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In May 2019, Noopur Raje, Massachusetts General Hospital Cancer Center, Boston, MA, Jesus Berdeja, Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN, Yi Lin, Mayo Clinic, Rochester, MN, and colleagues, published the results from a phase I dose escalation and expansion trial (CRB-401), investigating bb2121, a proposed novel CAR T-cell therapy, in patients with relapsed/refractory (RR) multiple myeloma (MM).1
The anti-B-cell maturation antigen (BCMA) CAR T-cell therapy, bb2121, has shown promising preclinical results across a range of BCMA expression levels. This led to the development of the CRB-401 (NCT02658929) multi-center clinical trial to evaluate the safety and efficacy as a potential treatment for RRMM.2 bb2121 is formed by transducing autologous peripheral-blood mononuclear cells with a second-generation chimeric antigen receptor (CAR):
Table 1 below shows the best overall responses by the dose of bb2121 administered. The objective response rate (ORR), defined as partial response (PR) or better, for the whole cohort was 85% (95% CI, 68.1–94.9). Three of the patients achieved a complete response (CR, 9%), whilst 12 achieved a stringent CR (sCR, 36%).
Peak CAR T expansion was after 11 days in patients who received doses higher than 150 x 106 CAR T cells. A very good partial response or better (≥VGPR) was only seen in patients receiving over 150 x 106 CAR T cells, indicating frequency and duration of response are dose-dependent.
Factors associated with achieving a PR (or better):
For the whole cohort, median progression-free survival (PFS) was 11.8 months (95% CI, 6.2–17.8). The median duration of response was 10.9 months (7.2–could not be estimated) with a median time to first partial response, or better, of 1 month (0.5–3.0).
In 18 patients, minimal residual disease (MRD) status was available, with 16 patients who achieved a partial response (PR) or better, being MRD-negative (≤10-4).
Based on BCMA expression, response rates were similar. In patients receiving 450 x 106 CAR T cells, 100% of patients with <50% BCMA expression responded, while 91% of patients ≥50% BCMA expression responding.
At a median follow-up of 11.3 months (6.2–22.8), 14 patients had ongoing responses whilst 17 experienced disease progression (12 of whom had responded to therapy).
Table 1: Best overall response by dose of bb2121 (%, [n])
BCMA, B-cell maturation antigen; PD; progressive disease; PR, partial response; sCR, stringent complete response; VGPR, very good partial response | ||||||
|
50 x 106 |
150 x 106 |
450 x 106 BCMA <50% |
450 x 106 BCMA ≥50% |
800 x 106 |
50 x 106 – 800 x 106
|
---|---|---|---|---|---|---|
N |
3 |
8 |
8 |
11 |
3 |
33 |
sCR |
0 |
63% (5) |
38% (3) |
36% (4) |
0 |
36% (12) |
CR |
0 |
0 |
0 |
9% (1) |
67% (2) |
9% (3) |
VGPR |
0 |
0 |
50% (4) |
36% (4) |
33% (1) |
27% (9) |
PR |
33% (1) |
12% (1) |
12% (1) |
9% (1) |
0 |
12% (4) |
Stable disease |
67% (2) |
12% (1) |
0 |
9% (1) |
0 |
12% (4) |
PD |
0 |
12% (1) |
0 |
0 |
0 |
3% (1) |
At doses above 150 x 106 CAR T cells, CRs were observed at all levels. Clinical responses were observed in 85% of patients in this study, lasting on average for 10.9 months. The single-infusion administration of bb2121 may offer an advantage over current salvage therapies offered in the RRMM setting, which require more frequent visits and follow-up. The bb2121 CAR T cells were shown to persist in vivo and the safety profile was manageable and in line with anti-CD19 CAR T studies and data.
References