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581 Fixed-Duration Epcoritamab + R-CHOP Induces High Complete Response Rates in Patients with Previously Untreated Diffuse Large B-Cell Lymphoma Withhigh-Risk Features: Long-Term Results from the Epcore NHL-2 Trial

Program: Oral and Poster Abstracts
Type: Oral
Session: 627. Aggressive Lymphomas: Pharmacologic Therapies: New R-CHOP Combinations for Treatment Naïve DLBCL
Hematology Disease Topics & Pathways:
Clinical trials, Research, Adult, Combination therapy, Non-Hodgkin lymphoma, Lymphomas, Bispecific Antibody Therapy, B Cell lymphoma, Clinical Research, Diseases, Biological therapies, Treatment Considerations, Aggressive lymphoma, Lymphoid Malignancies, Human, Study Population
Sunday, December 8, 2024: 1:00 PM

Lorenzo Falchi, MD1, Fritz Offner, MD, PhD2, Sven de Vos, MD, PhD3*, Joshua Brody, MD4*, Raul Cordoba, MD, PhD5, Kim Linton6*, Sylvia Snauwaert, MD, PhD7*, Michael Roost Clausen, MD, PhD8*, Toshihiko Oki, MD, PhD9*, Andrew J. Steele, PhD10*, Yi Hao, DrPH10*, Kimberly G. Archer10*, Ali Rana, MD, PhD10* and David Belada, MD, PhD11

1Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
2Universitair Ziekenhuis Ghent, Ghent, Belgium
3Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, CA
4Icahn School of Medicine at Mount Sinai, New York, NY
5Health Research Institute IIS-FJD, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
6The Christie NHS Foundation Trust, Manchester Cancer Research Centre, and Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
7Department of Hematology, AZ Sint-Jan Hospital, Bruges, Belgium
8Vejle Hospital, Vejle, Denmark
9AbbVie, North Chicago, IL
10Genmab, Plainsboro, NJ
114th Department of Internal Medicine – Hematology, University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic

Introduction: Epcoritamab, a CD3xCD20 bispecific antibody, has been approved as a single agent for the treatment of adults with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma after ≥2 lines of systemic therapy based on results from the phase 1/2 EPCORE® NHL-1 trial (NCT03625037). Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R‑CHOP) is an accepted standard treatment for patients with previously untreated (1L) DLBCL; however, relapse rates can reach 40%. High-risk patients with International Prognostic Index (IPI) 3–5 and patients with double‑hit/triple-hit lymphoma have suboptimal complete response (CR) rates and long‑term outcomes. Following R-CHOP, 5-y estimates of progression-free/overall survival (OS) decreased from 81%/88% in patients with IPI 0–1 to 67%/76% for IPI 2, 58%/67% for IPI 3, and 46%/54% for IPI 4–5 (Ruppert et al, Blood 2020), suggesting a need for novel regimens to increase cure rates for newly diagnosed patients with DLBCL with high-risk features. Previously, in arm 1 of the EPCORE NHL‑2 trial (phase 1b/2; NCT04663347), the combination of epcoritamab + R‑CHOP showed encouraging response rates and a manageable safety profile in 1L DLBCL, including in high-risk patients (Clausen et al, EHA 2023). Here, we present long-term follow-up beyond 2 y, including in subgroups, and minimal residual disease (MRD) analyses for the first time.

Methods: Adults with 1L CD20+ DLBCL and IPI ≥3 received subcutaneous epcoritamab (QW in cycles 1–4; Q3W in cycles 5–6) + R-CHOP for 6 cycles (21 d each) followed by epcoritamab monotherapy Q4W in 28‑d cycles for up to 1 y. The primary endpoint was overall response rate (ORR) based on best overall response per Lugano criteria. MRD negativity was assessed as a secondary endpoint using the exploratory AVENIO ctDNA method. Double-hit/triple-hit status was assessed by central lab.

Results: As of May 15, 2024, 47 patients had received epcoritamab 48 mg + R‑CHOP, with a median follow-up of 27.4 mo (range, 0.8–33.9). All patients had IPI 3–5 at screening, 6 (21%) of 28 patients with evaluable tissue available had double-hit/triple-hit DLBCL, and 16 patients (34%) had bulky disease (>10 cm). The median time from diagnosis to first dose was 4 wk (range, 1.3–60.4). Median relative dose intensity for all R‑CHOP components was ≥95%.

Among 46 evaluable patients, the ORR was 100%, with a CR rate of 87%. Most patients (96%; 44/46) completed 6 cycles of R-CHOP; 91% (40/44) had a CR, and the 2 patients who did not complete 6 cycles of R-CHOP had a partial response. Notably, patients with double-hit/triple-hit DLBCL had a CR rate (83%; 5/6) similar to the overall population. An estimated 74%/87% of patients remained progression free/alive at 24 mo. Durable responses were observed, with an estimated 83% of patients with CR remaining in CR at 24 mo. MRD negativity (cutoff, <1 mutant molecule per mL) was observed in 91% of evaluable patients (30/33).

The most common treatment-emergent AEs (TEAEs) of any grade (G) were neutropenia (70%), anemia (68%), CRS (60%), fatigue (49%), nausea (47%), pyrexia (43%), and injection-site reaction (40%). Four patients (9%) discontinued epcoritamab due to TEAEs; G5 TEAEs occurred in 2 patients (COVID-19 and septic shock). CRS events were mostly low grade (45% G1, 11% G2, 4% G3) and mainly occurred after the first full dose; all resolved, and none led to discontinuation. ICANS occurred in 2 patients (G1, n=1; G2, n=1) and resolved in a median of 2.5 d without leading to discontinuation.

Conclusions: Fixed-duration epcoritamab + R-CHOP induced deep, durable CRs (24-mo estimated duration of CR, 83%) and high rates of MRD negativity (91% of evaluable patients), leading to long-term remissions (24-mo estimated OS, 87%) beyond 2 y in patients with 1L DLBCL, including those with high-risk features, such as double-hit/triple-hit disease. These results suggest a high curative potential for this potent first-line combination. The safety profile was manageable, with no new safety signals detected, underscoring the combinability of epcoritamab with standards of care in 1L DLBCL. These data compare favorably with R-CHOP alone in this setting and further support the ongoing phase 3 trial of epcoritamab + R-CHOP in 1L DLBCL(NCT05578976).

Disclosures: Falchi: ADC Therapeutics: Membership on an entity's Board of Directors or advisory committees; AbbVie, Genentech, ADC Therapeutics, Seagen, Ipsen: Membership on an entity's Board of Directors or advisory committees; Taylor Francis: Other: Journal Editor; AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; EvolveImmune: Consultancy; Memorial Sloan Kettering Cancer Center: Current Employment; Roche: Consultancy, Research Funding; Genentech, Roche, Genmab, AbbVie, Innate, BeiGene: Research Funding; Genentech, Roche, Genmab, Abbvie, Sanofi, EvolveImmune: Honoraria; Genmab: Consultancy, Research Funding; Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Kaplan: Other: CME Presentation: Projects in Knowledge. Cordoba: Takeda: Consultancy, Speakers Bureau; Genmab: Consultancy; BMS: Consultancy, Speakers Bureau; Kite: Consultancy, Speakers Bureau; Janssen: Consultancy, Speakers Bureau; Incyte: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support, Speakers Bureau; AstraZeneca: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support, Speakers Bureau; BeiGene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support; Lilly: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support, Speakers Bureau; Johnson & Johnson: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel support; Kyowa Kirin: Consultancy; Pfizer: Research Funding. Linton: Nurix: Research Funding; CellCentric: Research Funding; Genmab: Consultancy, Other: Member of the Epcoritamab Global Council, Research Funding; AbbVie: Consultancy, Research Funding, Speakers Bureau; MorphoSys: Research Funding; Janssen: Research Funding; BeiGene: Consultancy, Research Funding; MSD: Research Funding; AstraZeneca: Research Funding; ADC Therapeutics: Research Funding; Roche: Consultancy, Research Funding; Kite/Gilead: Consultancy, Research Funding; BMS: Consultancy, Other: Travel Expenses, Research Funding, Speakers Bureau; Regeneron: Research Funding; Step Pharma: Research Funding; Viracta: Research Funding; Celgene: Consultancy, Other: Travel Expenses, Research Funding, Speakers Bureau. Clausen: Pfizer: Other: Travel Expenses; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel Expenses; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel Expenses; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Consultancy, Honoraria, Other: Travel Expenses; Genmab: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Travel Expenses; Incyte: Consultancy, Honoraria; Roche: Consultancy, Honoraria, Other: Travel Expenses. Oki: AbbVie: Current Employment. Steele: Genmab: Current Employment, Other: owns Genmab stock; Janssen: Other: owns Janssen stock; AbbVie: Other: owns AbbVie stock. Hao: Genmab: Current Employment. Archer: Genmab: Current Employment. Rana: Genmab: Current Employment. Belada: Takeda: Consultancy, Research Funding; Hoffmann-La Roche: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Genmab: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Gilead Sciences: Consultancy; AbbVie: Consultancy; Swixx BioPharma: Consultancy; Astra Zenecca: Research Funding; Regeneron: Research Funding; MorphoSys: Research Funding; Eli Lilly: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Consultancy; Pharmacyclis: Research Funding; Swixx: Consultancy.

*signifies non-member of ASH