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594 Pharmacodynamic Signatures and Correlatives of Response in Patients with Relapsed/Refractory Multiple Myeloma (RRMM) Treated with Talquetamab or Teclistamab Plus Daratumumab and Pomalidomide

Program: Oral and Poster Abstracts
Type: Oral
Session: 651. Multiple Myeloma and Plasma Cell Dyscrasias: Basic and Translational: Resistance and Response to Anti-Myeloma Therapies
Hematology Disease Topics & Pathways:
Research, Combination therapy, Translational Research, Diseases, Treatment Considerations, Biological therapies, Lymphoid Malignancies
Sunday, December 8, 2024: 1:15 PM

Deeksha Vishwamitra1, Sheri Skerget, PhD1*, Diana Cortes-Selva, PhD2*, Kalpana Bakshi1*, Lien Vandenberk, PhD3*, Weili Sun, PhD4, Jaszianne Tolbert, MD1, Colleen Kane, PhD1, Hein Ludlage, MSc5*, Bas D Koster, MD, PhD6, Julie S Larsen, PharmD4*, Tobias Kampfenkel, MD, MHBA7*, Ching Li1*, Farheen Zishan8*, Thomas Prior, PhD1*, Luciano J. Costa, MD, PhD9, Jesus G Berdeja, MD10, Cyrille Touzeau, MD, PhD11*, Aurore Perrot, MD, PhD12, Emma Searle, MD, PhD13*, Jeffrey V Matous, MD14, Ajai Chari, MD15, Donna Reece, MD16, Manisha Bhutani, MD17, Bhagirathbhai R. Dholaria, MBBS18, Anita D'Souza, MD, MS19*, Thomas G. Martin, MD15, John T. McKay20*, Alfred L Garfall21*, Amrita Y Krishnan, MD, FACP22, Niels W.C.J. van de Donk, MD, PhD23*, Nizar J. Bahlis, MD24 and Ricardo M. Attar, PhD1*

1Janssen Research & Development, Spring House, PA
2Johnson & Johnson Innovative Medicine, Spring House, PA
3Janssen Research & Development, Antwerp, Belgium
4Janssen Research & Development, Los Angeles, CA
5Janssen-Cilag Benelux, Leiden, Netherlands
6Janssen Biologics Europe, Leiden, Netherlands
7Janssen Research & Development, Neuss, Germany
8Janssen Research & Development, High Wycombe, United Kingdom
9University of Alabama at Birmingham, Birmingham, AL
10Tennessee Oncology, Sarah Cannon Research Institute, Nashville, TN
11Centre Hospitalier Universitaire de Nantes, Nantes, France
12Centre Hospitalier Universitaire de Toulouse, Oncopole, Toulouse, France
13The University of Manchester, Manchester, United Kingdom
14Sarah Cannon Research Institute, Colorado Blood Cancer Institute, Denver, CO
15University of California, San Francisco, San Francisco, CA
16Princess Margaret Cancer Centre, Toronto, ON, Canada
17Atrium Health Levine Cancer Institute/ Wake Forest School of Medicine, Charlotte, NC
18Vanderbilt University Medical Center, Nashville, TN
19Medical College of Wisconsin, Milwaukee, WI
20Wake Forest University School of Medicine, Winston-Salem, NC
21Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
22City of Hope Comprehensive Cancer Center, Duarte, CA
23Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
24Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada

Introduction: First-in-class bispecific antibodies (BsAbs) like talquetamab (tal; targeting G protein–coupled receptor class C group 5 member D) have shown deep, durable responses in RRMM. Targeting multiple epitopes with combination therapies may enhance antimyeloma activity. The anti-CD38 monoclonal antibody daratumumab (D) and immunomodulatory drugs (IMiDs) such as pomalidomide (P) are known to augment T-cell activity. D exhibits direct antitumor cytotoxicity, increases T-cell recruitment, and depletes CD38 immunoregulatory cells; P upregulates CD38 expression and increases natural killer (NK)-cell activity. We assessed immunologic pharmacodynamic profiles, correlatives of response, and associations with outcomes in patients (pts) treated with tal-DP from TRIMM-2 (NCT04108195) to better understand the potential of this regimen.

Methods: Eligible pts had ≥3 prior lines of therapy, including a proteasome inhibitor (PI) and IMiD, or were double refractory to a PI and IMiD. Pts received tal 0.4 mg/kg weekly (QW) or 0.8 mg/kg biweekly (Q2W) with step-up dosing and approved schedules of D 1800 mg and P 2 mg. Peripheral blood samples collected at baseline (BL) and on treatment were analyzed by flow cytometry. Max-fold change was calculated per pt using the highest fold change relative to BL or cycle (C) 2 day 1 (when P was added to tal-D). Correlations with progression-free survival (PFS), duration of response (DOR), and best response groups (complete response [CR]/stringent CR [sCR], partial response [PR]/very good PR [VGPR], and stable disease [SD]/progressive disease [PD]) were performed.

Results: Samples from 77 pts in TRIMM-2 were analyzed (tal QW, n=18; tal Q2W, n=59; CR/sCR, n=37; VGPR/PR, n=24; and SD/PD, n=6). Tal-D showed complementary pharmacodynamic effects, including T-cell margination, increased absolute T-cell recovery, expanded effector memory, and decreased naive-CD8 T cells during the first C, which were enhanced after addition of P in C2. While D treatment led to an initial reduction in CD38+ CD8 T cells, addition of tal transiently induced activation of this subset despite concurrent D dosing. After P administration, reinduction of CD38 on CD8 T cells was observed, indicating T-cell restimulation. D reduced immunosuppressive CD38+ regulatory T cells (Tregs), and addition of P rescued NK cells reduced by D. A subgroup analysis showed a pronounced impact of tal-DP on pts with prior BsAb exposure. Although a more dysfunctional, exhausted T-cell phenotype at BL was identified in these pts, tal-DP led to greater CD8 T-cell expansion, NK-cell recovery, CD38+ T-cell activation, and reduction of CD38+ Tregs vs pts without prior BsAb exposure. BL response signatures showed higher CD8 T-cell counts and lower expression of T-cell activation/coinhibitory receptor expression on CD8 T cells (CD38, PD-1/LAG-3, and PD-1/TIM-3) in pts with deeper responses that also demonstrated trends associated with improved PFS and DOR. Longitudinal correlative analyses showed greater, earlier recovery of absolute CD8 T cells in deeper responders to tal-DP that correlated with longer PFS and DOR, particularly following addition of P. NK-cell reduction was comparable across all response groups after tal-D; however, pts with deep responses exhibited NK-cell recovery after P was added, which was not evident in pts with less deep or no responses. Although D addition initially reduced CD38+ CD8 T cells, pts with deeper responses showed greater induction of CD38+ CD8 T-cell activation after addition of tal, which was sustained following P administration; in contrast, nonresponding pts displayed a shorter reactivation of CD38 T cells after P. Higher max-fold change in absolute NK-cell counts and CD38+ CD8 T cells showed trends toward improved PFS and DOR, notably in C2 after the addition of P. Finally, less persistent expression of coinhibitory receptors on CD8 T cells was observed in pts with deep responses, while a reduction in CD38+ Tregs was seen in all pts with tal-DP. Preliminary results with teclistamab (tec)-DP show comparable results to tal-DP, and further analyses are ongoing.

Conclusions: Tal-DP exhibits a deep, long-term impact on efficacy through complementary mechanisms of action and may be especially beneficial in pts with prior BsAb exposure, who typically have unfavorable BL immune profiles. Ongoing analyses of tec-DP from MajesTEC-2 (NCT04722146) will be presented.

Disclosures: Vishwamitra: Johnson and Johnson Innovative Medicine: Current Employment, Current equity holder in publicly-traded company. Skerget: Johnson & Johnson: Current Employment, Current equity holder in publicly-traded company. Cortes-Selva: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company. Bakshi: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company. Vandenberk: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company. Sun: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company. Tolbert: Janssen Research & Development, LLC: Current Employment, Current equity holder in publicly-traded company. Kane: Janssen Research & Development, LLC: Current Employment, Current equity holder in publicly-traded company. Ludlage: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company. Koster: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company. Larsen: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company. Kampfenkel: Janssen: Current Employment, Current holder of stock options in a privately-held company. Li: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company. Zishan: Johnson & Johnson: Consultancy. Prior: Janssen Research & Development, LLC: Current Employment, Current equity holder in publicly-traded company, Patents & Royalties: METHODS OF TREATING CANCERS AND ENHANCING EFFICACY OF GPRC5DXCD3 BISPECIFIC ANTIBODIES. Costa: Janssen: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria, Research Funding; Adaptive biotechnoligies: Honoraria; Genentech, Inc.: Consultancy, Honoraria, Research Funding; BMS: Consultancy, Honoraria, Research Funding; Sanofi: Consultancy, Honoraria; Caribou: Research Funding; Amgen: Consultancy, Honoraria, Research Funding. Berdeja: Janssen: Honoraria, Speakers Bureau; 2 Seventy Bio; AbbVie; Amgen; BMS; C4 Therapeutics; Caribou Biosciences; CARsgen; Cartesian Therapeutics; Celularity; CRISPR Therapeutics; Fate Therapeutics; Genentech; GSK; Ichnos Sciences; Incyte; Janssen; Juno Therapeutics; K36 Therapeutics; Karyopharm: Research Funding; AstraZeneca; BMS; Caribou Biosciences; Galapagos; Janssen; K36 Therapeutics; Kite Pharma; Legend Biotech; Pfizer; Regeneron; Roche; Sanofi-Aventis; Sebia; Takeda: Consultancy. Perrot: Sanofi: Honoraria, Research Funding; Pfizer: 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; GSK: Honoraria; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Honoraria; Menarini Stemline: Honoraria; Takeda: Honoraria, Research Funding; Abbvie: Honoraria. Searle: Shattuck Labs, Sanofi, BMS, DarkBlue Therapeutics: Consultancy; Janssen, Abbvie, Beigene, BMS, Nurix: Honoraria; Pfizer, Janssen, Jazz, Abbvie: Speakers Bureau. Matous: BeiGene; Pharmacyclics: Consultancy. Chari: Antengene: Honoraria; Janssen: Research Funding; AbbVie; Adaptive; Amgen; Antengene; Bristol Myers Squibb; Forus; Genetech/Roche; GSK; Janssen; Karyopharm; Millenium/Takeda; and Sanofi/Genzyme: Consultancy. Reece: BMS: Membership on an entity's Board of Directors or advisory committees; BMS, Janssen, Takeda, Pfizer: Honoraria; BMS, Janssen, Sanofi, GSK, Pfizer: Consultancy; Janssen, BMS, Sanofi, ORIC, Princess Margaret Cancer Centre: Other: Grants. Bhutani: BMS: Research Funding; Janssen: Research Funding; Takeda: Research Funding; Amgen: Research Funding; Caribou Biosciences: Research Funding; Abvvie: Research Funding. Dholaria: Janssen, Angiocrine, Pfizer, Poseida, MEI, Orcabio, Wugen, Allovir, Adicet, BMS, Molecular template, Atara: Research Funding; MJH BioScience, Arivan Research, Janssen, ADC therapeutics, Gilead, GSK, Caribou, Roche, Autolus, Sanofi.: Consultancy, Honoraria. D'Souza: Kedrion, Pfizer, Janssen, Bristol Myers Squibb, BMS, Janssen, and Prothena.: Consultancy; AbbVie, Sanofi, Novartis, Janssen, Regeneron, Takeda, TeneoBio, Caelum, and Prothena: Research Funding. Martin: Poseida: Research Funding; BMS: Research Funding; Sanofi: Research Funding; GSK, Pfizer, Roche: Honoraria; Janssen: Research Funding. McKay: Jannsen, BMS, Sanofi: Consultancy. Garfall: Abbvie, Bristol Myers Squibb, Regeneron, Smart Immune: Consultancy; CRISPR Therapeutics, Tmunity: Research Funding; GlaxoSmithKline: Honoraria; Johnson & Johnson: Honoraria, Research Funding; Legend Bio: Honoraria; Novartis: Consultancy, Research Funding. Krishnan: City of Hope National Medical Center: Current Employment; Johnson & Johnson: Membership on an entity's Board of Directors or advisory committees; AbbVie; Adaptive; Arcelx; GSK; Janssen; Roche; and Sanofi: Consultancy; Bristol Myers Squibb: Current holder of stock options in a privately-held company. van de Donk: Merck: Membership on an entity's Board of Directors or advisory committees; Adaptive Biotechnologies: Membership on an entity's Board of Directors or advisory committees; Bayer: Membership on an entity's Board of Directors or advisory committees; Roche: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Sanofi: Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Research Funding; Cellectis: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Kite Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees. Bahlis: AbbVie, Amgen, BMS, Celgene, Janssen, GSK, Genentech, Karyopharm, Kyte, Novartis, Pfizer, Roche, Sanofi, Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer, Janssen: Research Funding. Attar: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company.

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