Regeneron's Ordspono (odronextamab) has shown promising efficacy and a manageable safety profile in patients with relapsed/refractory (r/r) marginal zone lymphoma (MZL), according to data from the Phase II ELM-2 trial presented at the American Society of Hematology (ASH) 2024 Annual Meeting. The study evaluated Ordspono in patients with extranodal, nodal, and splenic MZL who had undergone second-line or later systemic therapy, addressing a significant unmet need in the third-line setting.
Efficacy and Durability
The ELM-2 trial reported an objective response rate (ORR) and complete response (CR) rate of 77.1% each (95% CI 59.9–89.6). The 12-month duration of response (DOR) was 80.2% (95% CI 49.6–93.3), indicating a durable response in responding patients. However, the median DOR, median duration of complete response (DOCR), median progression-free survival (PFS), and median overall survival (OS) were not reached, with a median follow-up of 11 months.
Safety Profile
The safety profile of Ordspono was generally manageable. Common treatment-emergent adverse events (TEAEs) included cytokine release syndrome (CRS) (54.8%), infusion-related reaction (35.7%), pyrexia (35.7%), and neutropenia (31%). Grade 3 or higher TEAEs occurred in 83.3% of patients, with neutropenia being the most common (23.8%). All CRS events were limited to grade 1–2 severity, attributed to the step-up dosing strategy and prophylactic steroid use. Notably, no cases of immune effector cell-associated neurotoxicity syndrome (ICANS) were observed.
Regulatory Landscape and Competition
Despite the promising results, the FDA rejected Regeneron’s biologics license application for Ordspono, citing the need for confirmatory trials and a clear timeline for resubmission. This contrasts with the European Commission's approval of Ordspono for treating adult patients with r/r follicular lymphoma (FL) or r/r diffuse large B-cell lymphoma (DLBCL) after two or more lines of systemic therapy, based on the same Phase II ELM-2 trial.
Ordspono also faces competition from other bispecific T-cell engager therapies (BiTEs), such as AbbVie and Genmab’s Epkinly (epcoritamab), Roche’s Columvi (glofitamab), and Roche’s Lunsumio (mosunetuzumab). Ordspono's intravenous administration may be less convenient compared to Epkinly’s subcutaneous administration. GlobalData’s analyst consensus forecast projects Ordspono’s total global sales to reach $569 million by 2030, contingent on confirmatory trials that provide robust comparisons to standard-of-care treatments or competing BiTEs.
Future Directions
Regeneron’s OLYMPIA odronextamab development program aims to establish Ordspono’s role in various B-cell non-Hodgkin lymphoma subtypes and earlier lines of therapy, with ongoing studies like the Phase III OLYMPIA-5 trial evaluating odronextamab-lenalidomide versus lenalidomide-rituximab (R2) in r/r MZL patients. Addressing these challenges could position Ordspono as a significant advancement in treating B-cell malignancies and the underserved third-line MZL setting.
