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4653 Pharmacodynamic Profiles of Patients (Pts) with Newly Diagnosed (ND) Vs Relapsed/Refractory Multiple Myeloma (RRMM) Who Received Teclistamab (Tec) or Talquetamab (Tal) Plus Daratumumab (Dara) and Lenalidomide (Len) in the Phase 1b Majestec-2 and Monumental-2 Studies

Program: Oral and Poster Abstracts
Session: 651. Multiple Myeloma and Plasma Cell Dyscrasias: Basic and Translational: Poster III
Hematology Disease Topics & Pathways:
Research, Combination therapy, Translational Research, Bispecific Antibody Therapy, Plasma Cell Disorders, Diseases, Biological therapies, Treatment Considerations, Lymphoid Malignancies, Human, Study Population
Monday, December 9, 2024, 6:00 PM-8:00 PM

Diana Cortes, PhD1*, Brendan Paul Hodkinson, PhD, BS1*, Ashwini Kumar, PhD1, Sheri Skerget, PhD1*, Gary E Mason, MD, MS1*, Elizabeth Shearin, PharmD2*, Hein Ludlage, MSc2*, Bas D Koster, MD, PhD3, Colleen Kane, PhD1, Thomas Renaud, MD4, Tobias Kampfenkel, MD, MHBA5*, Christoph Heuck, MD1*, Bhoomika Thakkar, MS4*, Farheen Zishan6*, Emma Searle, MD, PhD7*, Hang Quach, MD, FRACP, FRCPA, MBBS8, Gayathri Ravi, MD9, Cyrille Hulin, MD10*, Wojciech Janowski, MD11*, Jesus G Berdeja, MD12, Sébastien Anguille, MD13*, Jeffrey V Matous, MD14, Cyrille Touzeau, MD, PhD15*, Anne-Sophie Michallet, MD, PhD16*, Ajay K. Nooka, MD, MPH17, Tara Cochrane, MBBS, FRCPA, FRACP18, Anita D'Souza, MD, MS19*, Peter M. Voorhees, MD20, Karthik Ramasamy, MBBS, PhD21*, Aurore Perrot, MD, PhD22, Andrew Spencer, MBBS23*, Gurdeep Parmar, MBBS24* and Deeksha Vishwamitra1

1Janssen Research & Development, Spring House, PA
2Janssen-Cilag Benelux, Leiden, Netherlands
3Janssen Biologics Europe, Leiden, Netherlands
4Janssen Research & Development, Raritan, NJ
5Janssen Research & Development, Neuss, Germany
6Janssen Research & Development, High Wycombe, United Kingdom
7The Christie NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
8University of Melbourne, St. Vincent’s Hospital, Melbourne, VIC, Australia
9University of Alabama at Birmingham, Birmingham, AL
10Hôpital Haut Leveque, University Hospital, Pessac, France
11Calvary Mater Newcastle, Waratah, NSW, Australia
12Tennessee Oncology, Sarah Cannon Research Institute, Nashville, TN
13Vaccine and Infectious Disease Institute, University of Antwerp, Center for Cell Therapy and Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium
14Sarah Cannon Research Institute, Colorado Blood Cancer Institute, Denver, CO
15Centre Hospitalier Universitaire de Nantes, Nantes, France
16Hospices Civils, Centre Hospitalier Lyon Sud, Pierre Bénite, France
17Winship Cancer Institute, Emory University, Atlanta, GA
18Gold Coast University Hospital and Griffith University, Gold Coast, QLD, Australia
19Medical College of Wisconsin, Milwaukee, WI
20Atrium Health Levine Cancer Institute, Charlotte, NC
21Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
22Centre Hospitalier Universitaire de Toulouse, Oncopole, Toulouse, France
23School of Translational Medicine, Alfred Health-Monash University, Melbourne, VIC, Australia
24lllawarra Cancer Care Centre, Wollongong, NSW, Australia

Introduction: The first-in-class bispecific antibodies tec (targeting BCMA) and tal (targeting GPRC5D) have demonstrated deep, durable responses as monotherapies in pts with RRMM. Dara, an anti-CD38 monoclonal antibody, and len, an immunomodulatory drug (IMiD), have been shown to enhance T-cell cytotoxic activity against myeloma cells alone or in combination with other agents. We evaluated immune-cell profiles in pts with NDMM vs those with RRMM in the MajesTEC-2 (NCT04722146) and MonumenTAL-2 (NCT05050097) studies to identify differential immune signatures between pts with NDMM and RRMM treated with either tec-dara-len or tal-dara-len.

Methods: Pts in MajesTEC-2 received subcutaneous (SC) tec 1.5 mg/kg QW after step-up dosing (0.06 and 0.3 mg/kg) plus the approved schedules of dara 1800 mg + len 25 mg. In MonumenTAL-2, pts with RRMM received SC tal 0.3 mg/kg QW, and pts with NDMM received either 0.6 mg/kg Q2W or 0.8 mg/kg Q4W plus the approved schedules of dara 1800 mg + len 25 mg. Dexamethasone was given concurrent with the first 3 full IMiD-containing cycles. Peripheral blood and bone marrow samples were collected at baseline and post treatment at cycle 2 and/or 3 for evaluation of immune cells (CD3+, CD4+, CD8+, regulatory T cells [Tregs], and natural killer [NK] cells), T-cell receptor (TCR) sequencing, cytokine profiles, and assessment of activation/exhaustion markers by flow cytometry. Analyses include all pts for whom samples were available (MajesTEC-2: NDMM, n=11; RRMM, n=19 and MonumenTAL-2: NDMM, n=18; RRMM with ≥3 prior lines of therapy [pLOT] or 1–3 pLOT, n=20).

Results: Overall, pharmacodynamics following tec/tal-dara-len treatment revealed enhanced T-cell recovery plus an increase in effector memory T cells compared with tec/tal monotherapy and consistent with tec, tal, and dara mechanisms of action (MOA) and T-cell restimulation post len (including CD38 subsets), consistent with len MOA. While a reduction of immunosuppressive Tregs and of NK cells with tec/tal-dara (consistent with dara MOA) was observed, the addition of len resulted in increased numbers of NK cells. We sought to further assess whether a differential immune profile exists between pts with NDMM and RRMM treated with tec-dara-len or tal-dara-len. At baseline, pts with NDMM demonstrated a favorable immune fitness profile, indicated by higher absolute counts of peripheral T-cell numbers and NK cells and higher TCR diversity, higher proportions of T cells expressing CD38 (likely due to lack of prior dara exposure), and lower proportions of T cells expressing markers associated with T-cell activation/exhaustion compared with pts with RRMM. Longitudinally, pts with NDMM treated with tec/tal-dara-len showed greater recovery in number of peripheral CD3+ T cells compared with those with RRMM. With tec/tal-dara treatment, early induction of T-cell activation markers was greater in pts with NDMM than in pts with RRMM; specifically, len administration transiently restimulated T cells expressing HLA-DR. In addition, higher induction of pro-inflammatory cytokines such as IFNγ and sIL-2Rα, was seen in pts with NDMM compared with RRMM, suggesting a greater activation capacity in pts with NDMM with both tec/tal-dara-len. Tec/tal-dara-len led to a reduction of the proportion of CD38-expressing T-cell subsets in pts with NDMM and RRMM; the addition of len resulted in a transient upregulation of CD38 on T cells, but continuous dara dosing lowered the proportions of these cells. Further, reduction of NK cells with tec/tal-dara was observed in NDMM and RRMM, with minimal differences in NK cell recovery following the addition of len. Importantly, pts with NDMM exhibited higher T-cell clonal expansion capacity and a lower repertoire similarity post tal-dara-len compared with pts with RRMM, suggesting therapy-induced T-cell expansion.

Conclusions: This combined analysis was conducted to provide insights into the differential immune profiles in pts with NDMM vs RRMM treated with tec/tal-dara-len to enhance understanding of the therapeutic benefits and guide future treatment strategies, which are being evaluated in the phase 3 MajesTEC-7 study (NCT05552222). The more favorable immune profile observed in pts with NDMM vs RRMM suggests that earlier treatment with novel combinations, such as tec-dara-len and tal-dara-len, may improve pt outcomes. Correlations with efficacy will be presented at the meeting.

Disclosures: Cortes: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company. Hodkinson: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company. Kumar: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company. Skerget: Johnson & Johnson: Current Employment, Current equity holder in publicly-traded company. Mason: Janssen Research & Development, LLC: Current Employment, Current equity holder in publicly-traded company. Shearin: 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. Kane: Janssen Research & Development, LLC: Current Employment, Current equity holder in publicly-traded company. Renaud: Janssen: 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. Heuck: Janssen Research & Development, LLC: Current Employment, Current equity holder in publicly-traded company. Thakkar: Johnson & Johnson: Current Employment, Current holder of stock options in a privately-held company. Zishan: Johnson & Johnson: Consultancy. Searle: Shattuck Labs, Sanofi, BMS, DarkBlue Therapeutics: Consultancy; Pfizer, Janssen, Jazz, Abbvie: Speakers Bureau; Janssen, Abbvie, Beigene, BMS, Nurix: Honoraria. Quach: Pfizer: Consultancy; Roche: Consultancy; Sanofi: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Karyopharm: Consultancy, Research Funding; GSK: Consultancy, Research Funding; AbbVie: Research Funding; Johnson & Johnson: Consultancy. Ravi: Guidepoint: Consultancy. Janowski: Janssen, Pfizer, Beigene: Consultancy. 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. Matous: BeiGene; Pharmacyclics: Consultancy. Nooka: Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; ONK Therapeutics: Honoraria, Membership on an entity's Board of Directors or advisory committees; GSK: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Cellectar Biosciences: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AstraZeneca: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sebia: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Aduro Biotech: Research Funding; Arch Oncology: Research Funding; Cellectis: Research Funding; Adaptive Biotechnologies: Honoraria, Membership on an entity's Board of Directors or advisory committees; K36 Therapeutics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Genentech: Research Funding; Karyopharm: Research Funding; Kite Pharma: Research Funding; Merck: Research Funding. Cochrane: Beigene: Research Funding. 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. Voorhees: Karyopharm: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; GSK: Consultancy, Research Funding; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Regeneron: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Lava Therapeutics: Consultancy; Janssen: Consultancy, Research Funding; AstraZeneca: Consultancy; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Ramasamy: Sanofi: Research Funding; GSK: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene/Bristol-Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending meetings/travel, Research Funding; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Adaptive Biotech: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending meetings/travel; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending meetings/travel; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Oncopeptides: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Recordati: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending meetings/travel; Menarini Stemline: Membership on an entity's Board of Directors or advisory committees. Perrot: Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Research Funding; GSK: Honoraria; BMS: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Honoraria; Menarini Stemline: Honoraria; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Abbvie: Honoraria; Takeda: Honoraria, Research Funding. Spencer: F. Hoffmann-La Roche Ltd: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Research Funding. Parmar: Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel grant; Janssen Biotech: Membership on an entity's Board of Directors or advisory committees; BMS: Honoraria, Other: travel grants. Vishwamitra: Johnson and Johnson Innovative Medicine: Current Employment, Current equity holder in publicly-traded company.

*signifies non-member of ASH