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3033 Phase Ib/IIa Study of Amulirafusp Alfa (IMM0306) in Combination with Lenalidomide in Patients with Relapsed or Refractory CD20-Positive B-Cell Non-Hodgkin's Lymphoma

Program: Oral and Poster Abstracts
Session: 623. Mantle Cell, Follicular, Waldenstrom’s, and Other Indolent B Cell Lymphomas: Clinical and Epidemiological: Poster II
Hematology Disease Topics & Pathways:
Research, Clinical trials, Clinical Research
Sunday, December 8, 2024, 6:00 PM-8:00 PM

Lijuan Deng1*, Yanyan Liu, MD, PhD2*, Ningjing Lin, MD3*, Zhihua Yao4*, Jiuyang Zhang4*, Wei Meng5*, Qiying Lu5*, Wenzhi Tian5*, Jun Zhu, PhD6 and Yuqin Song, MD7

1Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
2Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
3Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing, China
4Lymphatic Comprehensive Internal Medicine Ward, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
5ImmuneOnco Biopharmaceuticals (Shanghai) Inc., Shanghai, China
6Department of Lymphoma, Peking University Cancer Hospital, Beijing, Beijing, China
7Key Laboratory of Carcinogenesis and Translational Research, Department of Lymphoma, Peking University Cancer Hospital, Beijing, China

Introduction: Amulirafusp alfa (IMM0306) is a fusion protein of CD20 monoclonal antibody with the CD47 binding domain of SIRPα added on the N-terminus of both heavy chains. It exerts potent cancer killing efficacy by activating both macrophages and NK cells via blockade of CD47-SIRPα interaction and FcɣR engagement. Lenalidomide was approved for relapsed or refractory (R/R) indolent non-Hodgkin's lymphoma (iNHL). Here, we report preliminary results from a Phase Ib study of IMM0306 in combination with lenalidomide in patients with R/R CD20-positive B-cell NHL.

Methods: This is an open-label, multicenter phase Ib/IIa study (NCT05771883). In phase Ib dose escalation part followed a standard "3+3" design, assessing 2 dose levels of IMM0306 (1.6 mg/kg, 2.0 mg/kg) intravenously administered once a week with 20 mg lenalidomide orally once a day on Days 1-21 of a 28-day cycle until disease progression or intolerable toxicity. Safety was evaluated per CTCAE version 5.0, tumor assessments performed every 8 weeks by Lugano 2014.

Results: As of Jun 24, 2024, 11 patients (9 follicular lymphoma [FL] and 2 marginal zone lymphoma [MZL]) were enrolled. Median age was 50.3 years old with 8 (72.7%) males. The median number of prior line of therapy was 1. All patients received previous anti-CD20 treatment. Preliminary efficacy was based on investigator's assessment with an overall response rate (ORR) of 90.9% (10/11), with 3 patients achieved complete response (CR) (27.3%, all FL) and 7 achieved partial response (PR) (63.6%, 5 FL, 2 MZL). Two DLTs (grade 4 PLT decreased without bleeding) were observed at 2.0 mg/kg IMM0306 in combination with 20 mg lenalidomide dose level, but none at 1.6 mg/kg IMM0306 in combination with 20 mg lenalidomide dose level. Based on the totality of data, 1.6 mg/kg IMM0306 in combination with 20 mg lenalidomide was selected as recommended Phase II dose (RP2D) for R/R FL and MZL. The most common treatment related adverse events (TRAEs) (≥20%) were WBC decreased (72.7%), lymphocyte decreased (63.6%), ANC decreased (63.6%), anemia (54.5%), bilirubin increased (45.5%), PLT decreased (27.3%), Anti-erythrocyte antibody positive (27.3%) and infusion-related reactions (27.3%). Grade ≥3 TRAEs occurred in 10 patients, including lymphocyte decreased (63.6%), ANC decreased (27.3%), WBC decreased (18.2%), PLT decreased (18.2%), pneumonia (9.1%) and pneumonia mycoplasma (9.1%). One patient experienced treatment related serious adverse event (Grade 4 PLT decreased). No patient experienced TRAEs leading to the study drug discontinuation or death. Two patients had a dose reduction of IMM0306, and 4 patients had dose reductions of lenalidomide due to TRAEs. As of July 5, 2024, the data from the phase IIa part (dose expansion showed promising preliminary efficacy. All 6 response-evaluable R/R FL patients who had failed ≥1 prior systemic therapy achieved 100% ORR (6/6) and 66.7% CR (4/6).

Conclusions: 1.6 mg/kg IMM0306 in combination with 20 mg lenalidomide was well-tolerated and with a promising preliminary anti-tumor activity in patients with R/R FL and MZL. This phase Ib/IIa study is ongoing.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH