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2299 Dreamm-5 Platform Trial: Belantamab Mafodotin (Belamaf) in Combination with Four Different Novel Agents in Patients with Relapsed/Refractory Multiple Myeloma (RRMM)

Program: Oral and Poster Abstracts
Session: 653. Myeloma/Amyloidosis: Therapy, excluding Transplantation: Poster II
Hematology Disease Topics & Pathways:
Adult, Diseases, Therapies, Combinations, Lymphoid Malignancies, Study Population, Clinically relevant
Sunday, December 6, 2020, 7:00 AM-3:30 PM

Paul G. Richardson, MD1, Ajay Nooka, MD, MPH2, Hang Quach, MD, FRACP, FRCPA, MBBS3, Suzanne Trudel, MD4*, David Routledge5,6*, Kevin Song, MD7, Hareth Nahi, MD8*, Sofia Paul9*, Josephine Khan10*, Maria Brouch9*, Geraldine Ferron-Brady, PhD9*, Anne Yeakey, MD11*, Chris Shelton9*, Rocio Montes de Oca, PhD12*, L. Mary Smith13*, Ellie Im14*, Christoph M Ahlers9*, Elaine M Paul11*, Beata Holkova9, Ira Gupta, MD15*, Brandon E. Kremer, MD, PhD14* and Paula Rodriguez-Otero, MD, PhD16*

1Dana-Farber Cancer Institute, Boston, MA
2Winship Cancer Institute, Emory University, Atlanta, GA
3University of Melbourne, St. Vincent’s Hospital Melbourne, Melbourne, Australia
4Princess Margaret Cancer Center, Toronto, ON, Canada
5Department of Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC, Australia
6Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
7The Vancouver General Hospital, Vancouver, BC, CAN
8Karolinska University Hospital, Stockholm, Sweden
9GlaxoSmithKline, Upper Providence, PA
10GlaxoSmithKline, Stevenage, United Kingdom
11GlaxoSmithKline, Research Triangle Park, NC
12Experimental Medicine Unit Oncology, GlaxoSmithKline, Philadelphia, PA
13SpringWorks Therapeutics Inc., Stamford, CT
14GlaxoSmithKline, Waltham, MA
15Clinical Oncology, GlaxoSmithKline, Upper Providence, PA
16Clínica Universidad de Navarra-Pamplona, Navarra, Spain

Introduction: Single-agent belamaf (GSK2857916), a B-cell maturation antigen–targeting antibody-drug conjugate, induced deep and durable responses in patients with RRMM, with a manageable safety profile with 13 months of follow-up (DREAMM-2; NCT03525678; Lonial et al, ASCO 2020, Poster 436). A platform trial design allows efficient evaluation of belamaf in combination with other anti-myeloma agents, such as a humanized wild-type IgG1 anti-OX40 agonist, an IgG4-inducible T-cell co-stimulator (ICOS) agonist, a gamma-secretase inhibitor, and a humanized programmed cell death (PD)-1 antagonist. The unique, multimodal mechanisms of action (MoAs) of belamaf, in combination with MoAs of these agents, has the potential to achieve synergistic effects in RRMM to further enhance anti-myeloma activity without compromising safety.

Methods: DREAMM-5 (NCT04126200) is a Phase I/II study that utilizes a master protocol with separate substudies comprised of sequential dose-exploration (DE) and cohort-expansion (CE) phases, to identify promising, effective belamaf combinations when compared with a shared single-agent belamaf control arm (CE phase only). The DE phase consists of multiple dosing cohorts with belamaf combinations in which patients are assigned to treatment slots by a predetermined algorithmic approach (N≤10 per cohort). A recommended Phase II dose (RP2D) for each combination treatment will be identified based on the safety and preliminary efficacy in the DE phase. At the end of the DE phase, an interim analysis of safety, pharmacokinetic, and efficacy data will also be performed for each substudy treatment combination to determine whether the combination should move forward at the RP2D to the CE phase. Patients in the CE phase (N≥35 per cohort) will be randomized to a substudy and within a substudy to either combination treatment or the belamaf monotherapy control arm; patients will also be stratified by number of prior therapies). Eligible patients will have RRMM and will have received ≥3 prior therapy lines, which includes a prior immunomodulatory agent, proteasome inhibitor, and anti-CD38 antibody; all patients will provide informed consent for participation. The primary objectives of the study are to identify the RP2D (DE phase) and the overall response rate (≥partial response, CE phase), along with safety and tolerability, for each combination treatment.

Substudies 1 (combination with GSK3174998, OX40 agonist antibody), 2 (combination with GSK3359609, ICOS agonist antibody), and 3 (combination with nirogacestat [PF-03084014; SpringWorks Therapeutics], gamma-secretase inhibitor) are currently open to enrollment. Substudy 4 (combination with dostarlimab; PD-1 antagonist antibody) is under review. Additional substudies will be explored based on scientific rationale and/or preclinical combination study results.

Funding: GSK (Study 208887); belamaf drug linker technology licensed from Seattle Genetics; belamaf monoclonal antibody produced using POTELLIGENT Technology licensed from BioWa; nirogacestat gamma-secretase inhibitor produced by and used in collaboration with SpringWorks Therapeutics.

Figure: DREAMM-5 study design

Disclosures: Richardson: Celgene/BMS, Oncopeptides, Takeda, Karyopharm: Research Funding. Nooka: GlaxoSmithKline: Consultancy, Honoraria, Other: Personal Fees: Travel/accomodations/expenses, Research Funding; Karyopharm Therapeutics, Adaptive technologies: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Spectrum Pharmaceuticals: Consultancy; Adaptive Technologies: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Oncopeptides: Consultancy, Honoraria; Celgene: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Bristol-Myers Squibb: Consultancy, Honoraria, Research Funding. Quach: Amgen, sanofi, celgene, Karyopharm, GSK: Research Funding; Amgen, Celgene, karyopharm, GSK, Janssen Cilag, Sanofi.: Membership on an entity's Board of Directors or advisory committees; GlaxoSmithKline, Karyopharm, Amgen, Celgene, Janssen Cilag: Consultancy; GlaxoSmithKline, Karyopharm, Amgen, Celgene, Janssen Cilag: Honoraria. Trudel: Celgene, Janssen, Takeda, Sanofi, Karyopharm, Amgen Canada: Honoraria; Celgene, Amgen, GSK: Consultancy, Research Funding; GSK, Celgene, Janssen, Amgen, Genentech: Research Funding. Routledge: Celgene, Sandoz: Consultancy; Amgen, BMS, Celgene, Sandoz: Honoraria. Song: Otsuka: Honoraria; Janssen: Honoraria, Research Funding; Amgen, Celgene,Takeda: Consultancy, Honoraria; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; GlaxoSmithKline: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene/BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees. Paul: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Khan: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Brouch: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Ferron-Brady: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Yeakey: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Shelton: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Montes de Oca: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Smith: SpringWorks: Current Employment, Current equity holder in publicly-traded company. Im: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Ahlers: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Paul: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Holkova: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Gupta: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company; Novartis: Current equity holder in publicly-traded company. Kremer: GlaxoSmithKline: Current Employment, Current equity holder in publicly-traded company. Rodriguez-Otero: GlaxoSmithKline: Consultancy, Current Employment, Current equity holder in publicly-traded company, Honoraria; Kite: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Oncopeptides: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Medscape: Membership on an entity's Board of Directors or advisory committees; Celgene/Bristol-Myers Squibb: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Janssen: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Sanofi: Consultancy, Honoraria.

*signifies non-member of ASH