MedPath

Blinatumomab

Generic Name
Blinatumomab
Brand Names
Blincyto
Drug Type
Biotech
CAS Number
853426-35-4
Unique Ingredient Identifier
4FR53SIF3A
Background

Blinatumomab is a BiTE-class (bi-specific T-cell engager) constructed monoclonal antibody formed by the recombinant fusion of an anti-CD3 single-chain variable fragment (scFV) and an anti-CD19 scFV through a short peptide linker. CD3 is an antigen expressed on the surface of T-cells, while CD19 is mostly expressed on the surface of malignant B-cells. Since blinatumomab has an affinity to both antigens, it redirects T-cells to tumor cells expressing CD19 and promotes tumor cell lysis and apoptosis.

Blinatumomab is manufactured by Amgen Inc. and marketed under the brand Blincyto. It was first approved by the FDA in December 2014 for the treatment of CD19-positive B-cell precursor acute lymphoblastic leukemia (ALL) in relapsed and refractory patients. In March 2018, it was approved under the FDA’s accelerated approval program for the treatment of CD19-positive B-cell precursor ALL in first or second complete remission with minimal residual disease (MRD) greater than or equal to 0.1% in adults and children. Full approval for this indication was granted in June 2023.

Blinatumomab has a short half-life, requiring patients to receive a continuous infusion over 4-week cycles using a portable mini-pump for optimum delivery.

Indication

Blinatumomab is indicated for the treatment of adults and children with relapsed or refractory CD19-positive B-cell precursor acute lymphoblastic leukemia (ALL). It is also indicated in adults and children for the treatment of CD19-positive B-cell precursor ALL in first or second complete remission with minimal residual disease (MRD) greater than or equal to 0.1%.

Associated Conditions
Precursor B-lymphoblastic leukaemia acute, Refractory B-cell precursor acute lymphoblastic leukemia, Relapsed B cell precursor Acute lymphoblastic leukemia

Amgen Reports Strong Global Demand in Q1 2025, Bolstering Long-Term Growth Outlook

• Amgen announced positive first quarter 2025 financial results, citing strong global demand across its product portfolio and successful new product launches. • Chairman and CEO Bob Bradway expressed confidence in Amgen's long-term growth prospects, supported by recent successful Phase 3 clinical trial results for several products. • The biotechnology company, which employs over 28,000 people globally, continues to focus on its mission of harnessing biology and technology to combat serious diseases.

CDMO Market Report: Key Regulatory Approvals and Clinical Advances in March-April 2025

• Multiple CDMOs secured significant contract manufacturing opportunities as regulatory bodies approved new indications for established drugs, particularly in oncology and rare diseases. • AstraZeneca's portfolio saw substantial growth with expanded approvals for Imfinzi, Tagrisso, and Lynparza, strengthening partnerships with contract manufacturers including Lonza, Dottikon, and Samsung Biologics. • Contract manufacturers supporting treatments for autoimmune conditions showed strong performance, with Argenx's Vyvgart Hytrulo receiving expanded indications for myasthenia gravis and CIDP.

Amgen Charts Growth Strategy Amid Patent Cliff: Biosimilars and Therapeutic Innovation Take Center Stage

• Amgen reports strong 2024 performance with $33.4 billion revenue, but faces patent expiration challenges for blockbusters Otezla and Enbrel, driving strategic pivot towards biosimilars and portfolio diversification. • Company targets $4 billion in biosimilar sales by 2030, launching Wezlana and Pavblu, while advancing development in four key therapeutic areas: oncology, general medicine, inflammation, and rare disease. • Strategic initiatives include expansion of BiTE platform in oncology, development of obesity drug MariTide, and international market penetration for rare disease treatments following Horizon Therapeutics acquisition.

Clinical Trial Diversity Crisis: Black Patients Severely Underrepresented in Multiple Myeloma Studies

• Recent phase 3 trials IMROZ and PERSEUS for multiple myeloma treatments showed alarming diversity gaps, with Black patients comprising only 0.9% and 1.3% of participants despite representing 20% of new myeloma cases. • FDA study of 32,000 clinical trial participants reveals significant racial disparities, with non-Hispanic Whites overrepresented at 75% while Hispanic and Black populations remain underrepresented relative to US demographics. • Real-world multiple myeloma patients show 44% worse progression-free survival compared to clinical trial participants, highlighting the consequences of non-representative trial populations.

Novel Approaches Reshape Lymphoma Treatment Landscape: Bispecific Antibodies and MRD-Guided Therapy Show Promise

• Bispecific antibodies demonstrate remarkable response rates in both diffuse large B-cell and follicular lymphoma, with promising durability in frontline treatment settings. • Groundbreaking ECOG-ACRIN trial reveals MRD-negative mantle cell lymphoma patients may not require stem cell transplantation, potentially changing decades of standard practice. • Research initiatives are expanding to include older lymphoma patients and focus on quality-of-life outcomes, with new trial designs better reflecting real-world patient populations.

Blinatumomab Approved for Consolidation Therapy in CD19-Positive B-ALL, Regardless of MRD Status

• The FDA approved blinatumomab in June 2024 for CD19-positive, Philadelphia chromosome-negative B-ALL consolidation, expanding its use in both adult and pediatric patients. • ECOG-ACRIN E1910 trial data supported the approval, showing superior overall survival with blinatumomab plus chemotherapy compared to chemotherapy alone. • Blinatumomab is now a standard component of consolidation therapy, irrespective of a patient's minimal residual disease (MRD) status or backbone chemotherapy. • Research continues to refine blinatumomab's role, exploring optimal patient selection, treatment sequencing, and the necessity of allogeneic stem cell transplant.

Potential Breakthrough in Dual Cellular Therapy for Advanced and Metastatic Solid Tumors

Roswell Park Comprehensive Cancer Center is conducting a phase 1 clinical trial, OASIS, to evaluate the effectiveness of a genetically modified oncolytic virus, CF33-CD19, combined with blinatumomab, in treating advanced or metastatic solid tumors. This innovative approach aims to extend the benefits of cellular immunotherapies to patients with cancers resistant to traditional therapies.

TCL1A Protein Identified as Predictor of Blinatumomab Response in Relapsed B-ALL

A study presented at the American Society of Hematology annual meeting has identified TCL1A as a potential predictive biomarker for blinatumomab response in relapsed pediatric B-cell acute lymphoblastic leukemia (B-ALL), offering new insights into improving treatment strategies.

MHRA Approves Amgen's Imdylltra (Tarlatamab) for Advanced Small Cell Lung Cancer

• The UK's MHRA has granted conditional marketing authorization to Amgen's Imdylltra (tarlatamab) for extensive-stage small cell lung cancer (ES-SCLC). • The approval is for adult patients who have progressed after at least two prior lines of therapy, including platinum-based chemotherapy. • Tarlatamab demonstrated a 41% objective response rate and a 9.7-month median duration of response in the Phase 2 DeLLphi-301 trial. • Imdylltra, a bispecific T-cell engager targeting DLL3, offers a new treatment option for ES-SCLC patients with limited alternatives.

Multispecific Antibodies Market Set to Exceed $40 Billion as Next-Generation Cancer Therapies Advance

• The multispecific antibodies market has surpassed $8.6 billion in sales as of Q3 2024, with 16 approved therapies demonstrating efficacy across oncology and other therapeutic areas. • Bispecific antibodies currently dominate the market, while more complex trispecific and tetraspecific antibodies are emerging in early development phases with potential for enhanced therapeutic advantages. • Over 900 multispecific antibodies are currently in clinical trials, reflecting substantial investment from pharmaceutical companies and biotechnology firms seeking to address complex diseases through multi-target approaches.

Blinatumomab Plus Chemotherapy Significantly Improves Survival in Pediatric B-ALL

• The addition of blinatumomab to chemotherapy significantly improves the 3-year disease-free survival rate in pediatric patients with standard-risk B-cell acute lymphoblastic leukemia. • In the overall study population, the 3-year DFS rate was 96% with blinatumomab plus chemotherapy compared to 87.9% with chemotherapy alone. • The study also found that blinatumomab plus chemotherapy reduced rates of bone marrow relapse compared to chemotherapy alone in both standard-risk average and high populations. • Safety results were consistent with the known profile of blinatumomab, with a slightly higher risk of infections observed in the blinatumomab arm.

Blinatumomab Plus Chemotherapy Significantly Improves Survival in Pediatric ALL

• A clinical trial demonstrated that adding blinatumomab to chemotherapy significantly improves three-year disease-free survival (DFS) rates in children with standard-risk acute lymphoblastic leukemia (ALL). • The trial reported a 96% three-year DFS rate for children receiving blinatumomab plus chemotherapy, compared to 87.9% with chemotherapy alone, marking a substantial improvement in outcomes. • Blinatumomab was well-tolerated, paving the way for reducing the use of more toxic chemotherapy drugs and improving the quality of life for young patients with B-cell ALL. • The Children's Oncology Group (COG) is incorporating blinatumomab into standard protocols, signaling a paradigm shift in the treatment of pediatric ALL and a new standard of care.

FDA Approves Autolus' Aucatzyl (obe-cel) for Relapsed/Refractory B-cell ALL

• The FDA has approved Autolus Therapeutics' Aucatzyl (obecabtagene autoleucel, obe-cel) for adult patients with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL). • Aucatzyl, a CAR T-cell therapy targeting CD19, demonstrated a 42% complete remission rate within three months in clinical trials, with a median response duration of 14.1 months. • Aucatzyl's design allows for rapid disengagement from target cells, potentially reducing T-cell exhaustion and minimizing adverse effects compared to other CAR T-therapies. • Unlike other CAR T-therapies, Aucatzyl does not require a Risk Evaluation and Mitigation Strategy (REMS) program, which may streamline its adoption and use in treatment centers.

FDA Grants Accelerated Approval to Tarlatamab for Previously Treated Extensive-Stage Small Cell Lung Cancer

• Tarlatamab (Imdelltra) receives accelerated FDA approval for extensive-stage small cell lung cancer (SCLC) post-platinum-based chemotherapy. • The approval was based on the DeLLphi-301 study, which demonstrated a 40% objective response rate among evaluable patients. • The median duration of response in the study was 9.7 months, with a significant proportion of responses lasting over 6 months. • Common adverse events included cytokine-release syndrome, fatigue, and pyrexia, necessitating careful monitoring and management.

Obe-cel Approved for Relapsed/Refractory B-Cell ALL: A New CAR T-Cell Therapy Option

• Obecabtagene autoleucel (obe-cel) received FDA approval in November 2024 for adult patients with relapsed or refractory B-cell acute lymphoblastic leukemia (ALL). • The approval was based on the FELIX trial, which demonstrated high overall remission rates and a manageable safety profile with split dosing. • Obe-cel's unique fast-off target binding and 4-1BB construct may lead to decreased T-cell exhaustion and reduced cytokine release syndrome (CRS) and neurotoxicity. • Analysis of the FELIX trial data suggests that patients with low-risk scores may experience better outcomes with obe-cel treatment.

Amgen's Q3 Earnings Buoyed by Oncology and Hyperlipidemia Drugs, MariTide Obesity Data Anticipated

• Amgen's Q3 revenues reached $8.5 billion, a 23% year-over-year increase, driven by strong sales of Blincyto, Repatha, and Lumakras, which exceeded analyst expectations. • MariTide's Phase II study is progressing well, with Amgen planning a broad Phase III program targeting obesity, related conditions, and type 2 diabetes, with data expected later this year. • Analysts express eagerness for MariTide data, viewing it as crucial for Amgen's future growth, especially with potential biosimilar competition for Prolia in 2025. • Some of Amgen's top-selling assets, like Tepezza, Prolia and Enbrel, experienced disappointing Q3 sales, missing analyst expectations and highlighting the need for new growth drivers.

Amgen's Q3 2024 Revenue Jumps 23% Fueled by Rare Disease Portfolio

• Amgen reported an impressive 23% revenue increase in Q3 2024, reaching $8.5 billion, driven by strong product sales, particularly in its rare disease portfolio. • The rare disease portfolio, boosted by the Horizon Therapeutics acquisition, saw a 21% year-over-year growth, with key drugs like Tepezza, Krystexxa, and Uplizna contributing significantly. • Despite success in rare diseases, Amgen discontinued the Phase II study of fipaxalparant for idiopathic pulmonary fibrosis after it failed to meet primary or secondary endpoints. • Amgen anticipates Phase II data for MariTide in overweight/obese adults with or without T2D in late 2024 and is planning a broad Phase III program in obesity and related conditions.

Autolus' Obe-cel Nears Potential FDA Approval for Adult B-cell ALL

• Autolus Therapeutics anticipates a November 16, 2024 PDUFA date for obe-cel, a CAR-T cell therapy targeting relapsed/refractory adult B-cell acute lymphoblastic leukemia (B-ALL). • Phase 1b/2 FELIX study data showed a 78% overall response rate (CR/CRi) in patients treated with obe-cel, with a median overall survival of 23.8 months. • Obe-cel may offer advantages over existing therapies like Tecartus, potentially demonstrating a more favorable safety profile with lower rates of cytokine release syndrome and ICANS. • Autolus has a strong cash position and partnerships with BioNTech, Moderna, and Bristol Myers Squibb, supporting the potential commercial launch and further development of obe-cel.

Tisagenlecleucel Shifts to Earlier Use in Pediatric B-ALL Treatment

• Tisagenlecleucel is increasingly used in earlier lines of therapy for pediatric and young adult patients with relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL). • A study showed a decrease in patients receiving tisagenlecleucel in later relapses and a reduction in hematopoietic stem cell transplants (HSCT) prior to CAR T-cell therapy. • Morphologic complete remission rates have increased, particularly in patients without morphologic disease, following tisagenlecleucel treatment. • Long-term safety profiles of tisagenlecleucel remain favorable across age groups, with expected low incidence of high-grade cytokine release syndrome.

FDA Approves Blinatumomab for Early-Stage CD19-Positive B-ALL

• The FDA has approved blinatumomab for adult and pediatric patients with CD19-positive, Philadelphia chromosome-negative B-cell precursor acute lymphoblastic leukemia (B-ALL) in the consolidation phase. • The approval was based on the Phase 3 E1910 trial, which showed a significant improvement in overall survival when blinatumomab was added to consolidation chemotherapy. • In the E1910 study, the 3-year OS rate was 84.8% in the blinatumomab arm compared to 69% in the chemotherapy arm (HR, 0.42; 95% CI, 0.24-0.75; P = 0.003). • Blinatumomab's approval marks a significant advancement in the treatment of B-ALL, offering a new standard of care to reduce relapse risk and improve survival rates.
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