Gopal Ajay K, Armand Philippe, Neelapu Sattva S, Bartlett Nancy L, Spurgeon Stephen E, Kuruvilla John, Savage Kerry J, Leonard John P, Gelb Arnold B, Ahmed Nasir, Dong Shiqi, Bathena Sai Praneeth, Suryawanshi Rasika, Wu Qun Jenny, Wang Sheen, Gladstone Douglas E
University of Washington, Seattle, Washington, United States.
Dana-Farber Cancer Institute, Boston, Massachusetts, United States.
Blood Adv. 2025 Mar 3. doi: 10.1182/bloodadvances.2024015086.
Despite high response rates, anti-PD-1 therapy monotherapy eventually fails in most patients with relapsed or refractory Hodgkin Lymphoma (HL) and is generally ineffective in most other B-cell malignancies. The lymphocyte activation gene 3 (LAG-3) cell-surface receptor represents another immune checkpoint molecule that can be targeted to induce remissions in these diseases; dual inhibition of PD-1 and LAG-3 is approved for treating advanced melanoma. We performed a multicenter phase 1/2a open-label study of the anti-LAG-3 antibody relatlimab (RELATIVITY-022) administered as monotherapy or in combination with nivolumab in patients with relapsed or refractory B-cell malignancies. In total, 106 patients were treated and no dose limiting toxicities were observed during escalation. The recommended phase 2 dose was relatlimab 240 mg as monotherapy or nivolumab 240 mg plus relatlimab 160 mg, administered every 2 weeks. No unexpected safety signals were observed compared to single agent anti-PD-1 therapy. In the HL expansion cohorts, overall response rate (ORR) was 62% and complete response rate (CRR) was 19% in anti-PD-(L)1 naïve patients (n = 21), with a median PFS of 19 months; ORR was 15% and CRR 0%, median PFS 6 months in anti-PD-(L)1 progressed patients (n = 20). In the DLBCL cohort, ORR was 7% with no CRs (n = 15), and median PFS was 2 months. Nivolumab plus relatlimab appeared to be safe and tolerable. Efficacy in PD-1 naïve HL patients was encouraging, although the contribution of relatlimab to overall efficacy of the combination needs to be further evaluated. Clinicaltrials.gov; NCT02061761.
尽管抗PD-1疗法的缓解率较高,但单药治疗最终在大多数复发或难治性霍奇金淋巴瘤(HL)患者中失败,并且在大多数其他B细胞恶性肿瘤中通常无效。淋巴细胞激活基因3(LAG-3)细胞表面受体是另一种免疫检查点分子,可作为这些疾病诱导缓解的靶点;PD-1和LAG-3的双重抑制已被批准用于治疗晚期黑色素瘤。我们开展了一项多中心1/2a期开放标签研究,在复发或难治性B细胞恶性肿瘤患者中,对抗LAG-3抗体瑞帕利单抗(RELATIVITY-022)进行单药治疗或与纳武利尤单抗联合治疗。总共治疗了106例患者,在剂量递增期间未观察到剂量限制性毒性。推荐的2期剂量为瑞帕利单抗单药治疗240mg,或纳武利尤单抗240mg加瑞帕利单抗160mg,每2周给药一次。与单药抗PD-1疗法相比,未观察到意外的安全信号。在HL扩展队列中,初治抗PD-(L)1患者(n = 21)的总缓解率(ORR)为62%,完全缓解率(CRR)为19%,中位无进展生存期(PFS)为19个月;抗PD-(L)1进展患者(n = 20)的ORR为15%,CRR为0%,中位PFS为6个月。在弥漫性大B细胞淋巴瘤(DLBCL)队列中,ORR为7%,无完全缓解(n = 15),中位PFS为2个月。纳武利尤单抗加瑞帕利单抗似乎安全且耐受性良好。初治PD-1的HL患者的疗效令人鼓舞,尽管瑞帕利单抗对联合治疗总体疗效的贡献需要进一步评估。Clinicaltrials.gov;NCT02061761。
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