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Study of Anitocabtagene-autoleucel in Relapsed or Refractory Multiple Myeloma (iMMagine-1)

Phase 2
Recruiting
Conditions
Multiple Myeloma
Interventions
Biological: anitocabtagene-autoleucel
Registration Number
NCT05396885
Lead Sponsor
Kite, A Gilead Company
Brief Summary

A Phase II study of anitocabtagene-autoleucel (formerly CART-ddBCMA) for patients with relapsed or refractory multiple myeloma. Anitocabtagene-autoleucel is a BCMA-directed CAR-T cell therapy.

Detailed Description

This is a Phase II open-label study of anitocabtagene-autoleucel \* in patients with relapsed or refractory multiple myeloma (MM). The study will have the following sequential phases: screening, enrollment, pre-treatment with lymphodepleting chemotherapy, treatment with anitocabtagene-autoleucel , and follow-up. If necessary, bridging therapy is allowed to control growth of MM disease while anitocabtagene-autoleucel is being manufactured.

Following a single infusion of anitocabtagene-autoleucel both safety and efficacy data will be assessed. Efficacy will be assessed monthly for the first 6 months, then quarterly up to 2 years, or upon patient relapse. The primary analysis will be conducted approximately 13 months after the final patient is dosed. This will allow approximately 12 months follow up from the time of the last observed response on study.

Long-term safety data will be collected under a separate long-term follow up study for up to 15 years per health authority guidelines.

\*Anitocabtagene-autoleucel drug product consists of autologous T cells that have been genetically modified ex vivo to express a D-domain Chimeric Antigen Receptor (CAR), followed by a cluster of differentiation 8 (CD8) hinge and transmembrane region that is fused to the intracellular signaling domains for 4-1BB and CD3ξ, that specifically recognizes B-cell maturation antigen (BCMA). The active substance of anitocabtagene-autoleucel is CAR+ CD3+ T cells that have undergone ex vivo T-cell activation, gene transfer by replication-deficient lentiviral vector, and expansion.

Recruitment & Eligibility

Status
RECRUITING
Sex
All
Target Recruitment
110
Inclusion Criteria
  1. Age 18 years or older and has capacity to give informed consent

  2. Relapsed or refractory multiple myeloma treated with at least 3 prior regimens of systemic therapy including proteasome inhibitor, immunomodulatory drugs (IMiD) and anti-CD38 antibody and are refractory to the last line of therapy. For each line, 2 consecutive cycles are required unless the best response after 1 cycle was progressive disease.

    Note: IMWG criteria defines refractory disease as disease progression on or within 60 days of a therapy Note: Induction treatment with or without hematopoietic stem cell transplant and with or without maintenance is considered a single regimen

  3. Documented measurable disease including at least one or more of the following criteria:

    1. Serum M-protein ≥1.0 g/dL
    2. Urine M-protein ≥200 mg/24 hours
    3. Involved serum free light chain ≥10 mg/dL with abnormal κ/λ ratio (i.e., >4:1 or <1:2)
  4. Eastern Cooperative Oncology Group (ECOG) performance status 0-1

  5. Life expectancy >12 weeks

  6. Adequate organ function defined as:

    1. Oxygen (O2) saturation ≥92% on room air

    2. Left Ventricular Ejection Fraction (LVEF) ≥45% by echocardiogram (ECHO) or multigated acquisition (MUGA) scan

    3. Absolute neutrophil count (ANC) ≥1.0k/µl, platelet count (PLT)

      ≥50k/µl, [NOTE: Platelet transfusion not allowed within 14 days; filgrastim (or biosimilar) not allowed within 7 days, pegfilgrastim (or biosimilar) within 14 days]

    4. Creatinine clearance ≥45 mL/min min (as determined by the Cockgroft-Gault equation) and not on dialysis

    5. Aspartate transaminase (AST)/alanine transaminase (ALT) <3 x upper limits of normal (ULN)

    6. Total bilirubin <1.5 x ULN (allow 3x ULN for Gilbert's syndrome)

    7. Prothrombin time test (PTT), prothrombin time (PT)/international normalized ratio (INR) <1.5 x ULN, unless on a stable dose of anti-coagulant for a thromboembolic event (Subjects with any history of thromboembolic stroke; or history or Grade 2 (G2) or greater hemorrhage within one year are excluded)

  7. Resolution of adverse events (AEs) from any prior systemic anticancer therapy, radiotherapy, or surgery to Grade 1 or baseline (except G2 alopecia and G2 sensory neuropathy)

  8. Male and female participants of childbearing potential must agree to use highly effective methods of birth control through 12 months after the dose of study treatment

  9. Willing to comply with and able to tolerate study procedures, including consent to participate in separate Long-term Safety Follow-up lasting up to 15 years per FDA guidance

  10. Subject's leukapheresis product from non-mobilized cells is received and accepted for cell processing by manufacturing site. NOTE: Leukapheresis will be performed only after all other eligibility criteria are confirmed

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Exclusion Criteria
  1. Plasma cell leukemia or history of plasma cell leukemia

  2. Treatment with the following therapies as specified below

    1. Any prior systemic treatment for multiple myeloma within the 14 days prior to scheduled leukapheresis
    2. Receiving high-dose (e.g., >10 mg prednisone or equivalent) systemic steroid therapy or any other form of immunosuppressive therapy within 14 days prior to leukapheresis
    3. Prior treatment with any gene therapy or gene-modified cellular immune-therapy
    4. Prior B-cell maturation antigen (BCMA) directed therapy
    5. Autologous stem cell transplantation within 3 months prior to leukapheresis, or any prior allogeneic stem cell transplantation
  3. Subjects with solitary plasmacytomas without evidence of other measurable disease are excluded

  4. History of allergy or hypersensitivity to study drug components. Subjects with a history of severe hypersensitivity reaction to dimethyl sulphoxide (DMSO) are excluded

  5. Contraindication to fludarabine or cyclophosphamide

  6. Severe or uncontrolled intercurrent illness or laboratory abnormalities including

    1. Active bacterial, viral, or fungal infection requiring systemic treatment (isolated fever may not constitute active infection in and of itself, (e.g., related to disease)
    2. Symptomatic congestive heart failure (i.e., New York Heart Association stage III or IV)
    3. Unstable angina, arrhythmia, or myocardial infarction (MI) within 6 months prior to Screening
    4. Significant pulmonary dysfunction
    5. Uncontrolled thromboembolic events or recent severe hemorrhage (i.e., within one year)
    6. Any history of pulmonary embolism (PE) in the past 12 months or deep vein thrombosis (DVT) within three months of enrollment. Therapeutic dosing of anticoagulants (e.g., warfarin, low molecular weight heparin, Factor Xa inhibitors) is allowed for history of PE/DVT if greater than twelve and three months, respectively, from time of enrollment, and should be at a stable maintenance dose.
    7. Auto-immune disease requiring immunosuppressive therapy within the last 24 months
  7. Seropositive for and with evidence of active hepatitis B or C infection at time of Screening, or HIV seropositive

    1. Subjects with a history of hepatitis B but have received antiviral therapy and have non-detectable viral DNA are eligible
    2. Subjects seropositive because of hepatitis B virus vaccine with no signs or active infection are eligible
    3. Subjects who had hepatitis C but have received antiviral therapy and show no detectable hepatitis C virus (HCV) viral RNA are eligible
  8. Active central nervous system (CNS) involvement by malignancy

  9. Any sign of active or prior CNS pathology including but not limited to history of epilepsy, seizure, paresis, aphasia, stroke, subarachnoid hemorrhage or CNS bleed, severe brain injury, dementia, cerebellar disease, Parkinson's disease, organic brain syndrome or psychosis

  10. Active malignancy not related to myeloma that has required therapy in the last 3 years or is not in complete remission. Exceptions to this criterion include successfully treated non-metastatic basal cell or squamous cell skin carcinoma, or prostate cancer that does not require therapy.

  11. Females who are pregnant or breastfeeding or females of childbearing potential not using an effective method of birth control

  12. Subjects with any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in study (or full access to medical records) as written including follow up, the interpretation of data or place the subject at unacceptable risk

  13. Any vaccine ≤ 6 weeks before leukapheresis and/or anticipation of the need for such a vaccine during the subject's participation in the study

  14. Concurrent enrollment on another study using an investigational therapy for the treatment of RRMM

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Study & Design

Study Type
INTERVENTIONAL
Study Design
SINGLE_GROUP
Arm && Interventions
GroupInterventionDescription
anitocabtagene-autoleucelanitocabtagene-autoleucelSingle dose of 115±10 x 10e-6 CAR+ anitocabtagene-autoleucel cells infused intravenously
Primary Outcome Measures
NameTimeMethod
Overall Response Rate (ORR)24 Months

ORR Per International Myeloma Working Group (IMWG) criteria, as assessed by an independent review committee (IRC)

Secondary Outcome Measures
NameTimeMethod
Health Related Quality of Life (HRQoL)24 Months

Measure the change in HRQoL pre- versus post-treatment with anitocabtagene-autoleucel

Time to Progression (TTP)24 Months

Measurement of time from date of anitocabtagene-autoleucel infusion to first documented IRC assessed progression using IMWG criteria or death due to disease progression

Stringent complete response (sCR) or complete response (CR) rate24 Months

The proportion of subjects in whom best response of sCR or CR,as assessed by an independent review committee (IRC) per by IMWG criteria

Progression Free Survival (PFS)24 Months

Measurement of time from the date of infusion of anitocabtagene-autoleucel to the date upon which the IMWG criteria for progressive disease or death occurs

Safety Profile of anitocabtagene-autoleucel as assessed by incidence and severity of adverse events24 Months

Summarization of adverse event (AE) terms, frequency, and severity using CTCAE version 5.0, the adverse events of special interest (AESIs), the serious adverse events (SAEs)

Overall Response Rate (ORR) of subjects limited to three lines of prior treatment24 Months

ORR per IMWG criteria, as assessed by an independent review committee (IRC), of subjects limited to three lines of prior treatment

Duration of Response (DoR)24 Months

Time from the date of first documentation of response of PR or better per IMWG criteria after anitocabtagene-autoleucel infusion to the earlier of first documentation of disease progression per IMWG criteria or death

Very Good Partial Response (VGPR) Rate and Partial Response (PR) Rate24 Months

The proportion of subjects with best response of VGPR and PR, respectively, by IMWG criteria

Minimal Residual Disease (MRD) negativity24 Months

The proportion of subjects that are MRD negative (i.e., no measurable tumor cells in at least 105 cells isolated from the bone marrow) from the EE population and from the MRD evaluable population (i.e., those subjects with baseline sample allowing MRD calibration)

Time to Initial Response24 months

Time to initial response measurement of time from the date of infusion of anitocabtagene-autoleucel to the date upon which the first IMWG response (i.e., PR or better) occurs

Overall Survival (OS)24 Months

Measurement of time (e.g., days or months) from the date of infusion of anitocabtagene-autoleucel to the date upon which death from any cause occurs

Pharmacokinetics of anitocabtagene-autoleucel24 Months

Define the Pharmacokinetics of anitocabtagene-autoleucel using vector copy number (VCN) on peripheral mononuclear cells at defined timepoints. Quantification of anitocabtagene-autoleucel cells using vector copy number (VCN) on peripheral blood mononuclear cells

Anti-anitocabtagene-autoleucel Antibodies24 Months

Proportion of subjects who develop antibodies against anitocabtagene-autoleucel and the timing and titer of antibodies developed

Trial Locations

Locations (20)

The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

🇺🇸

Baltimore, Maryland, United States

Northside Hospital, Inc

🇺🇸

Atlanta, Georgia, United States

John Theurer Cancer Center at Hackensack Meridian Health

🇺🇸

Hackensack, New Jersey, United States

MD Anderson Cancer Center

🇺🇸

Houston, Texas, United States

Barbara Ann Karmanos Cancer Hospital

🇺🇸

Detroit, Michigan, United States

Medical College of Wisconsin

🇺🇸

Milwaukee, Wisconsin, United States

Honor Health

🇺🇸

Scottsdale, Arizona, United States

University of Arkansas for Medical Sciences

🇺🇸

Little Rock, Arkansas, United States

Colorado Blood Cancer Institute

🇺🇸

Denver, Colorado, United States

The University of Chicago Biological Sciences

🇺🇸

Chicago, Illinois, United States

Moffitt Cancer Center

🇺🇸

Tampa, Florida, United States

University of Maryland School of Medicine Greenebaum Comprehensive Cancer Center

🇺🇸

Baltimore, Maryland, United States

Massachusetts General Hospital

🇺🇸

Boston, Massachusetts, United States

Dana-Farber Cancer Institute

🇺🇸

Boston, Massachusetts, United States

Beth Israel Deaconess Medical Center

🇺🇸

Boston, Massachusetts, United States

Levine Cancer Institute at Atrium Health

🇺🇸

Charlotte, North Carolina, United States

Oregon Health & Sciences University - Knight Cancer Institute

🇺🇸

Portland, Oregon, United States

Simmons Comprehensive Cancer Center at UT Southwestern Medical Center

🇺🇸

Dallas, Texas, United States

Huntsman Cancer Institute

🇺🇸

Salt Lake City, Utah, United States

UW Carbone Cancer Center

🇺🇸

Madison, Wisconsin, United States

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