linvoseltamab (REGN5458)

P1, N=6, Recruiting, Regeneron Pharmaceuticals | Not yet recruiting --> Recruiting

P2, N=28, Not yet recruiting, Dickran Kazandjian, MD

P1, N=6, Not yet recruiting, Regeneron Pharmaceuticals

P1/2, N=220, Not yet recruiting, Regeneron Pharmaceuticals

P2, N=40, Recruiting, Regeneron Pharmaceuticals | Not yet recruiting --> Recruiting

P1/2, N=387, Recruiting, Regeneron Pharmaceuticals | Active, not recruiting --> Recruiting | Trial completion date: Mar 2032 --> Jun 2032 | Trial primary completion date: Jun 2023 --> May 2032

P1/2, N=132, Recruiting, Regeneron Pharmaceuticals | Not yet recruiting --> Recruiting

P1, N=317, Recruiting, Regeneron Pharmaceuticals | Phase classification: P1b --> P1

P2, N=104, Not yet recruiting, Regeneron Pharmaceuticals

P2, N=40, Not yet recruiting, Regeneron Pharmaceuticals | Trial completion date: Apr 2032 --> Nov 2032 | Trial primary completion date: Apr 2032 --> Nov 2032

P3, N=286, Recruiting, Regeneron Pharmaceuticals | Not yet recruiting --> Recruiting

P1/2, N=132, Not yet recruiting, Regeneron Pharmaceuticals | Trial completion date: Jun 2035 --> Sep 2035 | Trial primary completion date: Jun 2035 --> Sep 2035

Teclistamab was approved for relapsed/refractory MM therapy in 2022, while elranatamab, linvoseltamab, F182112, talquetamab, and cevostamab are currently undergoing clinical trials. This study summarizes several latest reports on bsAbs for the treatment of MM from the ASCO 2023 Annual Meeting.

P2, N=40, Not yet recruiting, Regeneron Pharmaceuticals

This activity is supported by educational grants from AbbVie Inc, Genentech, a member of the Roche Group, Genmab US Inc, Karyopharm Therapeutics, Lilly, Regeneron Pharmaceuticals Inc, Sanofi, and Seagen Inc. Clinical and biological factors affecting the selection of up-front therapy for patients with MMLong-term findings with daratumumab-containing regimens for newly diagnosed MM; role for transplant-eligible and ineligible patientsPublished data with novel daratumumab-based quadruplet regimens for transplant-eligible patients with newly diagnosed MMSimilarities and differences between daratumumab and isatuximabKey findings from the Phase III GMMG HD7 trial comparing isatuximab with RVd to RVd alone for transplant-eligible patients with newly diagnosed MMOngoing Phase III studies of isatuximab as a part of induction therapy for transplant-eligible and ineligible patientsAvailable data with and current role of minimal residual disease assessment in therapeutic decision-makingOptimal maintenance approach for transplant-eligible and ineligible patientsResults from Phase III trials evaluating isatuximab-based combination regimens for relapsed/refractory (R/R) MMKey results from the Phase III BOSTON trial leading to the FDA approval of selinexor in combination with bortezomib/dexamethasone for R/R MM; available data with other selinexor-based combinationsStructural makeup and manufacturing of available B-cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T-cell platformsEfficacy and safety findings from the KarMMa (idecabtagene vicleucel) and CARTITUDE-1 (ciltacabtagene autoleucel) trials for R/R MMAvailable and emerging data with and ongoing studies of BCMA-targeted CAR T-cell therapies in earlier lines of treatmentSimilarities and differences in the cellular targets and mechanisms of action of bispecific antibodies in MMActivity and responses observed with available (teclistamab) and investigational (elranatamab, linvoseltamab, ABBV-383) BCMA-targeted bispecific antibodies in R/R MMBiological rationale for and available data with non-BCMA-targeted bispecific antibodies (eg, talquetamab, cevostamab, forimtamig); FDA breakthrough therapy designation for talquetamabSpectrum, incidence and severity of toxicities, including cytokine release syndrome and neurotoxicity, with bispecific antibodies in patients with MM; mitigation and management protocolsPublished data with and current role of venetoclax-based therapy for patients with MM and t(11;14) or Bcl-2 overexpressionOther promising novel strategies in clinical development for patients with MM

P1b, N=317, Recruiting, Regeneron Pharmaceuticals | Trial completion date: May 2032 --> Aug 2032 | Trial primary completion date: Oct 2026 --> Jan 2027

This Phase 1/2 study will assess the safety, tolerability, and preliminary antitumor activity of the BCMA×CD3 bispecific antibody linvoseltamab in NDMM patients.

Eligible patients will have received 1–4 prior lines of therapy, including lenalidomide and a PI, and have progressed on/after the last therapy; prior anti-CD38 mAb treatment is permitted. The LINKER MM-3 study will determine the utility of linvoseltamab monotherapy as a novel alternative treatment relative to a standard pomalidomide-based triplet therapy for patients with RRMM. Multiple myeloma, Relapse, Bispecific, B-cell maturation antigen

Linvoseltamab 200 mg showed better efficacy compared with 50 mg, including in pts with high disease burden. The 200 mg dose had consistent efficacy across high-risk subgroups and induced responses in pts who progressed on 50 mg. Safety was consistent across Ph 2 doses.

Despite promising efficacy in MM, BsAbs may come with substantial infection risk, warranting more detailed analysis of infections and immune phenotyping to guide targeted supportive care. Table – Summary of included studiesAgent Target Source Phase Enrolment (mm/yy) N Median prior lines All- Grade Infection N (%) Grade ≥3 Infection N (%) Alnuctamab (CC-93269) BCMA Wong 2022 I 03/18- 68 4 23 (34) 6 (9) ABBV-383 BCMA Voorhees 2022 I 10/22- 174 5 61/124 (50) 39/124 (22) Elranatamab BCMA Raje 2022 I 10/21- 123 5 82 (67) 43 (35) Linvoseltamab (REGN545) BCMA Bumma 2022 Ib/II 1/19- 252 5 136 (54) 73 (29) Pacanalotamab (AMG-420) BCMA Topp 2020 I 3/19 – 4/22 42 5 14 (33) 10 (24) Teclistamab BCMA Moreau 2022 I/II 09/20- 165 5 126 (77) 57 (45) Teclistamab + daratumumab BCMA + CD38 Rodriguez- Otero 2022 II 03/21- 46 5 29 (63) 8 (17) Forimtamig (RG6234) GPRC5D Carlo- Stella 2022 I 11/20- IV: 51 SC: 57 IV: 5 SC: 4 IV: 31 (61) SC: 26 (46) IV:11 (22) SC:15 (27) Talquetamab GPRC5D Chari 2022 I/II 02/21- 288 5 153 (53) 46 (16) Talquetamab + daratumumab GPRC5D + CD38 Van de Donk 2022 II 09/21- 46 5 23 (50) 6 (13) Cevostamab (BFCR4350A) FcRH5 Trudel 2021 I 07/21- 161 6 68 (43) 18 (11) Bispecific, Multiple myeloma, Cellular therapy

P1/2, N=132, Not yet recruiting, Regeneron Pharmaceuticals

Analyses of matched BMA and biopsy samples from heavily pretreated RRMM patients, reveal that most BMPC express BCMA, though soluble vs membrane-bound BCMA levels are heterogenous. Diversity in immune and plasma cell markers and subsets is also observed. Ongoing analyses include correlations of plasma and immune cell profile with response to T-cell-targeting therapies such as REGN5458.

Here we describe a fully human bsAb (REGN5458) that binds to B-cell maturation antigen (BCMA) and CD3, and compare its antitumor activities vs those of anti-BCMA CAR T cells to identify differences in efficacy and mechanism of action...In head-to-head in vivo studies, BCMAxCD3 bsAb rapidly cleared established systemic MM tumors, whereas CAR T cells cleared tumors with slower kinetics. Thus, using the same BCMA-binding domain, these results suggest that BCMAxCD3 bsAb rapidly exerts its therapeutic effects by engaging T cells already in place at the tumor site, whereas anti-BCMA CAR T cells require time to traffic to the tumor site, activate, and numerically expand before exerting antitumor effects.

Conclusions In this updated analysis of the first-in-human study, REGN5458 continues to show an acceptable safety profile and durable efficacy in heavily pre-treated patients with RRMM. Enrollment in the Phase 1 dose escalation portion is ongoing, and the Phase 2 portion of the study is recruiting.

This presentation will describe Regeneron’s bispecific platform and present preclinical data on REGN4018, a clinical-stage, T cell-engaging, bispecific-targeting Muc16 for solid tumor indications. In addition, status updates on Regeneron’s other clinical-stage bispecific antibodies (REGN1979, REGN5458, REGN5678) will be presented, as well as a discussion of new combinatorial approaches being taken to enhance bispecific anti-tumor efficacy.