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95 Efficacy and Safety of TAK-007, Cord Blood-Derived CD19 CAR-NK Cells, in Adult Patients with Relapsed/Refractory (R/R) B-Cell Non-Hodgkin Lymphoma (NHL)

Program: Oral and Poster Abstracts
Type: Oral
Session: 704. Cellular Immunotherapies: Early Phase Clinical Trials and Toxicities: CAR-T Cell Therapies for Lymphomas and ALL: New Strategies and Toxicities
Hematology Disease Topics & Pathways:
Clinical trials, Research, Lymphomas, Non-Hodgkin lymphoma, Clinical Research, Diseases, Treatment Considerations, Biological therapies, Lymphoid Malignancies, Natural Killer (NK) Cell Therapies
Saturday, December 7, 2024: 10:30 AM

Justin M. Darrah, MD1*, Indumathy Varadarajan2*, Amitkumar Mehta, MD3*, Jennifer N. Saultz, DO4, Matthew McKinney, MD5*, Monalisa Ghosh, MD6, Usama Gergis, MD, MBA7, Girish Bende8*, Siddha Kasar, PhD8*, Bradley Hupf8*, Sharon Chen8*, Leopold Sellner8* and Reem Karmali, MD9

1Division of Hematology and Cellular Therapy, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
2University of Virginia, Charlottesville, VA
3University of Alabama at Birmingham, Birmingham, AL
4Knight Cancer Institute, Oregon Health & Science University, Portland, OR
5Duke Cancer Institute, Durham, NC
6University of Michigan, Ann Arbor, MI
7Thomas Jefferson University, Philadelphia, PA
8Takeda Development Center Americas, Inc. (TDCA), Lexington, MA
9Northwestern Memorial Hospital, Chicago, IL

Autologous chimeric antigen receptor (CAR)-T cell therapies have provided significant benefit to patients (pts) with R/R B-cell NHL, but options remain limited for pts who are not eligible for autologous CAR-Ts or high-dose chemotherapy followed by autologous stem cell transplantation. Logistical limitations and safety concerns of autologous CAR-Ts may be overcome by allogeneic products with a more favorable safety profile. TAK-007 is an off-the-shelf, allogeneic, cryopreserved, umbilical cord blood-derived, CD19-targeting CAR natural killer (NK) cell therapy product with a dual mode of action including CD19 CAR-mediated and innate NK receptor-mediated (CAR-independent) killing of malignant B-cells. An open-label, multi-center phase 2 trial was conducted to evaluate the safety and preliminary efficacy of TAK-007 in adult pts with R/R large B cell lymphoma (LBCL) or indolent NHL (iNHL) (NCT05020015).

The study included a dose escalation phase evaluating 2 dose levels (200 x 106 [200M] and 800 x 106 [800M] CD19 CAR+ viable NK cells per pt), and an expansion phase at the dose level selected from dose escalation. Treatment included 3 consecutive days of IV lymphodepleting chemotherapy (LDC) with 300 mg/m2 cyclophosphamide and 30 mg/m2 fludarabine, followed by a single dose of TAK-007 >2 days later. Treatment was administered in a human leukocyte antigen (HLA)-agnostic manner. The primary endpoint was incidence of treatment-emergent adverse events (TEAEs). Response was assessed per Lugano 2014 criteria.

At data cut-off (Feb 23, 2024), 27 pts (LBCL, n=18; iNHL, n=9) had been enrolled into dose escalation (n=9) and expansion (n=18) at 9 sites across the US. Of these, 26 pts received TAK-007, with 1 LBCL pt in expansion withdrawn prior to TAK-007 administration due to adverse events. Pts had received a median of 5 (range, 2–11) prior lines of systemic therapy; 10 (59%) LBCL pts and 1 (11%) iNHL pt had received prior anti-CD19 CAR-Ts. At screening, 17 (65%) pts had grade ≥2 cytopenia. Median time from enrolment to LDC was 8 days. Half of the pts received TAK-007 in the outpatient setting. All 26 pts who received TAK-007 experienced ≥1 TEAE. Among non-hematological (heme) TEAE events, 77% were grade 1–2; 18 (69%) pts had grade ≥3 non-heme TEAEs. The most common grade ≥3 TEAEs (heme + non-heme) included neutropenia (73%), leukopenia (50%), anemia (38%), thrombocytopenia (38%), sepsis (27%), and febrile neutropenia (12%). No dose-limiting toxicities were observed. Serious TEAEs were reported in 20 (77%) pts but were not attributable to LDC or TAK-007 in 14 (54%). One pt had a grade 1 infusion-related reaction after TAK-007 administration. Cytokine release syndrome (CRS) was observed within 10 days of TAK-007 administration in 3 pts (grade 1, n=2; grade 2, n=1). No ICANS was reported within 60 days from TAK-007 administration. No significant increases in the levels of pro-inflammatory cytokines were observed. While no responses were seen in the 3 LBCL pts who received 200M TAK-007, 7 of 14 (50%) LBCL pts who received 800M TAK-007 had a response, including 3 (21%) complete responses (CRs). Among 8 pts who previously received CD19 CAR-Ts and received TAK-007, 2 (25%) had a response including 1 (13%) CR. Among 9 iNHL pts, 7 (78%) had a response including 5 (56%) CRs. Median duration of response was 3.4 months among LBCL pts and 4.7 months among iNHL pts. Clinical responses were seen across a range of CD19 antigen densities on pre-treatment biopsies. Cellular kinetics (average time course) exhibited multiphasic disposition, representing an initial cellular contraction followed by cellular expansion. Peak levels were observed on Days 7–10 post-TAK-007 administration, which were followed by a terminal elimination phase with decreasing levels on Days 10–28. The exposure-response analysis indicated a positive correlation between higher exposures (Cmax) and response (CR and overall response rate). Treatment-emergent humoral immunogenicity, specific to donor HLA or the extracellular domain of CAR molecules on TAK-007, was not reported.

TAK-007, an allogeneic off-the-shelf CD19 CAR-NK cell therapy, demonstrated early efficacy at 800M and a favorable safety profile in a heavily pretreated pt population, and may be a safer and simpler treatment option with a shorter turnaround time compared with autologous CD19-targeting CAR-T cells. The use of >1 dose of TAK-007 at 800M may further increase efficacy and durability of response.

Disclosures: Darrah: Kite, MorphoSys: Membership on an entity's Board of Directors or advisory committees. Varadarajan: Novartis: Consultancy; University of Virginia: Current Employment; Cadmon: Consultancy. Mehta: Seattle Genetics: Honoraria, Research Funding; TG Therapeutics: Honoraria, Research Funding; Affimed: Research Funding; Merck: Research Funding; Kite/Gilead: Research Funding; Roche-Genentech: Honoraria, Research Funding; ADC therapeutics: Research Funding; Gilead: Honoraria; Morphosys/Incyte: Honoraria, Speakers Bureau; Kyowa Kirin: Honoraria, Speakers Bureau; Bei Gen: Honoraria, Speakers Bureau; ADCT: Honoraria; Ipsen: Speakers Bureau; Astra Zeneca: Speakers Bureau; BMS: Speakers Bureau; Innate pharmaceuticals: Research Funding; Celgene/BMS: Research Funding; Juno pharmaceuticals/BMS: Research Funding; fortyseven inc/Gilead: Research Funding; Takeda: Research Funding; Incyte: Honoraria, Research Funding. Saultz: Ikena: Research Funding; Rigel: Consultancy; Sanofi: Consultancy. McKinney: Genentech/Roche: Consultancy, Research Funding; Incyte: Research Funding; Novartis: Research Funding; Takeda: Honoraria; Kite/Gilead: Speakers Bureau; ADC therapeutics: Speakers Bureau; Beigene: Honoraria. Ghosh: Cargo: Consultancy; BMS: Consultancy; Kite/Gilead: Research Funding; Novartis: Research Funding; Cabaletta Bio: Consultancy, Research Funding. Gergis: Kite: Other: Travel Support, Speakers Bureau; Astellas: Other: Travel Support, Speakers Bureau; Incyte: Other: Travel Support, Speakers Bureau; Biontech: Current equity holder in publicly-traded company; Moderna: Current equity holder in publicly-traded company; Jazz: Other: Travel Support, Speakers Bureau; Iovance: Current equity holder in publicly-traded company; VOR: Consultancy; Autolus: Consultancy. Bende: Takeda: Current Employment; US FDA: Ended employment in the past 24 months; HHS: Ended employment in the past 24 months. Kasar: Takeda Pharmaceuticals: Current Employment. Chen: Takeda: Current Employment, Ended employment in the past 24 months. Sellner: Takeda: Current Employment, Current equity holder in publicly-traded company, Divested equity in a private or publicly-traded company in the past 24 months. Karmali: Genentech/Roche: Honoraria; Abbvie: Honoraria; Ipsen: Speakers Bureau; BeiGene: Speakers Bureau; AstraZeneca: Speakers Bureau; Incyte: Speakers Bureau; Genmab: Honoraria; BMS: Honoraria.

OffLabel Disclosure: This abstract contains information about investigational use of TAK-007 in patients with relapsed/refractory B-cell non-Hodgkin lymphoma. Safety and efficacy have not been determined.

*signifies non-member of ASH