Date: 2015-06-02
Type of information: Presentation of results at a congress
phase: 3
Announcement: presentation of results at the American Society of Clinical Oncology (ASCO) annual meeting, in Chicago
Company: BMS (USA - NY) Abbvie (USA - IL)
Product: elotuzumab
Action
mechanism: monoclonal antibody. Elotuzumab is an investigational immunostimulatory antibody targeted against Signaling Lymphocyte Activation Molecule (SLAMF7), a cell-surface glycoprotein that is highly and uniformly expressed on myeloma cells and Natural Killer (NK) cells, but is not detected on normal solid tissues or on hematopoietic stem cells. Elotuzumab is being investigated to determine whether the compound may selectively target myeloma cells. It is believed that elotuzumab works through a dual mechanism of action: binding to SLAMF7 on NK cells, directly activating them and binding to SLAMF7 on myeloma cells, flagging them for NK cell recognition and destruction. Elotuzumab is being studied as a monotherapy in smodering myeloma and in combination with other therapies in first-line and relapsed or refractory multiple myeloma. A clinical development program for the agent is underway, including Phase 3 trials in first-line multiple myeloma (ELOQUENT-1) and relapsed or refractory multiple myeloma (ELOQUENT-2). Elotuzumab is also being investigated in a randomized Phase 2 study of bortezomib and dexamethasone in relapsed or refractory multiple myeloma. In May 2014, the FDA granted elotuzumab Breakthrough Therapy Designation for use in combination with one of the chemotherapy treatments for multiple myeloma (lenalidomide, used in combination with dexamethasone) in patients who have received one or more prior treatments. BMS and AbbVie are co-developing elotuzumab, with BMS leading the commercialization of the agent.
Disease: relapsed or refractory multiple myeloma
Therapeutic area: Cancer - Oncology
Country: Australia, Austria, Belgium, Canada, Czech Republic, Denmark, France, Germany, Greece, Hungary, Ireland, Israel, Italy, Japan, Poland, Puerto Rico, Romania, Spain, Switzerland, Turkey, Russian Federation, UK, USA
Trial
details: ELOQUENT-2 (CA204-004) is an open-label, multicenter Phase III study evaluating elotuzumab in combination with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with relapsed or refractory multiple myeloma. The purpose of this phase 3 randomized, open lapel trial study is to determine whether the addition of elotuzumab to lenalidomide/low-dose Dexamethasone will increase the progression free survival (PFS).The trial enrolled 646 patients who had received one to three prior therapies and who were not lenalidomide-refractory. Patients were randomized 1:1 to receive either elotuzumab 10 mg/kg in combination with lenalidomide and dexamethasone (ELd) or lenalidomide and dexamethasone alone (Ld) in 28-day cycles to disease progression or unacceptable toxicity. The co-primary endpoints were progression-free survival, as defined by hazard ratio, and objective response rate. Median follow-up for this interim analysis was 24.5 months with 35% of ELd patients (n=113) and 21% of Ld patients (n=66) remaining on therapy. Key secondary endpoints included overall survival and pain severity/interference with daily life. Exploratory objectives included tumor response, duration of response, health-related quality of life, and safety. (NCT01239797)
Latest
news: * On June 2, 2015, BMS has presented the first data of a Phase III, open-label study (Abstract #8508) evaluating elotuzumab in combination with lenalidomide and dexamethasone (ELd) in patients with relapsed or refractory multiple myeloma at the 51st Annual Meeting of the American Society of Clinical Oncology (ASCO). The results show a clinically relevant 30% reduction in risk of progression or death with Eld vs lenalidomide and dexamethasone alone (Ld) for the treatment of relapsed or refractory multiple myeloma. The study met its co-primary endpoints demonstrating superior progression-free survival (PFS) and overall response rate (ORR). The ELd arm demonstrated a 30% reduction in the risk of disease progression or death compared to the Ld arm (HR 0.70, 95% CI, [0.57, 0.85]; p = 0.0004). The PFS rates in the ELd arm versus the Ld arm were 68% versus 57% at 1 year and 41% versus 27% at 2 years, respectively. A significant ORR also was observed with 79% (74% to 83%) in the ELd arm compared to 66% (60% to 71%) in the Ld arm (odds ratio, 1.9; 1.4 to 2.8; p=0.0002). The safety profile was consistent with previously-reported studies and there were minimal incremental adverse events (AEs) with the addition of elotuzumab to lenalidomide and dexamethasone. Along with a 30% reduction in the risk of disease progression, which was sustained at two years, the median PFS in the ELd group was 19.4 months (95% CI, 16.6 to 22.2) versus 14.9 months (95% CI, 12.1 to 17.2) in the Ld group. The PFS benefit observed was consistent across all pre-specified subgroups. Patients in the ELd arm were exposed to treatment with lenalidomide 30% (or median of approximately five months) longer than patients in the Ld arm. Discontinuation was mainly due to disease progression (42% ELd, 47% Ld). The rate of discontinuation due to adverse events did not differ between arms. Grade 3-4 hematologic adverse events in the ELd and Ld arms, respectively, included lymphopenia (77% vs. 49%), neutropenia (34% vs. 44%), anemia (19% vs. 21%) and thrombocytopenia (19% vs. 20%), and the exposure-adjusted infection rate was the same in both arms. Infusion reactions occurred in 10% of patients with ELd; these were mostly Grade 1-2, and were manageable and resulted in discontinuation in only 1% of patients. A similar proportion of patients in each study group (2%) died due to an adverse event. As of this analysis, there were a total of 210 deaths in the study with 94 [30%] in the ELd group versus 116 [37%] in the Ld group. This represents a total of 49% of the 427 deaths required for the final analysis. Follow-up of longer-term outcomes, including overall survival, is ongoing. Also presented in a poster session at ASCO on Sunday, May 31 were results from the Phase II study that evaluated elotuzumab in combination with bortezomib and dexamethasone (EBd, n=77) versus bortezomib and dexamethasone (Bd, n=75) alone in patients with relapsed or refractory multiple myeloma [Abstract #8573]. Consistent with data from ELOQUENT-2, results from the Phase II study demonstrated a 28% reduction in the risk for disease progression or death in the EBd arm compared to Bd alone (HR 0.72, 70% CI, 0.59, 0.88). One-year PFS rates were 39% (95% CI 28%, 50%) for EBd versus 33% (95% CI 22%, 44%) for Bd. One-year survival rates were 85% (95% CI 75%, 92%) in the EBd arm versus 74% (95% CI 62%, 83%) in the Bd arm. Grade 3-4 AEs were reported in 68% of patients in the EBd group and 60% in the Bd group, including infections (19% vs. 15%), thrombocytopenia (9% vs. 17%), and peripheral neuropathy (8% vs. 9%).
