Session: 627. Aggressive Lymphomas: Pharmacologic Therapies: Poster III
Hematology Disease Topics & Pathways:
Research, Clinical trials, Combination therapy, Drug development, Clinical Research, Diseases, Treatment Considerations, Biological therapies, Lymphoid Malignancies, Monoclonal Antibody Therapy
Methods: Eligible patients included adults diagnosed with B-NHL that was r/r after at 2 or more prior systemic therapies. Lonca was administered on day 1 and VEN on days 1 – 5 of each 21-day cycle. Patients received VEN ramp-up dosing during cycle 1 (20-50-100-200-400mg) and 400mg daily on subsequent cycles. A maximum of 6 cycles was administered. Lonca dose escalation was done using BOIN design and three dose levels were tested: 50, 100 and 150 mcg/kg, with patients in the two latter dose levels receiving 50 mcg/kg and 75 mcg/kg on cycles 3 onwards, respectively. Response rates were assessed using Lugano criteria (Cheson et al. J Clin Oncol 2014)
Results: Thirteen patients enrolled and received at least one cycle of study treatment, including 8 patients with diffuse large B cell lymphoma (DLBCL), 3 patients with follicular lymphoma and 2 patients with Waldenstrom macroglobulinemia. Patients had a median age of 66 years (range 48-84), 4 (31%) were women, all were white and 3 (25%) had ECOG performance of 0. The median number of prior lines of therapy was 4 (range 3-9) and 12 (92%) patients were refractory to the last line of therapy. Eight (62%) had prior anti-CD19 CAR T cell therapy. We observed one dose limiting toxicity (DLT) at dose level 2 (grade 3 atrial fibrillation with rapid ventricular rate). No additional DLTs were observed. Five patients were treated on DL1, 5 on DL 2 and 3 on DL3. Enrollment continues in dose expansion at DL3.
All patients treated were evaluable for toxicity. The most common adverse events (AE) were anemia (n = 8, 67%), leukopenia (n = 7, 58%), thrombocytopenia (n = 6, 50%), and hyponatremia (n = 5). Skin abnormalities were observed in 6 (50%) patients including 3 (25%) cases of maculopapular rash; generalized edema or extremity edema occurred 5 (42%) patients and elevated gamma glutamyl transferase was observed in 4 (33%) patients. The most common grade 3 or higher AEs included neutropenia in 4 patients and atrial fibrillation, hypotension, generalized muscle weakness and increase bilirubin in 2 cases each. Two patients died while receiving active trial interventions: one case of pulmonary aspergillosis after COVID 19 pneumonia and one case of acute renal failure, malabsorption, and ascites in the context of intestinal involvement by DLBCL.
Among 11 efficacy – evaluable patients, 7 patients responded and 5 achieved CR, with overall and complete response rates of 64% and 45%, respectively. Among 4 aggressive NHL patients who had prior CAR T cell therapy, 3 responded to lonca + ven.
Conclusions: This is the first prospective clinical trial showing that the addition of venetoclax to loncastuximab is safe and efficacious in r/r B-NHL, including DLBCL patients whose disease progressed after anti-CD19 CAR T cells. Both patients with heavily treated refractory Waldenstrom macroglobulinemia achieved complete remission after this treatment. Enrollment continues in a dose expansion cohort that also includes patients with r/r mantle cell lymphoma. Updated analyses with longer follow-up and expanded enrollment will be presented.
Disclosures: Caimi: Abbvie: Honoraria, Research Funding; BMS: Other: Avisory Board, Research Funding; Novartis: Other: Advisory Board; Genentech: Other: Advisory Board, Research Funding; Synthekine: Other: Advisory Board, Research Funding; Sobi: Honoraria; Recordati: Honoraria, Research Funding; Abcon: Research Funding; Luminary Therapeutics: Other: Scientific Advisory Board, Research Funding; Genmab: Research Funding; ADC Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Profound Bio: Research Funding; Arvinas: Honoraria, Research Funding. Winter: ADC Therapeutics: Consultancy; BeiGene: Consultancy; BTG Pharmaceuticals: Consultancy; AstraZeneca: Consultancy. Jagadeesh: Affimed, Daiichi Sankyo: Membership on an entity's Board of Directors or advisory committees; AstraZeneca, ATARA Biotherapeutics, Debio Pharma, LOXO Pharmaceuticals, MEI Pharma, Regeneron Pharmaceuticals, Inc., Seagen, Trillium Pharmaceuticals: Research Funding. Sauter: Celgene/BMS: Research Funding; Celgene/BMS: Consultancy; Cargo Therapeutics: Research Funding; CSL Behring: Consultancy; Affimed: Research Funding; Ono Pharmaceuticals: Consultancy; MorphoSys: Consultancy; Bristol-Myers Squibb: Research Funding; Precision Biosciences: Research Funding; NKARTA: Research Funding; Kite/a Gilead Company: Consultancy; Syncopation Life Sciences: Consultancy; Actinium Pharmaceuticals: Research Funding; Sanofi-Genzyme: Research Funding; Karyopharm Therapeutics: Consultancy; Gamida Cell: Consultancy; Juno Therapeutics: Research Funding; GSK: Consultancy; CRISPR Therapeutics: Consultancy; Ipsen Biopharmaceuticals: Consultancy; NKARTA: Consultancy. Hill: Genentech: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; AstraZeneca: Consultancy, Honoraria, Research Funding; Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Consultancy, Honoraria, Research Funding; Pharmacyclics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Beigene: Consultancy, Honoraria, Research Funding.
OffLabel Disclosure: Research of combination of loncastuximab and venetoclax for treatment of relapsed non Hodgkin lymphoma. These agents are not approved in combination.
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