AstraZeneca's novel bispecific T-cell engager (BiTE), AZD0486, is showing promising results in patients with relapsed or refractory follicular lymphoma (r/r FL). Interim data from a first-in-human trial, presented at the 2024 American Society of Hematology (ASH) meeting, indicate high response rates with a manageable safety profile. The BiTE targets CD19 on cancerous cells and CD3 on the surface of T-cells, recruiting the patient’s T-cells to attack the lymphoma.
Mechanism of Action and Clinical Data
AZD0486 works by binding to both CD19, a protein expressed on lymphoma cells, and CD3, a protein on T-cells. This dual binding brings the T-cells into close proximity with the lymphoma cells, activating the T-cells to kill the cancer cells. The trial included patients who had received at least two prior lines of therapy. In the cohort of patients who received AZD0486 doses of 2.4 mg or higher (n = 27), the overall response rate (ORR) was an impressive 96%, with 85% achieving a complete response (CR).
Comparative Efficacy and Safety
These results compare favorably to existing treatments like Genentech's Lunsumio (mosunetuzumab) and Genmab's Epkinly (epcoritamab), both CD20xCD3 BiTEs approved for r/r FL. The EPCORE trial of Epkinly and the GO29781 trial of Lunsumio reported ORRs of 82% and 80%, and CRs of 60% and 60%, respectively. Cytokine release syndrome (CRS), a common side effect of immunotherapies, was observed in 45% of patients receiving a double step-up dose of AZD0486, but all cases were grade 1. This CRS rate is similar to Lunsumio (44% CRS, 1% grade 3) and better than Epkinly (60% CRS, 9% grade 2, 2% grade 3).
Market Impact and Future Directions
AstraZeneca has initiated a phase II trial of AZD0486 in r/r FL. If the positive results are maintained, AZD0486 could become the first CD19xCD3 BiTE approved for this indication. While GlobalData’s analyst consensus forecast projects AZD0486 to reach $158 million in global sales by 2030, compared to $2.4 billion for Epkinly and $949 million for Lunsumio, these new results may lead to revised, more optimistic forecasts. The evolving treatment landscape for follicular lymphoma includes cell therapies like Kite's Yescarta, Novartis' Kymriah, and BMS' Breyanzi, but their uptake has been limited due to cost and access issues. AZD0486 offers a potentially more accessible and effective option for patients with r/r FL.
