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莫昔单抗联合泊洛妥珠单抗治疗复发或难治性侵袭性大 B 细胞淋巴瘤的 1b/2 期试验。

Mosunetuzumab with polatuzumab vedotin in relapsed or refractory aggressive large B cell lymphoma: a phase 1b/2 trial.

机构信息

City of Hope Comprehensive Cancer Center, Duarte, CA, USA.

Brown University, Providence, RI, USA.

出版信息

Nat Med. 2024 Jan;30(1):229-239. doi: 10.1038/s41591-023-02726-5. Epub 2023 Dec 10.


DOI:10.1038/s41591-023-02726-5
PMID:38072960
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10803244/
Abstract

Relapsed/refractory aggressive large B cell lymphoma (LBCL) remains an area of unmet need. Here we report the primary analysis of a phase 1b/2 trial of outpatient mosunetuzumab (a CD20xCD3 T-cell-engaging bispecific antibody) plus polatuzumab vedotin (an anti-CD79B antibody-drug conjugate) in relapsed/refractory LBCL. The phase 2 component is a single arm of an ongoing multi-arm trial. The primary endpoint during dose expansion was independent review committee (IRC)-assessed best overall response rate. Secondary endpoints included investigator-assessed overall response rate, complete response, duration of response, progression-free survival and overall survival. At data cutoff, 120 patients were enrolled (22 dose escalation, 98 dose expansion). The primary endpoint was met during dose expansion, with IRC-assessed best overall response rate and complete response rates of 59.2% (58/98; 95% confidence interval (CI): 48.8-69.0) and 45.9% (45/98; 95% CI: 35.8-56.3), respectively (median follow-up, 23.9 months). Median duration of complete was not reached (95% CI: 20.5-not estimable (NE)). Median progression-free survival was 11.4 months (95% CI: 6.2-18.7). Median overall survival was 23.3 months (95% CI: 14.8-NE). Across dose escalation and expansion, the most common grade 3 or higher adverse events were neutropenia (25.0%, 30/120) and fatigue (6.7%, 8/120). Any-grade cytokine release syndrome occurred in 16.7% of patients. These data demonstrate that mosunetuzumab plus polatuzumab vedotin has a favorable safety profile with highly durable responses suitable as second-line therapy in transplant-ineligible relapsed/refractory LBCL. ClinicalTrials.gov identifier: NCT03671018 .

摘要

复发/难治侵袭性大 B 细胞淋巴瘤(LBCL)仍然存在未满足的需求。在这里,我们报告了一项 1b/2 期临床试验的初步分析,该试验评估了门诊型 mosunetuzumab(一种 CD20xCD3 T 细胞结合双特异性抗体)联合 polatuzumab vedotin(一种抗 CD79B 抗体药物偶联物)在复发/难治性 LBCL 中的应用。该 2 期部分是正在进行的多臂试验的单臂部分。扩展阶段的主要终点是独立审查委员会(IRC)评估的最佳总缓解率。次要终点包括研究者评估的总缓解率、完全缓解率、缓解持续时间、无进展生存期和总生存期。在数据截止时,共入组 120 例患者(22 例剂量递增,98 例剂量扩展)。在剂量扩展阶段达到了主要终点,IRC 评估的最佳总缓解率和完全缓解率分别为 59.2%(98/58;95%置信区间[CI]:48.8-69.0)和 45.9%(98/45;95%CI:35.8-56.3)(中位随访时间,23.9 个月)。完全缓解的中位持续时间未达到(95%CI:20.5-NE)。中位无进展生存期为 11.4 个月(95%CI:6.2-18.7)。中位总生存期为 23.3 个月(95%CI:14.8-NE)。在剂量递增和扩展阶段,最常见的 3 级或更高等级的不良事件是中性粒细胞减少症(25.0%,30/120)和疲劳(6.7%,8/120)。16.7%的患者出现任何等级的细胞因子释放综合征。这些数据表明,mosunetuzumab 联合 polatuzumab vedotin 具有良好的安全性,缓解持续时间长,适合作为不适合移植的复发/难治性 LBCL 的二线治疗药物。临床试验注册号:NCT03671018 。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/f8a8165dac06/41591_2023_2726_Fig10_ESM.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/2844bb1e083e/41591_2023_2726_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/f38069f981ed/41591_2023_2726_Fig4_ESM.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/8e23eb8cc315/41591_2023_2726_Fig5_ESM.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/7a78beeee5e4/41591_2023_2726_Fig7_ESM.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/31a7f84d9b18/41591_2023_2726_Fig8_ESM.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/ae47ed255649/41591_2023_2726_Fig9_ESM.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/f8a8165dac06/41591_2023_2726_Fig10_ESM.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/2844bb1e083e/41591_2023_2726_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/29868d42dcd5/41591_2023_2726_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/8e476f5188b6/41591_2023_2726_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/f38069f981ed/41591_2023_2726_Fig4_ESM.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/8e23eb8cc315/41591_2023_2726_Fig5_ESM.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/62c727a94353/41591_2023_2726_Fig6_ESM.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/7a78beeee5e4/41591_2023_2726_Fig7_ESM.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/31a7f84d9b18/41591_2023_2726_Fig8_ESM.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/ae47ed255649/41591_2023_2726_Fig9_ESM.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/789d/10803244/f8a8165dac06/41591_2023_2726_Fig10_ESM.jpg

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[3]
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[4]
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[5]
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[6]
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[8]
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[9]
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本文引用的文献

[1]
Axicabtagene ciloleucel as second-line therapy in large B cell lymphoma ineligible for autologous stem cell transplantation: a phase 2 trial.

Nat Med. 2023-10

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