Bristol Myers Squibb Announces First Disclosures and New Data at ASH 2022, Demonstrating Commitment to Raising Standards in Treatment Through Broad Multiple Myeloma Portfolio
Bristol Myers Squibb (NYSE: BMY) presented new data from its multiple myeloma portfolio at the 64th ASH Annual Meeting. The results include advancements in bispecific T cell engagers and CAR T therapies, such as alnuctamab, Abecma, and GPRC5D CAR T. Notable findings include alnuctamab showing reduced toxicity with sustained tumor response, while Abecma demonstrated high overall response rates in patients after relapse. The company emphasizes its commitment to innovative treatments in addressing the complex challenges of multiple myeloma.
- Alnuctamab shows improved safety profile with 53% overall response rate.
- GPRC5D CAR T demonstrates 89.5% overall response rate in heavily pre-treated patients.
- Abecma shows durable responses in multiple myeloma, with 45.9% complete response rate in early relapse cohort.
- None.
Studies highlight the range of targets and molecular approaches within the BMS multiple myeloma portfolio including bispecific T cell engager alnuctamab, first-in-class anti-BCMA CAR T cell therapy Abecma, GPRC5D CAR T (BMS-986393/CC-95266) and novel oral CELMoDTM agents mezigdomide and iberdomide
“At ASH this year, we are highlighting the next wave of advances from our diverse multiple myeloma portfolio, reflecting our strategy of leveraging an array of approaches and targets against the disease,” said
Results being presented at ASH highlight scientific progress across bispecific T cell engagers (TCE), chimeric antigen receptor (CAR) T cell therapies and novel CELMoDTM agents in advancing the treatment of relapsed/refractory multiple myeloma and include:
- First multicenter results from the Phase 1 study of bispecific TCE alnuctamab, administered subcutaneously every four weeks after six months, showing a reduction in inflammatory toxicity relative to intravenous administration, while maintaining anti-tumor activity with deep responses (Oral Presentation #162)
- First disclosure of Phase 1 results for GPRC5D CAR T (BMS-986393/CC-95266), demonstrating deep and durable responses with a manageable safety profile across all dose levels, including patients previously treated with a B-cell maturation antigen (BCMA)-directed CAR T cell therapy (Oral Presentation #364)
- Two first disclosures of results from cohorts 2a and 2c of the Phase 2 KarMMa-2 trial evaluating Abecma® (idecabtagene vicleucel), demonstrating durable responses and predictable safety in patients with multiple myeloma after early relapse or suboptimal response to stem cell transplant (Oral Presentation #361, Poster Presentation #3314)
- First results from the dose expansion cohort of the mezigdomide Phase 1/2 study evaluating the novel oral CELMoD agent with dexamethasone (DEX), showing durable efficacy and a manageable safety profile in patients who were highly refractory to multiple prior therapies (Oral Presentation #568)
- New results from a cohort with patients previously exposed to a BCMA-targeted therapy of the iberdomide Phase 1/2 study, evaluating the novel oral CELMoD agent with DEX, demonstrating clinically meaningful efficacy and safety regardless of type of prior anti-BCMA treatment (Poster Presentation #1918)
“Multiple myeloma continues to be an immensely challenging disease which affects patients across a number of demographics, fitness levels and comorbidities. While scientific advances have driven significant improvements in survival, the disease remains characterized by relapses and a disease burden that greatly impacts a patient’s quality of life,” said
Alnuctamab (BMS-986349/CC-93269) Phase 1 Study Results
Alnuctamab is a bispecific T cell engager (TCE) that simultaneously binds myeloma cells expressing B-cell maturation antigen (BCMA) and T cells (via CD3) in a unique 2:1 fashion. This interaction aims to drive myeloma cell death by inducing T cell activation and release of proinflammatory cytokines and cytolytic enzymes.
In the ongoing alnuctamab CC-93269-MM-001 open-label, Phase 1 study, 138 patients with relapsed/refractory (R/R) multiple myeloma were enrolled (as of
In interim results, SC alnuctamab (n=68) showed an improved safety profile compared to IV delivery, with cytokine release syndrome (CRS) limited to low-grade, short-lived events, allowing for dose escalation to higher target doses. Intravenous and SC alnuctamab both exhibited promising pharmacodynamic effects, triggering the release of the hallmark cytokines of TCEs(e.g., IL-1 and IL-6). However, SC alnuctamab triggered reduced and delayed cytokine production compared to more potent CRS induced by IV delivery. Subcutaneous alnuctamab also demonstrated encouraging dose-dependent anti-tumor activity across all target doses, particularly in patients who received the 30 mg target dose.
Alnuctamab CC-93269-MM-001 Study |
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Safety |
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IV alnuctamab
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Cytokine Release Syndrome (CRS) – Any Grade |
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Grade >3 CRS |
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SC alnuctamab
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CRS – Any Grade |
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Grade >3 CRS |
0 |
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Median time to onset of CRS |
3 days (range: 1-20) |
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Median duration of CRS |
2 days (range: 1-11) |
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SC alnuctamab efficacy
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Overall response rate (ORR) |
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ORR in patient treated with 30 mg dose |
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Median duration of response (DOR) |
NR
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Minimal residual disease (MRD)-negativity among patients who achieved a response (n=20 evaluable patients) |
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GPRC5D CAR T (BMS-986393/CC-95266) Phase 1 Study Results
GPRC5D has been identified as an orphan receptor that is highly expressed on multiple myeloma cells, with limited expression in other tissues. BMS-986393 is a GPRC5D-directed autologous CAR T cell therapy.
This Phase 1, first-in-human, multicenter, open-label study is evaluating BMS-986393 in patients with R/R multiple myeloma who had received three or more prior lines of therapy. Prior BCMA-targeted treatment, including CAR T cell therapy, was allowed. Primary objectives of the study were to determine safety and tolerability of BMS-986393 and inform the recommended dose for future development.
At the time of the interim analysis, BMS-986393 demonstrated a well-tolerated safety profile with mostly low-grade and short-lived occurrences of CRS and neurotoxicity across all tested dose levels. Neurotoxicity was infrequent and low-grade, with no Grade 3 or 4 events reported, and events were reversible with steroid treatment. All on-target off-tumor adverse events were Grade 1, and the majority (
BMS-986393 Phase 1 Study |
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Safety
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CRS – Any Grade |
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Grade 3/4 CRS |
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Median time to onset CRS |
3 days (range: 1-9) |
Median duration of CRS |
4 days |
Neurotoxicity – Grade 1/2 |
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Duration of neurotoxicity |
1-3 days |
On-target off-tumor AEs – Grade 1 |
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Dysgeusia/taste disorder |
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Nail disorder |
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Dysphagia |
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Efficacy
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ORR |
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CRR
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Patients treated with prior BCMA-directed therapies subgroup (n=9)
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Patients remaining in follow-up |
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Abecma® (idecabtagene vicleucel) KarMMa Phase 2 Cohorts 2a and 2c Study Results
KarMMa-2 (NCT03601078) is a multi-cohort, open-label, multicenter Phase 2 trial evaluating Abecma in patients with relapsed and refractory multiple myeloma (Cohort 1), patients with multiple myeloma who have progressive disease within 18 months of initial treatment including autologous stem cell transplant (ASCT) (Cohort 2a), or in patients with inadequate response following ASCT during initial treatment (Cohort 2c). Based on results from Cohorts 2a and 2c, Abecma demonstrated complete and durable responses in a significant proportion of patients, alongside a well-established and predictable safety profile with mostly low-grade occurrences of CRS and neurotoxicity. Abecma is being jointly developed and commercialized in the
Abecma KarMMa-2 Study COHORT 2a
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Efficacy |
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CRR (primary efficacy endpoint) |
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ORR |
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Median DOR |
15.7 months
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Safety |
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CRS – Grade 1/2 |
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CRS – Grade 3 |
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Neurotoxicity – Grade 1/2 |
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*Median follow-up – 21.5 months |
COHORT 2c
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Efficacy |
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CRR |
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ORR |
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Safety |
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CRS – Grade 1 |
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CRS – Grade 2 |
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Neurotoxicity |
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*Median follow-up – 27.9 months |
Novel CELMoD™ agents mezigdomide (CC-92480) and iberdomide (CC-220) Phase 1/2 Study Results
Cereblon E3 ligase modulators (CELMoD) are a class of oral immunomodulatory therapeutics that are designed to stimulate the immune system and directly kill cancer cells by inducing the degradation of tumor-promoting proteins.
The mezigdomide CC-92480-MM-001 trial is an ongoing open-label, international Phase 1/2 study to investigate the safety and efficacy of mezigdomide in combination with dexamethasone (DEX) in patients with relapsed/refractory (R/R) multiple myeloma. As part of the expansion cohort phase, 101 highly refractory patients that had received three or more prior lines of therapy, including an IMiD agent, a proteasome inhibitor (PI), and an anti-CD38 mAb, were given mezigdomide for 21 of 28 days in combination with weekly DEX at the recommended Phase 2 dose selected in part 1 of the study (1 mg once daily). The primary objective was efficacy as determined by objective response rate (ORR), while safety, tolerability and additional efficacy measures were included as the secondary objectives.
Based on interim results, mezigdomide, in combination with weekly DEX (40 mg; 20 mg if >75 years of age), showed promising efficacy in a highly refractory patient population. As of the data cut-off date, mezigdomide plus DEX showed a manageable safety profile.
Mezigdomide CC-92489-MM-001 Study |
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Efficacy |
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ORR in patients receiving three or more prior lines of therapy |
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ORR in patients that had also received prior BCMA-targeted therapies |
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Safety |
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Grade 3/4 treatment-emergent adverse events (TEAEs) |
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Hematologic TEAEs
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Mezigdomide dose interruptions and reductions due to TEAEs |
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Treatment discontinuation due to TEAEs |
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The iberdomide CC-220-MM-001 study is an ongoing Phase 1/2 multicenter, open-label and multi-cohort trial evaluating orally administered iberdomide in several combinations and segments of patients with R/R multiple myeloma. Results at ASH are being presented from the dose-expansion cohort evaluating iberdomide in combination with DEX in patients with multiple myeloma who have heavily-pretreated refractory disease and also received anti-BCMA therapy.
Iberdomide was given orally, 1.6 mg once daily for 21 of 28 days, plus weekly DEX (40 mg; 20 mg if >75 years of age). The primary objectives were preliminary efficacy measured by ORR and safety. Patients treated with iberdomide with DEX demonstrated meaningful clinical activity, regardless of modality (TCE, CAR T cell or antibody-drug conjugate therapy), suggesting that iberdomideretains its activity in these patients.
Iberdomide CC-220-MM-001 Study |
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Efficacy
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Overall response rate
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Safety |
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Grade 3/4 treatment-emergent adverse events (TEAEs)
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Iberdomide dose interruptions and reductions due to TEAEs |
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Treatment discontinuation due to TEAEs |
0 |
Important Safety Information
BOXED WARNING: CYTOKINE RELEASE SYNDROME, NEUROLOGIC TOXICITIES, HLH/MAS, AND PROLONGED CYTOPENIA
- Cytokine Release Syndrome (CRS), including fatal or life-threatening reactions, occurred in patients following treatment with ABECMA. Do not administer ABECMA to patients with active infection or inflammatory disorders. Treat severe or life-threatening CRS with tocilizumab or tocilizumab and corticosteroids.
- Neurologic Toxicities, which may be severe or life-threatening, occurred following treatment with ABECMA, including concurrently with CRS, after CRS resolution, or in the absence of CRS. Monitor for neurologic events after treatment with ABECMA. Provide supportive care and/or corticosteroids as needed.
- Hemophagocytic Lymphohistiocytosis/Macrophage Activation Syndrome (HLH/MAS) including fatal and life-threatening reactions, occurred in patients following treatment with ABECMA. HLH/MAS can occur with CRS or neurologic toxicities.
- Prolonged Cytopenia with bleeding and infection, including fatal outcomes following stem cell transplantation for hematopoietic recovery, occurred following treatment with ABECMA.
- ABECMA is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the ABECMA REMS.
Cytokine Release Syndrome (CRS): CRS, including fatal or life-threatening reactions, occurred following treatment with ABECMA. CRS occurred in
Identify CRS based on clinical presentation. Evaluate for and treat other causes of fever, hypoxia, and hypotension. CRS has been reported to be associated with findings of HLH/MAS, and the physiology of the syndromes may overlap. HLH/MAS is a potentially life-threatening condition. In patients with progressive symptoms of CRS or refractory CRS despite treatment, evaluate for evidence of HLH/MAS.
Fifty four percent (68/127) of patients received tocilizumab;
Overall rate of CRS was
Monitor patients at least daily for 7 days following ABECMA infusion at the REMS-certified healthcare facility for signs and symptoms of CRS. Monitor patients for signs or symptoms of CRS for at least 4 weeks after infusion. At the first sign of CRS, institute treatment with supportive care, tocilizumab and/or corticosteroids as indicated.
Counsel patients to seek immediate medical attention should signs or symptoms of CRS occur at any time.
Neurologic Toxicities: Neurologic toxicities, which may be severe or life-threatening, occurred following treatment with ABECMA, including concurrently with CRS, after CRS resolution, or in the absence of CRS. CAR T cell-associated neurotoxicity occurred in
Monitor patients at least daily for 7 days following ABECMA infusion at the REMS-certified healthcare facility for signs and symptoms of neurologic toxicities. Rule out other causes of neurologic symptoms. Monitor patients for signs or symptoms of neurologic toxicities for at least 4 weeks after infusion and treat promptly. Neurologic toxicity should be managed with supportive care and/or corticosteroids as needed.
Counsel patients to seek immediate medical attention should signs or symptoms of neurologic toxicity occur at any time.
Hemophagocytic Lymphohistiocytosis (HLH)/Macrophage Activation Syndrome (MAS): HLH/MAS occurred in
ABECMA REMS: Due to the risk of CRS and neurologic toxicities, ABECMA is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the ABECMA REMS. Further information is available at www.AbecmaREMS.com or 1-888-423-5436.
Hypersensitivity Reactions: Allergic reactions may occur with the infusion of ABECMA. Serious hypersensitivity reactions, including anaphylaxis, may be due to dimethyl sulfoxide (DMSO) in ABECMA.
Infections: ABECMA should not be administered to patients with active infections or inflammatory disorders. Severe, life-threatening, or fatal infections occurred in patients after ABECMA infusion. Infections (all grades) occurred in
Febrile neutropenia was observed in
Viral Reactivation: Cytomegalovirus (CMV) infection resulting in pneumonia and death has occurred following ABECMA administration. Monitor and treat for CMV reactivation in accordance with clinical guidelines. Hepatitis B virus (HBV) reactivation, in some cases resulting in fulminant hepatitis, hepatic failure, and death, can occur in patients treated with drugs directed against plasma cells. Perform screening for CMV, HBV, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) in accordance with clinical guidelines before collection of cells for manufacturing.
Prolonged Cytopenias: Patients may exhibit prolonged cytopenias following lymphodepleting chemotherapy and ABECMA infusion. In the KarMMa study,
Three patients underwent stem cell therapy for hematopoietic reconstitution due to prolonged cytopenia. Two of the three patients died from complications of prolonged cytopenia. Monitor blood counts prior to and after ABECMA infusion. Manage cytopenia with myeloid growth factor and blood product transfusion support according to institutional guidelines.
Hypogammaglobulinemia: Plasma cell aplasia and hypogammaglobulinemia can occur in patients receiving treatment with ABECMA. Hypogammaglobulinemia was reported as an adverse event in
Monitor immunoglobulin levels after treatment with ABECMA and administer IVIG for IgG <400 mg/dl. Manage per local institutional guidelines, including infection precautions and antibiotic or antiviral prophylaxis.
The safety of immunization with live viral vaccines during or following ABECMA treatment has not been studied. Vaccination with live virus vaccines is not recommended for at least 6 weeks prior to the start of lymphodepleting chemotherapy, during ABECMA treatment, and until immune recovery following treatment with ABECMA.
Secondary Malignancies: Patients treated with ABECMA may develop secondary malignancies. Monitor life-long for secondary malignancies. If a secondary malignancy occurs, contact
Effects on Ability to Drive and
Adverse Reactions: The most common nonlaboratory adverse reactions (incidence greater than or equal to
Please see full Prescribing Information, including Boxed WARNINGS and Medication Guide.
At BMS, we believe that every patient deserves a tailored treatment approach to achieve the best possible outcome for their disease, from extended survival and reduced treatment burden to the possibility of cure. Over two decades of trailblazing work in multiple myeloma, we have driven significant scientific and clinical advancements. As we look forward, we are leveraging our deep immunotherapy experience to progress an industry-leading pipeline across targets, molecular approaches and combinations (including BCMA-targeted therapies, targeted protein degradation, CAR T cell therapies and NK-cell engagers). Understanding that continued partnership with the multiple myeloma community is key to advancing scientific progress, we pride ourselves on an openness to collaborate, which is reflected in our ongoing research fueled by academic and industry partnerships. While multiple myeloma remains a relentless disease, we continue to transform the multiple myeloma treatment paradigm by dramatically improving outcomes for every patient.
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