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498 A Phase I Study of a Novel BCMA×CD3 Bispecific Antibody Emb-06 in Relapsed or Refractory Multiple Myeloma

Program: Oral and Poster Abstracts
Type: Oral
Session: 654. Multiple Myeloma: Pharmacologic Therapies: Targeting BCMA
Hematology Disease Topics & Pathways:
Research, Clinical trials, Adult, Drug development, Bispecific Antibody Therapy, Clinical Research, Plasma Cell Disorders, Diseases, Treatment Considerations, Biological therapies, Lymphoid Malignancies, Adverse Events, Study Population, Human, Measurable Residual Disease
Sunday, December 8, 2024: 10:45 AM

Peter T. Tan, MBBS1, LI Bao2*, Qingsong Yin, PhD3*, Chunrui Li4*, Sorab Jehangir Shavaksha5*, H. Miles Prince6*, Zhen Cai7*, SHAN GAO, PhD, MD8*, Qian Wang3*, Di Wang4*, YI LI9*, Mingfei Zhang10*, Qiumei Deng11*, Qiaoyang Lu10*, Chengjun Jiang10*, Fang Ren10*, Danqing Wu10*, Shuqi Zeng10*, Yonghong Zhu10*, Yi Tao12*, Yuanfang Liu, MD, PhD13* and Jian-Qing Mi12

1One Clinical Research Pty Ltd, Nedlands, Australia
2Beijing Jishuitan Hospital, Beijing, Beijing, CHN
3Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
4Tongji Hospital, Tongji Medical College of Huazhong University of Science & Technology, China, Wuhan, China
55Sunshine Coast Haematology and Oncology Clinic (SCHOC), Australia, Buderim, QLD, Australia
6Epworth Healthcare and University of Melbourne, Melbourne, VIC, Australia
7Department of Haematology, First Affiliated Hospital of Zhejiang University, Hangzhou, China
8Beijing Jishuitan Hospital, Beijing, Beijing, China
9The First Affiliated Hospital, Zhejiang University School of Medicine, China, Hangzhou, China
10Shanghai EpimAb Biotherapeutics, Shanghai, China, Shanghai, China
11Epimab Biotherapeutics, Shanghai, China
12Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
13Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Background: Despite advances in T-cell engager therapies for multiple myeloma, the prevalence of cytokine release syndrome (CRS) and severe neurotoxicity presents clinical challenges. EMB-06 is a novel 2+2 BCMA×CD3 T-cell engaging bispecific antibody developed using EpimAb’s proprietary Fabs-In-Tandem-Immunoglobulin (FIT-Ig®) platform. Unlike existing T-cell engagers, EMB-06 features tetravalent binding domains in cis-configuration and optimized anti-CD3 arms. Preclinical studies have shown that EMB-06 induces minimal cytokine release while maintaining robust anti-tumor activity. Here we report the initial results from an ongoing multicenter, first-in-human, Phase I study of EMB-06 in relapsed or refractory multiple myeloma (RRMM).

Methods: The primary objectives of the Phase 1 dose-escalation study are to assess the safety, tolerability, maximum tolerated dose (MTD), and/or recommended Phase 2 dose (RP2D) of EMB-06. Secondary objectives include assessment of pharmacokinetics (PK), pharmacodynamics (PD), immunogenicity, and preliminary anti-tumor efficacy. Eligible patients with RRMM must have received at least two lines of prior therapies, including proteasome inhibitors (PI), immunomodulatory agents (IMiD), and if accessible, an anti-CD38 antibody. The dose escalation was conducted in accordance with the Bayesian optimal interval (BOIN) design. Efficacy was analyzed in response-evaluable patients, defined as those who received at least one dose of EMB-06 and had at least one post-baseline response evaluation.

Results: As of June 7, 2024, 40 patients had been treated with EMB-06 at doses ranging from 0.2 mg to 300 mg. The median age (range) was 66 years (46-82). Patients had received a median (range) of 3 prior lines of therapy (2-6), and 35 patients (87.5%) were refractory to their most recent therapy. Treatment-related adverse events (TRAEs) were reported in 26 patients (65%), with Grade ≥3 TRAEs in 16 patients (40%). The most common treatment-related adverse events (TRAEs) included neutropenia (30%), ALP increase (27.5%), AST increase (27.5%), white blood cell count decreased (25%), anemia (25%), absolute lymphocyte count decreased (25%), CRS (25%), ALT increase (18%), platelet count decreased (17.5%), upper respiratory tract infections (15%), infective pneumonia (15%). All CRS cases were Grade 1 (20%) or 2 (5%) per ASTCT criteria. No ICANS was observed, and only one patient experienced treatment-related neurological adverse event (Grade 1 paresthesia). One dose-limiting toxicity (DLT) was observed in the 60 mg cohort, presenting as pneumonia, cardiac failure, increased creatinine, and hepatic insufficiency in one patient. Serious TRAEs occurred in 27.5% of patients, predominantly due to infective pneumonia (12.5%). Grade 5 AEs, unrelated to the study drug, occurred in four patients: three due to multiple myeloma progression and one due to heart failure. EMB-06 exhibited a dose-proportional increase in PK exposure across 0.2-300 mg, with a median half-life of 4.4 days. PD activity, including T-cell redistribution and activation with transient low-level cytokine release, was observed at doses ≥0.6 mg. The overall response rate (ORR) was 39% (15/38) among 38 evaluable patients. Among the 12 patients treated with doses ≥120 mg, the ORR was 92%, including 1 stringent complete response (sCR), 3 complete responses (CRs), 5 very good partial responses (VGPRs), and 2 partial responses (PRs). Of the 4 MRD evaluable patients with CR or sCR, 4 (100%) were MRD negative (≤ 10–5). The median time to response (≥PR) was 1.2 months (range, 1.1-2.1). The median duration of response (DoR) was not reached, with only one patient experiencing progressive disease at a DoR of 22.2 months. Notably, patients experiencing treatment delays of at least 3 months due to adverse events (AEs) still exhibited sustained responses in one patient and deepened responses in two patients (from VGPR to CR and from PR to CR, respectively).

Conclusions: In this analysis of full dose escalation study, EMB-06 demonstrated a differentiated safety profile in RRMM patients, with low rates of CRS and no ICANS, and durable efficacy in heavily pre-treated RRMM patients.

Disclosures: No relevant conflicts of interest to declare.

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