Department of Haematology, Rigshospitalet, Copenhagen, Denmark.
Lunenburg Lymphoma Phase I/II Consortium-HOVON/LLPC, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands.
Lancet. 2021 Sep 25;398(10306):1157-1169. doi: 10.1016/S0140-6736(21)00889-8. Epub 2021 Sep 8.
BACKGROUND: Patients with relapsed or refractory B-cell non-Hodgkin lymphoma have few treatment options. We aimed to establish the safety and recommended phase 2 dose of epcoritamab, a novel bispecific antibody that targets CD3 and CD20 and induces T-cell-mediated cytotoxic activity against CD20+ malignant B cells. METHODS: For the dose-escalation part of this phase 1/2 study, we enrolled adults (aged ≥18 years) with relapsed or refractory CD20+ B-cell non-Hodgkin lymphoma at ten sites across four countries (Denmark, the Netherlands, the UK, and Spain). Eligible patients received priming and intermediate doses followed by full doses of subcutaneous epcoritamab administered in 28-day cycles; each subsequent cohort involved escalation of the priming, intermediate, or full dose (0·0128-60 mg). The primary objectives were to determine the maximum tolerated dose and the recommended phase 2 dose. Safety, antitumour activity, pharmacokinetics, and immune biomarkers were also assessed. This study is registered with ClinicalTrials.gov, NCT03625037, with the dose-expansion part ongoing. FINDINGS: Between June 26, 2018, and July 14, 2020, we enrolled 73 patients with relapsed, progressive, or refractory CD20+ mature B-cell non-Hodgkin lymphoma. 68 patients received escalating full doses (0·0128-60 mg) of subcutaneous epcoritamab. No dose-limiting toxic effects were observed, and the maximum tolerated dose was not reached; the full dose of 48 mg was identified as the recommended phase 2 dose. All 68 patients received at least one dose of epcoritamab and were included in safety analyses: common adverse events were pyrexia (47 patients [69%]), primarily associated with cytokine release syndrome (CRS; 40 [59%], all grade 1-2), and injection site reactions (32 [47%]; 31 grade 1). There were no grade 3 or higher CRS events. No discontinuations occurred due to treatment-related adverse events or treatment-related deaths. Overall response rate in patients with relapsed or refractory diffuse large B-cell lymphoma was 68% (95% CI 45-86), with 45% achieving a complete response at full doses of 12-60 mg. At 48 mg, the overall response rate was 88% (47-100), with 38% achieving a complete response. Patients with relapsed or refractory follicular lymphoma had an overall response rate of 90% (55-100), with 50% achieving a complete response at full doses of 0·76-48 mg. Epcoritamab induced robust and sustained B-cell depletion, and CD4+ and CD8+ T-cell activation and expansion, with modest increases in cytokine levels. INTERPRETATION: Single-agent subcutaneous epcoritamab for treatment of patients with relapsed or refractory B-cell non-Hodgkin lymphoma merits investigation in ongoing phase 2 and phase 3 studies. FUNDING: Genmab and AbbVie.
背景:复发或难治性 B 细胞非霍奇金淋巴瘤患者的治疗选择有限。我们旨在确定新型双特异性抗体 epcoritamab 的安全性和推荐的 2 期剂量,该抗体靶向 CD3 和 CD20,并诱导 T 细胞介导的针对 CD20+恶性 B 细胞的细胞毒性作用。
方法:在这项 1/2 期的剂量递增研究中,我们在丹麦、荷兰、英国和西班牙的 10 个地点招募了患有复发或难治性 CD20+B 细胞非霍奇金淋巴瘤的成年患者(年龄≥18 岁)。符合条件的患者接受皮下注射 epcoritamab 的起始和中间剂量,然后在 28 天的周期中接受全剂量;随后的每个队列都涉及起始、中间或全剂量(0·0128-60mg)的递增。主要目的是确定最大耐受剂量和推荐的 2 期剂量。还评估了安全性、抗肿瘤活性、药代动力学和免疫生物标志物。这项研究在 ClinicalTrials.gov 上注册,NCT03625037,正在进行扩展部分。
结果:在 2018 年 6 月 26 日至 2020 年 7 月 14 日期间,我们招募了 73 名患有复发、进展或难治性 CD20+成熟 B 细胞非霍奇金淋巴瘤的患者。68 名患者接受了皮下注射递增全剂量(0·0128-60mg)的 epcoritamab。未观察到剂量限制毒性作用,也未达到最大耐受剂量;48mg 的全剂量被确定为推荐的 2 期剂量。所有 68 名患者至少接受了一剂 epcoritamab,并纳入安全性分析:常见的不良反应是发热(47 名患者[69%]),主要与细胞因子释放综合征(CRS;40 名[59%],均为 1-2 级)和注射部位反应(32 名[47%];31 级 1)有关。没有 3 级或更高的 CRS 事件。没有因治疗相关不良事件或治疗相关死亡而停药。在复发或难治性弥漫性大 B 细胞淋巴瘤患者中,总缓解率为 68%(95%CI 45-86%),12-60mg 全剂量时 45%达到完全缓解。在 48mg 时,总缓解率为 88%(47-100%),38%达到完全缓解。复发或难治性滤泡性淋巴瘤患者的总缓解率为 90%(55-100%),0.76-48mg 全剂量时 50%达到完全缓解。Epcoritamab 诱导了强烈和持续的 B 细胞耗竭,以及 CD4+和 CD8+T 细胞的激活和扩增,细胞因子水平适度增加。
结论:单药皮下注射 epcoritamab 治疗复发或难治性 B 细胞非霍奇金淋巴瘤值得在正在进行的 2 期和 3 期研究中进一步研究。
注:以上译文仅供参考,具体内容以原文为准。
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