Clínica Universidad de Navarra, CIMA, CIBERONC, IDISNA, Pamplona, Spain
Paula Rodríguez-Otero , Carolina D. Schinke , Ajai Chari , Brea Lipe , Noa Lavi , Leo Rasche , Deeksha Vishwamitra , Sheri Skerget , Raluca Verona , Xuewen Ma , Sheetal Khedkar , Brandi Hilder , Tara J. Masterson , Michela Campagna , Thomas Renaud , Jaszianne A. Tolbert , Christoph Heuck , Marie-Anne Damiette Smit , Niels W.C.J. van de Donk
Background: Infection, a key complication of MM, may be due to patient, disease, or treatment-related factors. Immunotherapies that impact normal immune cells may increase risk of infection. Tal, a bispecific antibody with clinical benefit in pts with RRMM, targets G protein–coupled receptor family C group 5 member D (GPRC5D), a protein of unknown function with significantly higher expression on malignant versus normal plasma cells. We report the infection profile and immune function with tal in the phase (ph) 1/2 MonumenTAL-1 study (NCT03399799/NCT04634552). Methods: Pts had RRMM, were intolerant to/progressed on established therapies (ph 1), or had ≥3 prior lines of therapy (ph 2; ≥1 proteasome inhibitor/immunomodulatory drug/anti-CD38 antibody). Subcutaneous tal was given at 0.4 mg/kg QW or 0.8 mg/kg Q2W. Infections (graded by CTCAE v4.03) were treated per local guidelines. B-cell subpopulations and IgG levels were assessed from whole blood and serum samples, respectively. Results: We evaluated 339 pts on tal QW or Q2W, of whom 51 had prior T-cell redirection therapy (pTCRT); infection rates are shown in the table (median follow-up, 15.9, 10.1, and 13.1 mo, respectively). New-onset infections were most prevalent during cycles 1–2. Grade (gr) 3/4 infections observed in >2 pts were pneumonia (3.5%) and UTI (2.1%) on tal QW; pneumonia (2.1%) and COVID-19 (2.1%) on tal Q2W; and pneumonia (5.9%) with pTCRT. Opportunistic infections were observed in 3.5%, 4.1%, and 5.9% of pts, respectively. Less than 1.5% of pts died from infections: COVID-19 pneumonia (n=2) and one each due to septic shock, fungal sepsis, and unknown etiology. Hypogammaglobulinemia rates by IgG values were 64.3% (tal QW), 65.5% (tal Q2W), and 70.6% (pTCRT); IVIg use was 14.7%, 12.4%, and 15.7%, respectively. CD19+ B-cell levels were stable, and there was a trend toward increased non-clonal IgG over time. Conclusions: Roughly 20% of pts had gr 3/4 infections on tal (most frequently cycles 1–2), with low rates of opportunistic infections, discontinuation, and death. Infection rates, particularly rates of fatal infections, appear lower with tal than with BCMA-targeted T-cell–based therapies. A trend toward increased non-clonal IgG suggests potential recovery of humoral immunity accompanies rapid, deep, and durable responses to tal. These results distinguish tal as an important emerging therapy for RRMM. Clinical trial information: NCT03399799, NCT04634552.
Pts, n (%) | Tal 0.4 mg/kg QW (n=143) | Tal 0.8 mg/kg Q2W (n=145) | pTCRT (n=51) |
---|---|---|---|
Infections | |||
Any Gr | 83 (58.0) | 94 (64.8) | 36 (70.6) |
Gr 3/4 | 31 (21.7) | 23 (15.9) | 13 (25.5) |
Led to death | 3 (2.1) | 2 (1.4) | 0 |
Led to discontinuation | 2 (1.4) | 0 | 1 (2.0) |
Led to dose interruption | 44 (30.8) | 43 (29.7) | 16 (31.4) |
Gr 3/4 neutropenia | 44 (30.8) | 32 (22.1) | 27 (52.9) |
Any infection + concomitant Gr 3/4 neutropenia | 11 (7.7) | 3 (2.1) | 9 (17.6) |
Gr 3/4 infection + concomitant Gr 3/4 neutropenia | 4 (2.8) | 1 (0.7) | 1 (2.0) |
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Abstract Disclosures
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