CART-ddBCMA for Multiple Myeloma

(iMMagine-1 Trial)

Recruiting at19 trial locations

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: Kite, A Gilead Company

Must not be taking: Steroids, Immunosuppressants, Anticoagulants, others

Disqualifiers: Plasma cell leukemia, Active infection, CNS involvement, others

No Placebo Group

Prior Safety Data

Approved in 1 Jurisdiction

Trial Summary

What is the purpose of this trial?

This trial tests a new treatment called anitocabtagene-autoleucel for patients whose multiple myeloma has returned or not responded to other treatments. The treatment uses the patient's own immune cells, which are modified to better attack the cancer cells.

Will I have to stop taking my current medications?

The trial requires that you stop any systemic treatment for multiple myeloma and high-dose steroid therapy at least 14 days before a specific procedure called leukapheresis. If you are on these medications, you will need to stop them before participating.

What data supports the effectiveness of the treatment CART-ddBCMA for Multiple Myeloma?

Research shows that BCMA-targeting CAR T-cells, like CART-ddBCMA, are powerful treatments for multiple myeloma, with studies indicating they can lead to significant tumor reduction and improved patient responses. Additionally, similar treatments have shown promise in early trials, suggesting potential effectiveness in managing this condition. ^{1 2 3 4 5}

What makes the CART-ddBCMA treatment unique for multiple myeloma?

CART-ddBCMA is a novel treatment for multiple myeloma that uses a synthetic antigen-binding domain to target BCMA, aiming to reduce immune reactions and improve stability. It is administered as a single dose after chemotherapy and has shown promising results with a high rate of complete responses in patients who have tried multiple other treatments. ^{6 7 8 9 10}

Research Team

Tim Welliver, MD, PhD

Principal Investigator

Arcellx, Inc.

Eligibility Criteria

Adults with relapsed or refractory multiple myeloma who have tried at least three prior treatments, including proteasome inhibitors, IMiDs, and anti-CD38 antibodies. They must show measurable disease signs, be in good physical condition (ECOG 0-1), have a life expectancy over 12 weeks, and proper organ function. Participants should not be pregnant or breastfeeding and must agree to use effective birth control for a year post-treatment.

Inclusion Criteria

My multiple myeloma has not responded to 3 types of treatments including a proteasome inhibitor, IMiD, and anti-CD38 antibody.

I am 18 or older and can understand and agree to the study's details.

Documented measurable disease including at least one or more of the following criteria: Serum M-protein ≥1.0 g/dL, Urine M-protein ≥200 mg/24 hours, Involved serum free light chain ≥10 mg/dL with abnormal κ/λ ratio (i.e., >4:1 or <1:2), Eastern Cooperative Oncology Group (ECOG) performance status 0-1, Life expectancy >12 weeks

Exclusion Criteria

I have or had plasma cell leukemia.

Treatment with the following therapies as specified below: Any prior systemic treatment for multiple myeloma within the 14 days prior to scheduled leukapheresis, Receiving high-dose (e.g., >10 mg prednisone or equivalent) systemic steroid therapy or any other form of immunosuppressive therapy within 14 days prior to leukapheresis, Prior treatment with any gene therapy or gene-modified cellular immune-therapy, Prior B-cell maturation antigen (BCMA) directed therapy, Autologous stem cell transplantation within 3 months prior to leukapheresis, or any prior allogeneic stem cell transplantation, Subjects with solitary plasmacytomas without evidence of other measurable disease are excluded, History of allergy or hypersensitivity to study drug components. Subjects with a history of severe hypersensitivity reaction to dimethyl sulphoxide (DMSO) are excluded, Contraindication to fludarabine or cyclophosphamide, Severe or uncontrolled intercurrent illness or laboratory abnormalities including: Active bacterial, viral, or fungal infection requiring systemic treatment (isolated fever may not constitute active infection in and of itself, (e.g., related to disease), Symptomatic congestive heart failure (i.e., New York Heart Association stage III or IV), Unstable angina, arrhythmia, or myocardial infarction (MI) within 6 months prior to Screening, Significant pulmonary dysfunction, Uncontrolled thromboembolic events or recent severe hemorrhage (i.e., within one year), Any history of pulmonary embolism (PE) in the past 12 months or deep vein thrombosis (DVT) within three months of enrollment. Therapeutic dosing of anticoagulants (e.g., warfarin, low molecular weight heparin, Factor Xa inhibitors) is allowed for history of PE/DVT if greater than twelve and three months, respectively, from time of enrollment, and should be at a stable maintenance dose, Auto-immune disease requiring immunosuppressive therapy within the last 24 months, Seropositive for and with evidence of active hepatitis B or C infection at time of Screening, or HIV seropositive, Subjects with a history of hepatitis B but have received antiviral therapy and have non-detectable viral DNA are eligible, Subjects seropositive because of hepatitis B virus vaccine with no signs or active infection are eligible, Subjects who had hepatitis C but have received antiviral therapy and show no detectable hepatitis C virus (HCV) viral RNA are eligible, Active central nervous system (CNS) involvement by malignancy, Any sign of active or prior CNS pathology including but not limited to history of epilepsy, seizure, paresis, aphasia, stroke, subarachnoid hemorrhage or CNS bleed, severe brain injury, dementia, cerebellar disease, Parkinson's disease, organic brain syndrome or psychosis, Active malignancy not related to myeloma that has required therapy in the last 3 years or is not in complete remission. Exceptions to this criterion include successfully treated non-metastatic basal cell or squamous cell skin carcinoma, or prostate cancer that does not require therapy, Females who are pregnant or breastfeeding or females of childbearing potential not using an effective method of birth control, Subjects with any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in study (or full access to medical records) as written including follow up, the interpretation of data or place the subject at unacceptable risk, Any vaccine ≤ 6 weeks before leukapheresis and/or anticipation of the need for such a vaccine during the subject's participation in the study, Concurrent enrollment on another study using an investigational therapy for the treatment of RRMM

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Enrollment

Participants are enrolled and prepared for treatment

1-2 weeks

Pre-treatment

Participants receive lymphodepleting chemotherapy before CAR-T cell infusion

1 week

Treatment

Single infusion of anitocabtagene-autoleucel is administered

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and efficacy monthly for the first 6 months, then quarterly up to 2 years

24 months

Long-term follow-up

Long-term safety data collection for up to 15 years

15 years

Treatment Details

Interventions

• CART-ddBCMA (CAR T-cell Therapy)

Trial Overview The trial is testing CART-ddBCMA, which is a type of CAR-T cell therapy targeting BCMA on cancer cells. It's for patients whose multiple myeloma has returned after treatment or hasn't responded to standard therapies. The study will assess the safety and effectiveness of this new intervention.

Participant Groups

Group I: anitocabtagene-autoleucel Experimental Treatment 1 Intervention

Single dose of 115±10 x 10e-6 CAR+ anitocabtagene-autoleucel cells infused intravenously

Who Is Running the Clinical Trial?

Kite, A Gilead Company

Lead Sponsor

Trials

45

Recruited

4,300+

Multiple Myeloma Research Foundation

Collaborator

Trials

11

Recruited

3,600+

Arcellx, Inc.

Industry Sponsor

Trials

5

Recruited

650+

Findings from Research

B-cell maturation antigen (BCMA) CAR T cells are emerging as a highly effective treatment for multiple myeloma, showing promise for inclusion in first-line therapy based on clinical and preclinical data.

Advancements in patient stratification through genomic analysis and improvements in CAR T-cell manufacturing are enhancing early diagnosis, management of side effects, and overall access to this innovative treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

CAR T-Cell Therapy in Multiple Myeloma: Mission Accomplished? Rasche, L., Hudecek, M., Einsele, H.[2023]

In a study involving 50 primary multiple myeloma (MM) samples, all expressed B-cell maturation antigen (BCMA), and 78% also expressed TACI, suggesting that targeting both antigens could enhance treatment effectiveness.

The engineered APRIL-based CAR (ACAR) demonstrated significant tumor-killing ability against both BCMA and TACI expressing cells, achieving up to 72.9% killing of primary MM cells, and showed potential to control tumors even in the presence of BCMA-targeting antibodies, indicating a promising strategy to prevent tumor escape.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An APRIL-based chimeric antigen receptor for dual targeting of BCMA and TACI in multiple myeloma. Lee, L., Draper, B., Chaplin, N., et al.[2023]

Patients with multiple myeloma who do not respond to existing therapies have limited survival, but new treatments like CAR T-lymphocytes, bispecific antibodies, and antibody-drug conjugates are showing promise in early trials.

Idecabtagene vicleucel (ide cel) and belantamab mafodotin (belamaf) have been approved for use in relapsed/refractory multiple myeloma based on positive results from phase 2 studies, indicating their potential effectiveness in this challenging patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chimeric antigen receptor T-cells, bispecific antibodies, and antibody-drug conjugates for multiple myeloma: An update. Lakshman, A., Kumar, SK.[2022]

The novel CAR T-cell therapy CART-ddBCMA targeting B-cell maturation antigen was well tolerated in a phase 1 study involving 13 patients with relapsed and refractory multiple myeloma, showing a favorable safety profile with manageable adverse events.

All patients responded to the treatment, with 75% achieving complete or stringent complete responses, and 89% of evaluable patients reaching minimal residual disease negativity after a median follow-up of 56 weeks, indicating durable efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase 1 study of CART-ddBCMA for the treatment of subjects with relapsed and refractory multiple myeloma. Frigault, MJ., Bishop, MR., Rosenblatt, J., et al.[2023]

Ciltacabtagene autoleucel (cilta-cel) significantly improved progression-free survival in patients with lenalidomide-refractory multiple myeloma, with a median progression-free survival not reached in the cilta-cel group compared to 11.8 months in the standard-care group, based on a phase 3 trial with 419 participants.

The cilta-cel group also showed higher overall response rates (84.6% vs. 67.3%) and complete response rates (73.1% vs. 21.8%) compared to standard care, although most patients experienced grade 3 or 4 adverse events, including cytokine release syndrome.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cilta-cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma. San-Miguel, J., Dhakal, B., Yong, K., et al.[2023]

Ciltacabtagene autoleucel (cilta-cel) demonstrated a significantly higher overall response rate (84% vs. 28%) and longer progression-free survival in patients with relapsed/refractory multiple myeloma compared to standard non-CAR-T therapies, based on a comparison of 113 patients in the CARTITUDE-1 study and 190 patients from the MAMMOTH dataset.

In the modified intent-to-treat population, cilta-cel showed an even more impressive overall response rate of 96% compared to 30% in the MAMMOTH cohort, indicating its potential as a highly effective treatment option for patients who have exhausted other therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of Cilta-cel, an Anti-BCMA CAR-T Cell Therapy, Versus Conventional Treatment in Patients With Relapsed/Refractory Multiple Myeloma. Costa, LJ., Lin, Y., Cornell, RF., et al.[2022]

Ciltacabtagene autoleucel (cilta-cel) demonstrated significantly better efficacy compared to physician's choice of treatment in patients with relapsed or refractory multiple myeloma, with a relative risk of 2.95 for overall response rate and 111.70 for complete response or better.

The study showed that cilta-cel also improved progression-free survival and overall survival, with hazard ratios of 0.24 and 0.21 respectively, indicating it could be a promising new treatment option for patients who have already been exposed to multiple therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative Efficacy of Ciltacabtagene Autoleucel in CARTITUDE-1 vs Physician's Choice of Therapy in the Long-Term Follow-Up of POLLUX, CASTOR, and EQUULEUS Clinical Trials for the Treatment of Patients with Relapsed or Refractory Multiple Myeloma. Weisel, K., Martin, T., Krishnan, A., et al.[2022]

Ciltacabtagene autoleucel (cilta-cel) has been approved by the FDA as a fifth-line treatment option for patients with relapsed or refractory multiple myeloma, marking a significant advancement in therapy options for this challenging condition.

Cilta-cel is notable for being the second chimeric antigen receptor T-cell therapy targeting BCMA to receive regulatory approval within a year, highlighting the rapid development of innovative treatments in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cilta-cel OK'd for Multiple Myeloma. [2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

CAR T-Cell Therapy in Multiple Myeloma: Mission Accomplished? [2023]

2. United States pubmed.ncbi.nlm.nih.gov

An APRIL-based chimeric antigen receptor for dual targeting of BCMA and TACI in multiple myeloma. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Chimeric antigen receptor T-cells, bispecific antibodies, and antibody-drug conjugates for multiple myeloma: An update. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Anti-BCMA/CD19 CAR T Cells with Early Immunomodulatory Maintenance for Multiple Myeloma Responding to Initial or Later-Line Therapy. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Long-Term Follow-Up of Combination of B-Cell Maturation Antigen and CD19 Chimeric Antigen Receptor T Cells in Multiple Myeloma. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Phase 1 study of CART-ddBCMA for the treatment of subjects with relapsed and refractory multiple myeloma. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Cilta-cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Comparison of Cilta-cel, an Anti-BCMA CAR-T Cell Therapy, Versus Conventional Treatment in Patients With Relapsed/Refractory Multiple Myeloma. [2022]

9. New Zealand pubmed.ncbi.nlm.nih.gov

Comparative Efficacy of Ciltacabtagene Autoleucel in CARTITUDE-1 vs Physician's Choice of Therapy in the Long-Term Follow-Up of POLLUX, CASTOR, and EQUULEUS Clinical Trials for the Treatment of Patients with Relapsed or Refractory Multiple Myeloma. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Cilta-cel OK'd for Multiple Myeloma. [2022]