On December 5, 2020 Sierra Oncology, Inc. (SRRA), a late-stage biopharmaceutical company on a quest to deliver targeted therapies that treat rare forms of cancer, reported updated overall survival (OS) data for momelotinib in both JAKi-naïve and patients previously treated with ruxolitinib (Press release, Sierra Oncology, DEC 5, 2020, View Source [SID1234572217]). The data were presented in an oral presentation at the 2020 American Society of Hematology (ASH) (Free ASH Whitepaper) Annual Meeting by Srdan Verstovsek, MD, PhD, Chief, Section for Myeloproliferative Neoplasms, Department of Leukemia, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center.

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"Momelotinib’s unique mechanism of action—targeting JAK1, JAK2 and ACVR1—is translating to durability of activity and survival data consistent with its clinical and biologic profile," said Dr. Verstovsek. "Notably, momelotinib showed improved rates in transfusion independence and the duration thereof as well as overall survival, and that benefit was present regardless of whether or not the patient was previously treated with a JAK inhibitor."

"As the SIMPLIFY data sets continue to mature, we are seeing increasingly exciting outcomes in terms of overall survival, as well as myelofibrosis disease hallmarks, including splenic response and transfusion independence," said Barbara Klencke, MD, Chief Development Officer at Sierra Oncology. "We believe these data presented at the ASH (Free ASH Whitepaper) annual meeting, in combination with previously reported safety data, tell a truly innovative story for how momelotinib can fulfill an unmet need for intermediate and high-risk myelofibrosis patients who are not ideal candidates for currently approved therapies. We look forward to continuing enrollment in the Phase 3 MOMENTUM study to further highlight where momelotinib may be a preferred treatment option for patients and their physicians."

Robust Overall Survival and Sustained Efficacy Outcomes During Long Term Exposure to Momelotinib in JAK Inhibitor Naïve and Previously JAK Inhibitor Treated Intermediate/High Risk Myelofibrosis Patients (Abstract #54)

The SIMPLIFY-1 (S1) and SIMPLIFY-2 (S2) Phase 3 studies evaluated momelotinib (MMB) against ruxolitinib (S1) or best available therapy (S2) for a 24-week randomization treatment phase, followed by an opportunity for extended momelotinib treatment for all patients. Results based on a total 588 patients presented by Dr. Verstovsek include:

Robust OS was observed in both JAKi-naïve and previously ruxolitinib-treated patients
In S1, the median OS has not been reached in the MMB arm and 53.1 months in the control arm (HR=0.99, p=0.97)
In S2, the median OS was 34.3 months in originally MMB-randomized patients and 37.5 months in the BAT/RUXàMMB arm (HR=0.96, p=0.86), representing the best reported OS in this previously RUX-treated setting
Sustained transfusion independence was observed with extended MMB treatment
In S1, TI response at Week 24 was 67% in the MMB arm and 49% in the control arm (p<0.001). 40% of MMB-treated patients achieved a splenic response at any time during S1
The median duration of TI has not been reached after >3 years of follow up
In S2, TI response at Week 24 was 43% in the MMB arm and 21% in the control arm (p=0.001)
Compound safety was favorable for MMB with limited hematological toxicity and lack of cumulative toxicity
Patients were randomized 1:1 (S1) and 2:1 (S2) to receive MMB (200 mg QD) versus RUX (20 mg BID) or BAT (88.5% RUX/RUX+) for 24 weeks followed by extended momelotinib treatment. Both trials had primary endpoints of Splenic Response Rate and secondary endpoints of Total Symptom Score and Transfusion Independence Rate.

About Momelotinib

Momelotinib is a selective and orally bioavailable JAK1, JAK2 and ACVR1 inhibitor currently under investigation for the treatment of myelofibrosis. Myelofibrosis results from dysregulated JAK-STAT signaling and is characterized by constitutional symptoms, splenomegaly (enlarged spleen) and progressive anemia.

Momelotinib is currently under investigation in the MOMENTUM clinical trial, a global, randomized, double-blind Phase 3 study for symptomatic and anemic myelofibrosis patients. Top-line data are anticipated in H1 2022. The U.S. Food & Drug Administration has granted Fast Track designation for momelotinib.

On December 5, 2020 Kura Oncology, Inc. (Nasdaq: KURA), a clinical-stage biopharmaceutical company focused on the development of precision medicines for the treatment of cancer, reported preliminary clinical data from KOMET-001, an ongoing Phase 1/2A clinical trial of the Company’s oral, potent and selective menin inhibitor, KO-539, including single-agent activity in genetically defined subgroups of patients with relapsed or refractory acute myeloid leukemia (AML) (Press release, Kura Oncology, DEC 5, 2020, View Source [SID1234572216]).

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These data are being presented during an oral session at the 62nd American Society of Hematology (ASH) (Free ASH Whitepaper) Annual Meeting and Exposition. A copy of the presentation is available on Kura’s website at www.kuraoncology.com/pipeline/publications.

"The preliminary first-in-human data generated by KO-539 for the treatment of patients with relapsed or refractory AML is encouraging," said Eunice Wang, M.D., Chief of the Leukemia Service at Roswell Park Comprehensive Cancer Center and principal investigator of the trial. "In addition to a favorable safety and tolerability profile, we have observed evidence of biologic activity in each dose-escalation cohort treated to date. I am delighted to observe evidence of clinical activity in patients with diverse genetic backgrounds, including patients with NPM1 mutations. The preliminary clinical data for KO-539 suggest it has the potential to be effective for multiple genetically defined AML subgroups of high unmet need."

As of the data cutoff on November 2, 2020, the first-in-human, open-label, multicenter trial enrolled 12 patients with relapsed or refractory AML, of whom eight were evaluable for efficacy. Patients were enrolled into four dose cohorts: 50 mg, 100 mg, 200 mg and 400 mg. KO-539 was administered orally, on a once-daily schedule in continuous 28-day cycles. These patients were heavily pretreated and received a median of three prior lines of therapy (range 2-7). Clinical or biological activity was reported in six of the eight efficacy-evaluable patients, including:

An NPM1 mutant patient with DNMT3A and KMT2D co-mutations achieved a complete remission (CR) with no measurable residual disease. The patient entered the trial following seven prior lines of therapy and remains on KO-539 after three cycles.

A second NPM1 mutant patient with FLT3-ITD, TET2 and CUX1 co-mutations achieved a morphological leukemia-free state (MLFS) following four prior lines of therapy. Both NPM1 mutant patients were dosed at 200 mg.

A patient with SETD2 and RUNX1 co-mutations achieved a CR after two cycles and was dose-escalated from 100 mg to 200 mg on cycle seven after blast counts were observed to increase. The patient experienced clinical benefit for more than six months prior to disease progression.

A patient with a KMT2A/MLL rearrangement had a marked decrease in hydroxyurea requirements and attained peripheral blood count stabilization at the 50 mg starting dose.
Notably, the clinical activity observed across patients was not correlated with concomitant treatment with CYP3A4 inhibitors. This is supported by drug pharmacokinetic studies in patients, which showed that KO-539 metabolism appears to be unaffected by co-administration of CYP3A4 inhibitors.

Four patients were not evaluable for efficacy as of the data cutoff, including an NPM1 mutant patient and a DNMT3A mutant patient with CUX1, ASXL1, IDH2, CBL, U2AF1 and RUNX1 co-mutations in the 400 mg cohort and a KMT2A/MLL-r patient in the 200 mg cohort.

Continuous daily dosing of KO-539 has been well tolerated and with a manageable safety profile to date. There have been no drug discontinuations due to treatment-related adverse events (AEs) and no evidence of QTc prolongation or other clinically significant EKG changes. Treatment related AEs (grade ≥ 3) have included pancreatitis, increased lipase, decreased neutrophil count, tumor lysis syndrome and deep venous thrombosis.

Kura expects to determine a maximum tolerated dose and/or a recommended Phase 2 dose in the first quarter of 2021, at which point the Company intends to advance into expansion cohorts in NPM1-mutant AML and KMT2A/MLL-rearranged AML, selected patient populations where KO‑539 has the potential to demonstrate pronounced clinical benefit.

"We are pleased to see encouraging evidence of biologic and clinical activity from KO-539 in the preliminary data, particularly in these heavily pretreated AML patients who were enrolled without genetic selection in the dose-escalation portion of this trial," said Stephen Dale, M.D., Chief Medical Officer of Kura Oncology. "We are also encouraged by the clinical activity observed in cytogenetically normal patients with various co-mutations whose activity may be implicated by the upstream menin-KMT2A/MLL interaction, and believe these patients may represent a potential third expansion cohort. Meanwhile, we continue to explore options to broaden the opportunity for KO-539 in the treatment of acute leukemias, as well as in combination with chemotherapy and targeted therapies to support advancement to earlier lines of therapy."

Virtual Investor Event

Kura’s management will host a virtual investor event at 2:00 p.m. ET / 11:00 a.m. PT today, December 5, 2020, to provide a review of KO-539 following the oral presentation of preliminary clinical data at the ASH (Free ASH Whitepaper) Annual Meeting. The event will feature members of the Kura management team along with two of the investigators from the KOMET-001 clinical trial, Dr. Eunice Wang and Dr. Ghayas Issa. A live video webcast of the event will be available in the Investors section of Kura’s website at www.kuraoncology.com, with an archived replay available shortly after the conclusion of the event.

About Acute Myeloid Leukemia

AML is the most common acute leukemia in adults and begins when the bone marrow makes abnormal myeloblasts (white blood cells), red blood cells or platelets. Despite the many available treatments for AML, prognosis for patients remains poor, especially in the relapsed/refractory setting. More than 50% of patients with AML who achieve a CR after induction therapy relapse within one to three years, and less than 10% of those with relapsed/refractory AML are alive at three years. Prognosis is poor in patients with KMT2A rearrangements and in those with co-mutations that may include NPM1.

About KOMET-001

KOMET-001 (Kura Oncology Menin Inhibitor Trial) is a Phase 1/2A clinical trial to determine the safety, tolerability and recommended Phase 2 dose of KO-539 in patients with refractory or relapsed AML. A planned expansion phase in specific genetic subgroups, including NPM1 mutant AML and KMT2A/MLL rearranged AML, is expected to further evaluate anti-leukemic activity and tolerability of KO-539. Additional information about KOMET-001 can be found at kuraoncology.com/clinical-trials-komet.

About KO-539

KO-539 is a novel, once-daily, oral investigational drug candidate targeting the menin-KMT2A/MLL protein-protein interaction for treatment of genetically defined AML patients with high unmet need. In preclinical models, KO-539 inhibits the KMT2A/MLL protein complex and has downstream effects on HOXA9/MEIS1 expression. KO-539 has received Orphan Drug Designation from the U.S. Food and Drug Administration for the treatment of AML.

On December 5, 2020 Intellia Therapeutics, Inc. (NASDAQ:NTLA), reported that new preclinical data in support of NTLA-5001, the company’s wholly owned Wilms’ Tumor 1 (WT1)-directed T cell receptor (TCR)-T cell therapy candidate for the treatment of acute myeloid leukemia (AML), at the 62nd American Society of Hematology (ASH) (Free ASH Whitepaper) Annual Meeting, taking place virtually from December 5-8, 2020 (Press release, Intellia Therapeutics, DEC 5, 2020, View Source [SID1234572215]). NTLA-5001 capitalizes on how natural T cells recognize and respond to tumors. The target, WT1, is highly overexpressed in AML, a cancer of the blood and bone marrow that is often fatal despite existing treatments (NIH SEER Cancer Stat Facts: Leukemia – AML). The new preclinical data being presented today highlight the faster expansion and superior function of T cells manufactured by Intellia’s proprietary approach, compared to a standard genome editing process. Specifically, NTLA-5001’s lead TCR-T cells resulted in significantly higher anti-tumor activity in mouse models of acute leukemias than that observed in mice treated with cells engineered using the standard process.

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"NTLA-5001 is the first potential CRISPR-based cancer treatment engineered using Intellia’s proprietary process. Based on our preclinical results, we believe our process will result in a pipeline of safer and more efficacious oncological products, with reduced manufacturing time and, importantly, reduced vein-to-vein time, compared to currently available approaches. Showing in vivo efficacy in acute leukemia mouse models, as presented today at ASH (Free ASH Whitepaper), is extremely encouraging and an important steppingstone to entering the clinic next year," said Intellia President and Chief Executive Officer John Leonard, M.D. "In our first-in-human trial, we plan to establish the safety and activity that will enable us to move quickly to a pivotal investigation of NTLA-5001 for the treatment of AML, which is the most common type of acute leukemia in adults."

NTLA-5001 is being developed using Intellia’s proprietary process to treat AML patients regardless of the genetic subtype of a patient’s leukemia. Intellia plans to submit an Investigational New Drug (IND) application or equivalent for NTLA-5001 in the first half of 2021, subject to the impact of the COVID-19 pandemic, with the first-in-human trial planned to evaluate safety and activity in patients with persistent or recurrent AML who have previously received first-line therapies. Additional efforts are underway to evaluate the potential use of NTLA-5001 to treat WT1-positive solid tumors.

Presentation Details

Title: "NTLA-5001, a T Cell Product Candidate with CRISPR-Based Targeted Insertion of a High-Avidity, Natural, WT1-Specific TCR, Shows Efficacy in In Vivo Models of AML and ALL"
Publication Number: 1435
Session Name: 703. Adoptive Immunotherapy: Poster I
Presenting Author: Birgit Schultes, Ph.D., vice president of Intellia’s Cell Therapy group

With Intellia’s proprietary T cell engineering process, CRISPR/Cas9 in combination with adeno-associated virus (AAV) is used to insert a WT1-directed TCR in locus, while eliminating the expression of the endogenous TCRs. Benefits of Intellia’s approach include the following:

Intellia’s proprietary T cell engineering process enables multiple, sequential gene edits and is a significant improvement over standard engineering processes commonly used to introduce proteins and nucleic acids into cells.
Sequential editing maintains high T cell viability and may result in safer T cell products because treated cells have minimal levels of translocations, similar to unedited cells, and do not cause graft-versus-host disease (GvHD).
The observed faster T cell expansion with favorable T cell memory phenotype could lead to a reduced vein-to-vein time and better T cell persistence in patients, respectively.
T cells engineered using Intellia’s proprietary process to express the lead TCR to the WT137-45 epitope are efficacious, durable and safe in vivo in gold-standard mouse models of AML and acute lymphocytic leukemia (ALL). In collaboration with Chiara Bonini’s team at IRCCS Ospedale San Raffaele (OSR), the AML mouse model was developed using patient-derived primary AML blasts. WT1-specific T cell administration inhibited tumor growth more significantly and durably in blood, bone marrow and spleen than T cells edited using an industry standard electroporation process. Researchers additionally used an aggressive ALL model in immunocompromised mice engineered to express T cell-supporting cytokines at levels comparable to those in patients post-conditioning regimen, or post-lymphodepletion. In the ALL model, WT1-specific T cells also bestowed significant tumor control.

The presentation can be found here, on the Scientific Publications & Presentations page of Intellia’s website.

On December 5, 2020 Novartis reported analyses from two separate trials with Kymriah (tisagenlecleucel) in patients with certain advanced lymphomas. In the interim analysis of the investigational Phase II ELARA study, Kymriah led to a complete response (CR) in 65% of patients with relapsed or refractory (r/r) follicular lymphoma (FL) and an overall response rate (ORR) of 83% after at least three months of follow-up (Press release, Novartis, DEC 5, 2020, View Source [SID1234572214]). These patients continued to relapse or have refractory disease despite exposure to numerous lines of therapy (median four prior lines of therapy [range 2-13]) prior to Kymriah infusion1. The second analysis – a 40-month median follow-up from the Phase II JULIET trial – reported that the two-year progression-free survival (PFS) rate was 33% in patients with r/r diffuse large B-cell lymphoma (DLBCL), an important finding given these patients have limited treatment options that provide durable responses2. The JULIET study continued to show the effectiveness and well-characterized safety profile of Kymriah for these patients. These results were presented today during the 62nd American Society of Hematology (ASH) (Free ASH Whitepaper) Annual Meeting & Exposition (ASH) (Free ASH Whitepaper).

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"For people who have follicular lymphoma that continues to relapse or does not respond after treatment with many lines of therapy, response to therapy becomes less likely with each additional treatment," said Nathan H. Fowler, MD, Department of Lymphoma and Myeloma, Division of Cancer Medicine at MD Anderson Cancer Center. "We are encouraged by these interim results from the ELARA trial, as there is a great need for potentially definitive options and an alternative to stem cell transplant. We look forward to continuing to learn more about how Kymriah may provide benefit for these patients."

In the interim analysis of the investigational ELARA clinical trial, in which 52 patients were evaluable for efficacy with a median follow-up of 9.9 months, Kymriah led to responses for the majority of patients treated. Specifically, after at least three months of follow-up, 65% (99.5% CI, 45.1-82.4) of patients achieved a complete response, meeting the primary endpoint. The overall response rate was 83% (95% CI, 69.7-91.8). For those who had a complete response, the vast majority (90%) sustained responses for six months or more.

Safety results from this analysis of the ELARA trial suggest there was no emergence of new safety signals for Kymriah in the 97 patients evaluable for safety. No patients experienced grade 3/4 CRS, as defined by the Lee Scale, and any grade CRS occurred in 49% of patients (29% grade 1; 20% grade 2). To treat CRS, 15% of patients required tocilizumab and 3% required steroids. One percent of patients experienced grade 3/4 NEs and any grade NEs occurred in 9% of patients. Median time to CRS and severe NE onset was four and 8.5 days respectively, with respective median time to resolution of four and two days. All neurological and CRS events resolved with appropriate management. Three patients died from progressive disease and no deaths were treatment-related. Kymriah was administered in the outpatient setting for 18% of patients in the ELARA trial1.

Results from the primary analysis of the ELARA study, with data from 90 patients followed up for at least 6 months, will be presented at an upcoming medical meeting.

"Novartis is dedicated to continuing to explore the safety and efficacy of Kymriah for patients with advanced blood cancers who do not achieve long-term remissions despite multiple prior lines of therapy," said John Tsai, MD, Head of Global Drug Development and Chief Medical Officer, Novartis. "As we go deeper with our research in CAR-T cell therapies, these new analyses showcase the potential to rewrite cancer survival in patients with certain advanced lymphomas."

New updated efficacy results from pivotal JULIET clinical trial

New updated efficacy results from a 40-month median follow-up analysis demonstrated continued durable responses for patients with r/r DLBCL treated with Kymriah in the JULIET trial (n=115). Among the 61 patients who responded to treatment, the relapse-free probability was 60% at 24 and 36 months; median DOR was not reached (95% CI, 10-not estimable [NE])3. Two-year progression-free survival rate was 33% 2. Survival probability at 24 and 36 months was 40% and 36%, respectively. Importantly, no new safety signals were observed after more than three years of long-term follow-up observation3.

"Before the availability of Kymriah, long-term responses to treatment for those living with relapsed or refractory DLBCL were rare," said Ulrich Jaeger, MD, Medical University of Vienna, Vienna, Austria. "With these results from the JULIET trial, including biomarker analysis to better define patient subgroups who may benefit the most from CAR-T cell therapy, we are providing further evidence that Kymriah may be a definitive option for some patients. Additionally, with no new safety signals observed, physicians can continue to confidently refer their patients to certified centers to be treated with Kymriah."

The relationship between biomarkers, such as baseline Myc overexpression in tumors and tumor microenvironment (TME) characteristics, and response to Kymriah was also assessed in this analysis. Outcomes were better for those with negative Myc expression compared to those who had Myc overexpression, which leads to an unfavorable immunosuppressive TME with a restricted T-cell response. These results are consistent with historical outcomes for patients with Myc- and Myc+ expression4. Analyses to further identify biomarkers for response to CAR-T cell therapy are ongoing.

More information about Novartis activities at ASH (Free ASH Whitepaper) can be found on the Novartis 2020 ASH (Free ASH Whitepaper) Annual Meeting virtual portal.

About Follicular Lymphoma
Follicular lymphoma, the second most common form of non-Hodgkin lymphoma (NHL), is an indolent lymphoma, and represents approximately 22% of NHL cases5,6. Despite new treatments that improve overall survival, FL is regarded as an incurable malignancy with a relapsing and remitting pattern7,8. Throughout the lifetime of a patient with relapsing FL, they may be exposed to a median of five lines of prior treatment, with an upper range of 12 lines9,10. Although patients in third or later line treatment for FL have multiple systemic therapies available, the efficacy of these regimens drops off rapidly in later lines5. Additionally, because of this relapsing and remitting pattern, patients who are refractory to treatment or quickly relapse may exhaust available treatment options8.

About the ELARA trial
ELARA is a Phase II, single-arm, multicenter, open-label trial investigating the efficacy and safety of Kymriah in adult patients with r/r FL. This international trial has enrolled patients from over 30 sites in 12 countries worldwide. The primary endpoint is CRR based on best response by central review (Lugano 2014 criteria). Patients evaluable for efficacy had measurable disease at infusion and more than six months of follow-up from infusion or discontinued early. After infusion, disease assessments were performed every three months. Secondary endpoints include overall response rate, duration of response, progression-free survival, overall survival and safety.

In Q2 2020, the FDA granted Regenerative Medicine Advanced Therapy (RMAT) designation to Kymriah in r/r FL, based on preliminary results from the ELARA trial. RMAT designation is intended to expedite the development and review of Kymriah as a regenerative therapy for this underserved patient population. Kymriah also has Orphan Drug designation from the FDA for this indication.

About the JULIET Trial
JULIET was the first multi-center global registration study for Kymriah in adult patients with r/r DLBCL. JULIET, led by researchers at the University of Pennsylvania, enrolled patients from 27 sites in 10 countries across the US, Canada, Australia, Japan and Europe, including Austria, France, Germany, Italy, Norway and the Netherlands.

About Kymriah
Kymriah is the first-ever FDA-approved CAR-T cell therapy, and the first-ever CAR-T to be approved in two distinct indications. It is a one-time treatment designed to empower patients’ immune systems to fight their cancer. Kymriah is currently approved for the treatment of r/r pediatric and young adult (up to 25 years of age) acute lymphoblastic leukemia (ALL), and r/r adult DLBCL11.

About Novartis Commitment to Oncology Cell & Gene
Novartis has a mission to reimagine medicine by bringing curative cell & gene therapies to patients worldwide. Novartis has a deep CAR-T pipeline and ongoing investment in manufacturing and supply chain process improvements. With active research underway to broaden the impact of cell and gene therapy in oncology, Novartis is going deeper in hematological malignancies, reaching patients with other cancer types and evaluating next-generation CAR-T cell therapies that focus on new targets and utilize new technologies.

Novartis was the first pharmaceutical company to significantly invest in pioneering CAR-T research and initiate global CAR-T trials. Kymriah, the first approved CAR-T cell therapy, developed in collaboration with the Perelman School of Medicine at the University of Pennsylvania, is the foundation of Novartis’ commitment to CAR-T cell therapy. Kymriah is currently approved for use in at least one indication in 27 countries and at more than 270 certified treatment centers, with the ambition for further expansion to help fulfill the ultimate goal of bringing CAR-T cell therapy to every patient in need.

The Novartis global CAR-T manufacturing footprint spans seven facilities, across four continents. This comprehensive, integrated footprint strengthens the flexibility, resilience and sustainability of the Novartis manufacturing and supply chain. Commercial and clinical trial manufacturing is now ongoing at Novartis-owned facilities in Stein, Switzerland, Les Ulis, France and Morris Plains, New Jersey, USA, as well as at the contract manufacturing sites at Fraunhofer-Institut for cell therapy and immunology (Fraunhofer-Institut für Zelltherapie und Immunologie) facility in Leipzig, Germany, and now FBRI in Kobe, Japan. Manufacturing production at Cell Therapies in Australia and Cellular Biomedicine Group in China is forthcoming.

Kymriah (tisagenlecleucel) US Important Safety information
Kymriah may cause side effects that are severe or life-threatening, such as Cytokine Release Syndrome (CRS) or Neurological Toxicities. Patients with CRS may experience symptoms including difficulty breathing, fever (100.4°F/38°C or higher), chills/shaking chills, severe nausea, vomiting and diarrhea, severe muscle or joint pain, very low blood pressure, or dizziness/lightheadedness. Patients may be admitted to the hospital for CRS and treated with other medications.

Patients with neurological toxicities may experience symptoms such as altered or decreased consciousness, headaches, delirium, confusion, agitation, anxiety, seizures, difficulty speaking and understanding, or loss of balance. Patients should be advised to call their healthcare provider or get emergency help right away if they experience any of these signs and symptoms of CRS or neurological toxicities.

Because of the risk of CRS and neurological toxicities, Kymriah is only available through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called Kymriah REMS.

Serious allergic reactions, including anaphylaxis, may occur after Kymriah infusion. Kymriah can increase the risk of life-threatening infections that may lead to death. Patients should be advised to tell their healthcare provider right away if they develop fever, chills, or any signs or symptoms of an infection.

Patients may experience prolonged low blood cell counts (cytopenia), where one or more types of blood cells (red blood cells, white blood cells, or platelets) are decreased. The patient’s healthcare provider will do blood tests to check all of their blood cell counts after treatment with Kymriah. Patients should be advised to tell their healthcare provider right away if they get a fever, are feeling tired, or have bruising or bleeding.

Patients may experience hypogammaglobulinemia, a condition in which the level of immunoglobulins (antibodies) in the blood is low and the risk of infection is increased. It is expected that patients may develop hypogammaglobulinemia with Kymriah, and may need to receive immunoglobulin replacement for an indefinite amount of time following treatment with Kymriah. Patients should tell their healthcare provider about their treatment with Kymriah before receiving a live virus vaccine.

After treatment with Kymriah, patients will be monitored lifelong by their healthcare provider, as they may develop secondary cancers or recurrence of their cancer.

Patients should not drive, operate heavy machinery, or do other dangerous activities for eight weeks after receiving Kymriah because the treatment can cause temporary memory and coordination problems, including sleepiness, confusion, weakness, dizziness, and seizures.

Some of the most common side effects of Kymriah are difficulty breathing, fever (100.4°F/38°C or higher), chills/shaking chills, confusion, severe nausea, vomiting and diarrhea, severe muscle or joint pain, very low blood pressure, dizziness/lightheadedness, and headache. However, these are not all of the possible side effects of Kymriah. Patients should talk to their healthcare provider for medical advice about side effects.

Prior to a female patient starting treatment with Kymriah, their healthcare provider may do a pregnancy test. There is no information available for Kymriah use in pregnant or breast-feeding women. Therefore, Kymriah is not recommended for women who are pregnant or breast feeding. Patients should talk to their healthcare provider about birth control and pregnancy.

Patients should tell their healthcare provider about all the medicines they take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

After receiving Kymriah, patients should be advised that some commercial HIV tests may cause a false-positive test result. Patients should also be advised not to donate blood, organs, or tissues and cells for transplantation after receiving Kymriah.

On December 5, 2020 Regeneron Pharmaceuticals, Inc. (NASDAQ: REGN) reported updated data for REGN5458, a BCMAxCD3 bispecific antibody, from the Phase 1 portion of a Phase 1/2 trial in patients with relapsed or refractory (R/R) multiple myeloma. The results were shared in an oral presentation at the virtual 2020 American Society of Hematology (ASH) (Free ASH Whitepaper) Annual Meeting. BCMA (B-cell maturation antigen) is a protein that is typically over-expressed on multiple myeloma cells. REGN5458 is designed to bind to BCMA on multiple myeloma cells and the CD3 receptor on T-cells in order to bridge them together and activate T-cells to kill the cancer cells.

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"REGN5458 continues to show early, deep and durable anti-tumor responses in patients with relapsed and refractory multiple myeloma across all dose levels. This is particularly encouraging given that a majority of patients were heavily pretreated and had few options remaining. All patients were triple-refractory, with 57% being penta-refractory," said Deepu Madduri, M.D., Assistant Professor of Medicine at the Icahn School of Medicine at Mount Sinai in New York and a trial investigator. "As these data continue to mature, we look forward to assessing whether responses will further deepen and remain durable with ongoing REGN5458 treatment."

In the trial, the 49 patients evaluated had a median of five prior lines of therapy (range: 2-17) with 100% being triple-refractory and 57% being penta-refractory; all patients were refractory to anti-CD38 therapy. With a median follow up of 2.6 months (range: 1-13), responses generally occurred by week 4 and deepened over time. Exploratory analyses suggest that patient-reported global health status/quality of life (per EORTC QLQ-C30) also improved meaningfully at week 4 and was maintained through week 24, with assessment ongoing.

*As of data cut-off, dose level 6 patients had been followed for a median of 2 months, and responses may deepen over time.

Among all patients who responded to treatment (n=19) as of data cut-off:

95% (n=18) achieved a VGPR or better
42% (n=8) had a CR or sCR
57% of evaluable patients (4 of 7 patients) were minimal residual disease (MRD) negative
Tumor response was not correlated with BCMA expression as assessed by immunohistochemistry
In assessing durability among patients who responded to treatment and with data continuing to mature at the time of analysis:

Among responding patients with ≥6 months of follow-up, 83% (10 of 12 patients) have ongoing responses for up to 13 months at the time of analysis
74% of responders (n=14) remain on treatment
The observed median duration of response was 6 months (range: 1-13)
The most common adverse events (AEs) were cytokine release syndrome (CRS; 39%; n=19), anemia (37%; n=18), fatigue (35%; n=17), nausea (31%; n=15), pyrexia (31%; n=15) and back pain (27%; n=13). Grade ≥3 AEs occurred in 69% (n=34) of patients with the most common being anemia (22%; n=11), neutropenia (14%; n=7) and lymphopenia (12%; n=6). There were no reports of Grade ≥3 CRS or neurotoxicity. Dose-limiting toxicity was reported in 2 patients with 1 patient experiencing acute kidney injury and 1 patient experiencing elevated alanine aminotransferase (ALT)/raised aspartate aminotransferase (AST). Both cases were resolved with supportive care, and the patient that experienced elevated ALT/AST remains on REGN5458 and has since achieved a VGPR.

"REGN5458 is the second CD3 bispecific in our oncology portfolio to show clinically meaningful results. Alongside our CD20xCD3 bispecific odronextamab, REGN5458 offers additional evidence to support the potential of our bispecific platform to transform the treatment of diverse blood cancers for patients," said L. Andres Sirulnik, M.D., Ph.D., Senior Vice President, Translational & Clinical Sciences, Hematology at Regeneron. "Regeneron continues to drive increasing momentum across our oncology and non-oncology hematology programs. We are currently enrolling patients in a potentially registrational Phase 2 portion of this REGN5458 trial. We are also expanding our odronextamab program with multiple pivotal trials in 2021."

In addition to the REGN5458 data, updated results from the Phase 1 odronextamab trial in R/R follicular lymphoma, diffuse large B-cell lymphoma and other B-cell non-Hodgkin lymphomas will also be shared in an oral presentation (Abstract 400) at ASH (Free ASH Whitepaper) and will include patient follow-up data of up to 3 years.

REGN5458 and odronextamab were invented using Regeneron’s proprietary VelocImmune technology and created using the company’s Veloci-Bi platform. These allow for the creation of bispecific antibodies that closely resemble natural human antibodies with no linkers or artificial sequences. Additionally, Regeneron bispecifics are manufactured using similar approaches used for human monoclonal antibody medicines, yielding similar properties and pharmacokinetics.

REGN5458 and odronextamab are currently under clinical development, and their safety and efficacy have not been evaluated by any regulatory authority.

About the Phase 1/2 Dose-escalation Trial
REGN5458 monotherapy is being investigated in an open-label, Phase 1/2 dose-escalation trial in patients with R/R multiple myeloma who are at least triple refractory to existing therapeutic options, including proteasome inhibitors, immunomodulatory drugs and CD38 antibody treatments. The Phase 1 portion of the trial is primarily assessing safety, tolerability, and dose-limiting toxicities of REGN5458, with efficacy as secondary endpoints. The Phase 2 portion is currently enrolling patients and will further assess REGN5458 anti-tumor activity and safety.

Among the patients being enrolled are those with heavily pre-treated, triple refractory and penta-exposed multiple myeloma, including those with extra-medullary (outside of the bone marrow) and non-secretory (do not secrete detectable myeloma proteins) disease.

About Multiple Myeloma
Multiple myeloma is the second most common blood cancer with approximately 30,192 and 168,765 new diagnoses in the U.S. and the world, respectively, in 2020. It is characterized by the proliferation of cancerous plasma cells (multiple myeloma cells) that crowd out healthy blood cells in the bone marrow, infiltrate other tissues and cause potentially life-threatening organ injury. Multiple myeloma is not curable despite treatment advances. While current treatments are able to slow progression of the cancer, most patients will ultimately experience cancer progression and require additional therapies.