineligible for HDT-ASCT
- DLBCL, NOS
- “double-hit“ or “triple-hit“ DLBCL
- FL Grade 3B
- Arm 6: Newly diagnosed, previously untreated FL grade 1-3A
- Arm 7:
- FL Grade 1-3A
- If PR or CR per Lugano criteria following first-line or second-line treatment with SOC regimen, and last dose of SOC within 6 months prior to enrollment.
- Arm 8:
- DLBCL, NOS
- T-cell/histiocyte rich DLBCL
- “double-hit“ or “triple-hit“ DLBCL
- FL Grade 3B
- Arm 9:
- R/R FL
- Progressed within 24 months of initiating first-line treatment
- Arm 10:
- Documented DLBCL and eligible for HDT-ASCT
- DLBCL, NOS
- "double-hit" or "triple-hit" DLBCL
- FL Grade 3B
- Adults with R/R CD20+ DLBCL who had failed or were ineligible for ASCT were enrolled
- Adults with 1L CD20+ DLBCL who were not considered candidates for full-dose R-CHOP due to age ≥75 y or age ≥65 y with comorbidities (reduced left ventricular ejection fraction, history of myocardial infarction [>6 mo prior to enrollment], exertional chest pain, arrhythmia [grade ≤2], hypertension requiring treatment, or diabetes) were enrolled.
- Adult pts with 1L CD20+ DLBCL who were not considered candidates for full‑dose R-CHOP (age ≥75 y or age ≥65 y with comorbidities) were enrolled.
- Chemotherapy, radiation therapy, or major surgery within 4 weeks prior to the first dose of epcoritamab
- Any prior treatment with a bispecific antibody targeting CD3 and CD20.
- Treatment with CAR-T therapy within 30 days prior to first dose of epcoritamab
- Clinically significant cardiovascular disease
- Evidence of significant, uncontrolled concomitant diseases that could affect compliance with the protocol or interpretation of results
- CNS lymphoma or known CNS involvement by lymphoma at screening as confirmed by MRI/CT scan of the brain and, if clinically indicated, by lumbar puncture
- Active positive tests for hepatitis B virus or hepatitis C virus indicating acute or chronic infection
- Known history of seropositivity of human immunodeficiency virus (HIV)
- Active tuberculosis or history of completed treatment for active tuberculosis within the past 12 months
- Neuropathy > grade 1
- Receiving immunostimulatory agent
- Prior allogeneic HSCT
- Current seizure disorder requiring anti-epileptic therapy
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