Wu Fan, Zhou Jian, Zheng Xirong, Masilamani Madhan, Cheng Yiming, Caia Andrea, Cook Mark, Piasecki Julia, Lamba Manisha
Translational Medicine & Clinical Pharmacology, Bristol Myers Squibb, Princeton, NJ, USA.
Clinical Science, Bristol Myers Squibb, Boudry, Switzerland.
Clin Pharmacokinet. 2025 Jun 3. doi: 10.1007/s40262-025-01531-2.
BACKGROUND: Idecabtagene vicleucel (ide-cel, ABECMA) is an autologous, B-cell maturation antigen (BCMA)-directed, chimeric antigen receptor (CAR) T-cell therapy. The current modeling analyses aim to characterize the cellular kinetics (CK) of ide-cel and to assess the covariate effects impacting ide-cel cellular kinetics in patients with relapsed/refractory multiple myeloma. METHODS: A modified piecewise model was developed to characterize ide-cel CK through the nonlinear mixed effects method. The model parameterization was conducted using the ide-cel whole-blood transgene data in CK-evaluable subjects (N = 225) from the ide-cel arm of the study KarMMa-3 (NCT03651128). The structural model consists of an initial lag phase and then saturable cell expansion, followed by conversion from effector cells to memory cells and their elimination. Model simulations were performed to evaluate covariate effects on ide-cel exposure parameters. RESULTS: The piecewise CK model with saturable expansion sufficiently captured the clinically observed ide-cel transgene data. The simulations using the final population CK model suggested that the magnitude of covariate effects on ide-cel exposure parameters was considerably smaller than the intersubject variability in the population. Additional analyses revealed a negative effect of treatment-emergent immunogenicity on the ide-cel persistence. Apparent associations were identified between cellular kinetic parameters and clinical responses. CONCLUSIONS: The cellular kinetics of ide-cel can be adequately described by the modified piecewise model. No clinically meaningful covariate effects on cellular kinetics were identified from this modeling study. The population CK model suggests that higher cell expansion rate and lower elimination rates of effector and memory cells were observed in patients with longer progression-free survival.
背景:伊德凯达基(ide-cel,ABECMA)是一种自体、靶向B细胞成熟抗原(BCMA)的嵌合抗原受体(CAR)T细胞疗法。目前的模型分析旨在描述伊德凯达基的细胞动力学(CK),并评估影响复发/难治性多发性骨髓瘤患者伊德凯达基细胞动力学的协变量效应。 方法:开发了一种改良的分段模型,通过非线性混合效应方法来描述伊德凯达基的CK。使用来自研究KarMMa-3(NCT03651128)伊德凯达基组中CK可评估受试者(N = 225)的伊德凯达基全血转基因数据进行模型参数化。结构模型包括一个初始滞后阶段,然后是饱和细胞扩增,接着是效应细胞向记忆细胞的转化及其清除。进行模型模拟以评估协变量对伊德凯达基暴露参数的影响。 结果:具有饱和扩增的分段CK模型充分捕捉了临床上观察到的伊德凯达基转基因数据。使用最终总体CK模型的模拟表明,协变量对伊德凯达基暴露参数的影响程度远小于总体中的个体间变异性。进一步分析显示,治疗引发的免疫原性对伊德凯达基的持久性有负面影响。在细胞动力学参数与临床反应之间发现了明显的关联。 结论:改良的分段模型可以充分描述伊德凯达基的细胞动力学。该模型研究未发现对细胞动力学有临床意义的协变量效应。总体CK模型表明,无进展生存期较长的患者观察到更高的细胞扩增率以及更低的效应细胞和记忆细胞清除率。
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