Genmab Announces Data From Multiple Clinical Trials Showing Treatment with Fixed-Duration Epcoritamab Led to Remissions in First-Line Diffuse Large B-Cell Lymphoma (DLBCL) and Follicular Lymphoma (FL)
- New two- and three-year EPCORE® NHL-2 follow-up data evaluating epcoritamab in combination with standard of care regimens demonstrate remission in patients with DLBCL and FL
- Latest EPCORE DLBCL-3 trial results show encouraging overall response and complete response rates for epcoritamab monotherapy in newly-diagnosed, elderly patients with DLBCL
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Data presented at the 67th Annual Meeting and Exposition of the
American Society of Hematology (ASH) reinforce the potential utility of epcoritamab in earlier lines of therapy with a fixed treatment duration
In EPCORE DLBCL-3, the ORR was 73% in elderly patients with DLBCL treated with first-line, fixed-duration epcoritamab monotherapy who were unable to receive standard anthracycline-based chemotherapy. The study also showed that 54% of patients were progression free and 65% were alive at one year. The results from both studies were presented today in two oral presentations (abstracts 63 and 64) and two poster presentations (abstracts 1955 and 5357) at the 67th Annual Meeting and Exposition of the
EPCORE® NHL-2, Arm 8 Results
Two-year follow up from Arm 8 of the EPCORE NHL-2 trial (abstract 64) showed fixed-duration epcoritamab plus rituximab plus dose-attenuated cyclophosphamide, doxorubicin, vincristine, and prednisone (R-mini-CHOP) demonstrated an ORR of 93% and complete response (CR) rate of 86% in elderly patients with newly diagnosed DLBCL ineligible for full-dose R-CHOP due to age or comorbidities (n=28). Responses were maintained at two years for an estimated 79% of all responders. Additionally, 20 out of 22 patients who completed the eight cycles of treatment had a CR at the end of treatment and 90% of them remained in CR nearly two years later. Minimal residual disease (MRD) negativity was reported in 20 out of 21 evaluable patients, including clinically relevant sub-groups; this was achieved in 16 patients by the start of cycle 3, and 12 maintained this status through the start of cycle 6.
Treatment-emergent adverse events (TEAEs) were consistent with previous studies evaluating epcoritamab and included Grade ≥3 infection in 32% (n=9) of patients, occurring within the first 6 cycles of treatment in the majority (7/9) of these patients. TEAEs led to epcoritamab discontinuation in 11% (n=3) of patients, including Grade 2 rhinitis, Grade 2 cytokine release syndrome (CRS), and Grade 5 confusional state and cytomegalovirus infection reactivation in a 90-year-old patient with a recent acute cerebrovascular accident.
“Despite an older population of newly diagnosed diffuse large B-cell lymphoma, the outcomes observed in Arm 8 of the EPCORE NHL-2 evaluating fixed-duration epcoritamab plus R-mini-CHOP are encouraging,” said
EPCORE® NHL-2; Arm 1 Results
In Arm 1 (abstract 1955), treatment with fixed-duration epcoritamab plus R-CHOP resulted in durable remissions lasting more than three years in most patients with newly diagnosed DLBCL and high International Prognostic Index (IPI) scores, an indicator of poor prognosis (n=47). After a median follow up of 44.2 months (95% CI, 38.9-44.4), the ORR was 98% and the CR rate was 85%. An estimated 74% of CRs were ongoing at three years. High CR rates were observed regardless of IPI score (IPI 3, 86% vs IPI 4-5, 83%). At three years, an estimated 69% of patients remained progression free and 83% were alive; survival outcomes were consistent regardless of IPI score (3 vs 4–5). Efficacy outcomes were also similar across subgroups based on age (≤60 vs >60 years), tumor size (<10 vs ≥10 cm), or cell of origin (germinal center B cell [GCB] vs non-GCB). By cycle 3, 86% of MRD evaluable patients were MRD negative and the reduction of circulating tumor DNA (ctDNA) levels was sustained through post-treatment follow-up in most patients with CR.
Serious and Grade ≥3 infections primarily occurred in the first six months of treatment, then rates decreased. Safety was consistent with prior reports. No new serious infections were reported in the post-treatment period. No new Grade 5 adverse events (AEs) were reported.
EPCORE® NHL-2; Arm 3 Results
Data from Arm 3 (abstract 5357) showed that treatment with fixed-duration epcoritamab plus bendamustine and rituximab (BR) for the first-line treatment of FL resulted in deep and durable responses at a median follow-up of 41.3 months. Three-year estimates for duration of response (DOR), duration of CR (DOCR), progression-free survival (PFS) and OS were 87%, 87%, 83% and 96%, respectively. PFS was consistently high overall and in both low- and high-risk subgroups. These results underscore the potential for long-term efficacy of this first-line treatment combination in FL.
No new safety signals were reported after the data cutoff/additional 11 months of follow up. Grade ≥3 TEAEs and serious TEAEs, including neutropenia and infection, primarily occurred in the first 24 weeks of treatment, coinciding with the epcoritamab plus BR treatment period, and rates improved over time during the epcoritamab monotherapy treatment period. Since the prior data cutoff, three patients experienced new COVID-19 infection events (Grade 1-2). There was a sustained reduction in peripheral CD4+ T cells, whereas peripheral CD8+ T cells expanded after the first full dose, resulting in a reduced CD4:CD8 ratio.
“The ongoing epcoritamab development program continues to generate positive data supporting its potential as a core therapy alone and in combination across a range of B-cell malignancies, both as an initial treatment and in later lines of therapy,” said Dr.
EPCORE® DLBCL-3 Trial Results
Separately, new results from the ongoing Phase 2 EPCOREDLBCL-3 trial (abstract 63), for fixed-duration epcoritamab monotherapy in newly diagnosed elderly patients with DLBCL and comorbidities, were also presented.
An ORR of 73% was observed (n=60 response evaluable patients), and 62% of patients achieved a CR. Median time to response was 1.5 months, and median time to CR was 2.1 months; eight patients with a partial response or stable disease at first assessment achieved a CR at subsequent assessments. Median duration of response (mDOR) and median duration of CR (mDOCR) were not reached (NR). An estimated 70% of all responses and 78% of CRs were ongoing at one year. In the overall population (N=66), median PFS was 13.0 months (95% CI, 5.4–NR) and median OS was NR (95% CI, 13.0–NR). An estimated 54% of patients were progression free, and 65% were alive at one year. Additionally, MRD negativity in responders was also reached early and was maintained, with most becoming MRD negative by the third treatment cycle and sustained through post-treatment follow-up.
Safety was consistent with previous reports of epcoritamab monotherapy in this population. TEAEs occurred in 94% of patients, with CRS (71%), diarrhea (23%), and fatigue (23%) being most frequent (≥20%). CRS events were primarily low Grade (Grade 1: 38%; Grade 2: 29%; Grade 3: 5%), with most (92%) occurring in cycle 1; 98% of cases resolved by data cutoff. ICANS occurred in 18% of patients (Grade 1: 8%; Grade 2: 8%; Grade 3: 3%); 11/12 cases resolved by data cutoff. Neutropenia was reported in 16% of patients, 68% of patients had an infection of any Grade, and 23% had a Grade ≥3 infection. Two additional Grade 5 TEAEs (pneumonia, death) occurred since the previous disclosure.
“Elderly patients who are living with diffuse large B-cell lymphoma, particularly those with comorbidities, often are not able to tolerate standard treatment, creating a tremendous need for effective chemotherapy-free options,” said
The safety and efficacy of epcoritamab have not been established for these investigational uses.
About Diffuse Large B-Cell Lymphoma (DLBCL)
DLBCL is the most common type of non-Hodgkin lymphoma (NHL) worldwide, accounting for approximately 25-30 percent of all NHL cases.i In the
About Follicular Lymphoma (FL)
FL is typically an indolent (or slow-growing) form of non-Hodgkin lymphoma (NHL) that arises from B-lymphocytes and is the second most common form of NHL accounting for 20-30 percent of all cases.v About 15,000 people develop FL each year in the
About the EPCORE® NHL-2 Trial
EPCORE NHL-2 is a Phase 1b/2 open-label interventional trial to evaluate the safety, tolerability, pharmacokinetics, pharmacodynamics/biomarkers, immunogenicity, and preliminary efficacy of epcoritamab as a monotherapy and in combination with other standard of care agents in patients with B-cell non-Hodgkin lymphoma (B-NHL). The trial consists of two parts: Part 1 (Dose Escalation) and Part 2 (Dose Expansion). The primary objective of Part 1 is safety, and the primary goal of Part 2 is preliminary efficacy. The primary endpoint was overall response rate (ORR) based on best overall response per Lugano criteria. MRD negativity was assessed as a secondary endpoint.
More information on this trial can be found at https://www.clinicaltrials.gov/ (NCT: 04663347).
About the EPCORE® DLBCL-3 Trial
EPCORE DLBCL-3 is an open-label, randomized, global, Phase 2 trial to evaluate the efficacy and safety of epcoritamab as monotherapy or in combination with lenalidomide as first-line therapy for anthracycline-ineligible subjects with diffuse large B-cell lymphoma (DLBCL). This is a 2-stage trial. In Stage 1, eligible patients will be randomized to either epcoritamab monotherapy or epcoritamab plus lenalidomide. In Stage 2, additional patients may be enrolled at the treatment regimen selected for expansion. Each treatment cycle is 28 days. Patients will receive a maximum of 12 cycles (up to 1 year) of treatment. The primary objective is to evaluate the clinical efficacy of epcoritamab monotherapy or epcoritamab and lenalidomide. The primary endpoint is to achieve a complete response rate determined by Lugano criteria. Additional secondary endpoints include overall response rate, duration of response, duration of complete response, rate of minimal residual disease negativity, progression-free survival and overall survival.
More information on this trial can be found at https://www.clinicaltrials.gov/ (NCT:05660967).
About Epcoritamab
Epcoritamab is an IgG1-bispecific antibody created using
Epcoritamab (approved under the brand name EPKINLY® in the
EPKINLY® (epcoritamab-bysp)
What is EPKINLY?
EPKINLY is a prescription medicine used to treat adults with:
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certain types of diffuse large B-cell lymphoma (DLBCL) or high-grade B-cell lymphoma that has come back (relapsed) or that did not respond (refractory), after 2 or more treatments.
- EPKINLY for the treatment of DLBCL is approved based on patient response data. Studies are ongoing to confirm the clinical benefit of EPKINLY.
- follicular lymphoma (FL) that has come back or that did not respond to previous treatment, together with lenalidomide and rituximab
- follicular lymphoma (FL) that has come back or that did not respond after receiving 2 or more treatments.
It is not known if EPKINLY is safe and effective in children.
Important Warnings—EPKINLY can cause serious side effects, including:
- Cytokine release syndrome (CRS), which is common during treatment with EPKINLY and can be serious or lead to death. To help reduce your risk of CRS, you will receive EPKINLY on a step-up dosing schedule (when you receive 2 or 3 smaller step-up doses of EPKINLY before your first full dose during your first cycle of treatment), and you may also receive other medicines before and for 3 days after receiving EPKINLY. If your dose of EPKINLY is delayed for any reason, you may need to repeat the step-up dosing schedule.
- Neurologic problems that can be serious, and can be life-threatening, and lead to death. Neurologic problems may happen days or weeks after you receive EPKINLY.
People with DLBCL or high-grade B-cell lymphoma should be hospitalized for 24 hours after receiving their first full dose of EPKINLY on Day 15 of Cycle 1 due to the risk of CRS and neurologic problems.
People with follicular lymphoma (FL) may need to be hospitalized after receiving their first full dose of EPKINLY on Day 22 of Cycle 1 due to the risk of CRS.
Tell your healthcare provider or get medical help right away if you develop a fever of 100.4°F (38°C) or higher; dizziness or lightheadedness; trouble breathing; chills; fast heartbeat; feeling anxious; headache; confusion; shaking (tremors); problems with balance and movement, such as trouble walking; trouble speaking or writing; confusion and disorientation; drowsiness, tiredness or lack of energy; muscle weakness; seizures; or memory loss. These may be symptoms of CRS or neurologic problems. If you have any symptoms that impair consciousness, do not drive or use heavy machinery or do other dangerous activities until your symptoms go away.
EPKINLY can cause other serious side effects, including:
- Infections that may lead to death. Your healthcare provider will check you for signs and symptoms of infection before and during treatment and treat you as needed if you develop an infection. You should receive medicines from your healthcare provider before you start treatment to help prevent infection. Tell your healthcare provider right away if you develop any symptoms of infection during treatment, including fever of 100.4°F (38°C) or higher, cough, chest pain, tiredness, shortness of breath, painful rash, sore throat, pain during urination, feeling weak or generally unwell, or confusion.
- Low blood cell counts, which can be serious or severe. Your healthcare provider will check your blood cell counts during treatment. EPKINLY may cause low blood cell counts, including low white blood cells (neutropenia and lymphopenia), which can increase your risk for infection; low red blood cells (anemia), which can cause tiredness and shortness of breath; and low platelets (thrombocytopenia), which can cause bruising or bleeding problems.
Your healthcare provider will monitor you for symptoms of CRS, neurologic problems, infections, and low blood cell counts during treatment with EPKINLY. Your healthcare provider may temporarily stop or completely stop treatment with EPKINLY if you develop certain side effects.
Before you receive EPKINLY, tell your healthcare provider about all your medical conditions, including if you have an infection, are pregnant or plan to become pregnant, or are breastfeeding or plan to breastfeed. If you receive EPKINLY while pregnant, it may harm your unborn baby. If you are a female who can become pregnant, your healthcare provider should do a pregnancy test before you start treatment with EPKINLY and you should use effective birth control (contraception) during treatment and for 4 months after your last dose of EPKINLY. Tell your healthcare provider if you become pregnant or think that you may be pregnant during treatment with EPKINLY. Do not breastfeed during treatment with EPKINLY and for 4 months after your last dose of EPKINLY.
The most common side effects of EPKINLY when used alone in DLBCL or high-grade B-cell lymphoma or FL include CRS, injection site reactions, tiredness, muscle and bone pain, fever, diarrhea, COVID-19, rash, and stomach-area (abdominal) pain. The most common severe abnormal laboratory test results with EPKINLY when used alone include decreased white blood cells, decreased red blood cells, and decreased platelets.
The most common side effects of EPKINLY when used together with lenalidomide and rituximab in FL include rash, upper respiratory tract infections, tiredness, injection site reactions, constipation, diarrhea, CRS, pneumonia, COVID-19, and fever. The most common severe abnormal laboratory test results with EPKINLY when used together with lenalidomide and rituximab include decreased white blood cells and decreased platelets.
These are not all of the possible side effects of EPKINLY. Call your doctor for medical advice about side effects.
You are encouraged to report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch or to
Please see Medication Guide , including Important Warnings.
About
Established in 1999,
This Media Release contains forward-looking statements. The words “believe,” “expect,” “anticipate,” “intend” and “plan” and similar expressions identify forward looking statements. Actual results or performance may differ materially from any future results or performance expressed or implied by such statements. The important factors that could cause our actual results or performance to differ materially include, among others, risks associated with preclinical and clinical development of products, uncertainties related to the outcome and conduct of clinical trials including unforeseen safety issues, uncertainties related to product manufacturing, the lack of market acceptance of our products, our inability to manage growth, the competitive environment in relation to our business area and markets, our inability to attract and retain suitably qualified personnel, the unenforceability or lack of protection of our patents and proprietary rights, our relationships with affiliated entities, changes and developments in technology which may render our products or technologies obsolete, and other factors. For a further discussion of these risks, please refer to the risk management sections in Genmab’s most recent financial reports, which are available on
www.genmab.com
and the risk factors included in Genmab’s most recent Annual Report on Form 20-F and other filings with the U.S. Securities and Exchange Commission (SEC), which are available at
www.sec.gov
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i NHL Subtypes. |
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ii Diffuse large B-cell lymphoma (DLBCL) research. Blood Cancer United. https://bloodcancerunited.org/research/blood-cancer-research-development-progress/lymphoma/diffuse-large-b-cell-lymphoma-dlbcl. Accessed |
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iii Sehn LH, Salles G. N Engl J Med. 2021;384:842-858. |
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iv Kanas G, Ge W, Quek RGW, et al. Leukemia & Lymphoma. 2022;63(1):54-63. |
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vii Ghione P, Palomba ML, Ghesquieres H, et al. Treatment patterns and outcomes in relapsed/refractory follicular lymphoma: results from the international SCHOLAR-5 study. Haematologica. 2023;108(3):822-832. doi: 10.3324/haematol.2022.281421. |
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viii Al-Tourah AJ, Gill KK, Chhanabhai M, et al. Population-based analysis of incidence and outcome of transformed non-Hodgkin's lymphoma. J Clin Oncol. 2008 Nov 10;26(32):5165-9. doi: 10.1200/JCO.2008.16.0283. Epub 2008 |
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ix Rivas-Delgado A, Magnano L, Moreno-Velázquez M, et al. Response duration and survival shorten after each relapse in patients with follicular lymphoma treated in the rituximab era. Br |
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x Engelberts PJ, et al. DuoBody-CD3xCD20 Induces Potent T-Cell-Mediated Killing of Malignant B Cells in Preclinical Models and Provides Opportunities for Subcutaneous Dosing. EBioMedicine. 2020;52:102625. doi: 10.1016/j.ebiom.2019.102625. |
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