EP4630454A1 - Methods of treatment using b-cell maturation antigen antagonists - Google Patents
Methods of treatment using b-cell maturation antigen antagonistsInfo
- Publication number
- EP4630454A1 EP4630454A1 EP23822454.7A EP23822454A EP4630454A1 EP 4630454 A1 EP4630454 A1 EP 4630454A1 EP 23822454 A EP23822454 A EP 23822454A EP 4630454 A1 EP4630454 A1 EP 4630454A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- bcma
- belantamab
- antagonist
- patient
- antibody
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Pending
Links
Classifications
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
- C07K16/18—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans
- C07K16/28—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
- C07K16/2878—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants against the NGF-receptor/TNF-receptor superfamily, e.g. CD27, CD30, CD40, CD95
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
- A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
- A61K39/3955—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against proteinaceous materials, e.g. enzymes, hormones, lymphokines
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
- A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
- A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
- A61K47/68—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment
- A61K47/6801—Drug-antibody or immunoglobulin conjugates defined by the pharmacologically or therapeutically active agent
- A61K47/6803—Drugs conjugated to an antibody or immunoglobulin, e.g. cisplatin-antibody conjugates
- A61K47/68031—Drugs conjugated to an antibody or immunoglobulin, e.g. cisplatin-antibody conjugates the drug being an auristatin
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
- A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
- A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
- A61K47/68—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment
- A61K47/6835—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site
- A61K47/6851—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site the antibody targeting a determinant of a tumour cell
- A61K47/6867—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site the antibody targeting a determinant of a tumour cell the tumour determinant being from a cell of a blood cancer
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P35/00—Antineoplastic agents
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K2039/545—Medicinal preparations containing antigens or antibodies characterised by the dose, timing or administration schedule
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K2317/00—Immunoglobulins specific features
- C07K2317/20—Immunoglobulins specific features characterized by taxonomic origin
- C07K2317/24—Immunoglobulins specific features characterized by taxonomic origin containing regions, domains or residues from different species, e.g. chimeric, humanized or veneered
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K2317/00—Immunoglobulins specific features
- C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
- C07K2317/76—Antagonist effect on antigen, e.g. neutralization or inhibition of binding
Definitions
- the present disclosure generally relates to methods of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) by the administration of one or more BCMA antagonists.
- BCMA B-cell maturation antigen
- B-cell maturation antigen is a cell surface receptor expressed in the plasmablast lineage and upregulated on various disease cell types including multiple myeloma (MM) cells.
- MM is an incurable malignant clonal plasma cell disorder and accounts for 1% of all cancers and for 10% of all hematologic malignancies globally.
- NDMM multiple myeloma
- Belantamab mafodotin is a BCMA-directed antibody-drug conjugate (ADC) that is conjugated to a microtubule disrupting agent, monomethyl auristatin-F (MMAF) and has demonstrated antitumor activity in MM cells.
- ADC BCMA-directed antibody-drug conjugate
- MMAF monomethyl auristatin-F
- Belantamab mafodotin is produced in an afucosylated form, which enhances interaction with the FcyRIIIa receptor. This enhanced interaction increases antibody-dependent cellular cytotoxicity (ADCC) and antibody-dependent cellular phagocytosis (ADCP) activities, including against MM cells.
- ADCC antibody-dependent cellular cytotoxicity
- ADCP antibody-dependent cellular phagocytosis
- belantamab mafodotin possesses a dual anti-tumor activity via delivery of the MMAF cytotoxin, as well as through ADCC/ADCP.
- Ocular toxicity has been reported for belantamab mafodotin, as well as in other MMAF containing ADCs, leading to dose delays and dose reductions. Therefore, there is a need for additional therapies for treatment of MM and other diseases associated with abnormal BCMA expression with manageable toxicity.
- the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering to the patient belantamab at a dose of about 300 mg to about 2000 mg.
- BCMA B-cell maturation antigen
- the disclosure provides the use of belantamab in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) by administration of belantamab at a dose of about 300 mg to about 2000 mg.
- BCMA B-cell maturation antigen
- the disclosure provides use of belantamab in the manufacture of a medicament for use in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) by administration of belantamab at a dose of about 300 mg to about 2000 mg.
- BCMA B-cell maturation antigen
- the dose is about 300 mg, about 900 mg, or about 2000 mg.
- the dose is administered at a regular interval for a period of time.
- the dose is administered once every week ⁇ 3 days to once every four weeks ⁇ 3 days.
- the dose is administered once every two weeks ⁇ 3 days.
- the dose is administered once every three weeks ⁇ 3 days.
- the dose is administered once every four weeks ⁇ 3 days.
- the dose is administered on days 1 and 15 of a 28 day cycle.
- the dose is administered on day 1 of a 21 day cycle.
- the patient has been treated with at least one prior line of cancer treatment.
- the patient has been treated with one, two, three, or four prior lines of cancer treatments.
- the prior lines of cancer treatments include an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent.
- belantamab is administered through an intravenous infusion or a subcutaneous injection.
- the patient is further receiving at least one additional cancer treatment, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
- the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
- the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time.
- the patient is receiving lenalidomide on days 1-21 of a 28 day cycle.
- the additional cancer treatment is dexamethasone. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly. In an embodiment, the patient is receiving dexamethasone on days 1, 8, 15, and 22 of a 28 day cycle. In an embodiment, (i) the patient is less than 75 years old and is receiving dexamethasone at a dose of 40 mg once weekly; or (ii) the patient is at least 75 years old and is receiving dexamethasone at a dose of 20 mg once weekly.
- the patient has a BMI of at least 18.5 and is receiving dexamethasone at a dose of 40 mg once weekly; or (ii) the patient has a BMI less than 18.5 and is receiving dexamethasone at a dose of 20 mg once weekly.
- the method or use further comprises discontinuing administration of belantamab and subsequently administering belantamab mafodotin. In an embodiment, the method or use further comprises administering belantamab mafodotin and subsequently discontinuing administration of belantamab. In an embodiment, belantamab mafodotin is administered at a dose of 2.5 mg/kg once every three weeks ⁇ 3 days.
- the method or use further comprises administering a lead-in dose of belantamab mafodotin prior to beginning administration of belantamab, wherein the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 3.4 mg/kg once during a lead-in period.
- the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 1.9 mg/kg once during a lead-in period.
- the lead-in dose of belantamab mafodotin is about 1.4 mg/kg, about 1.9 mg/kg, about 2.5 mg/kg, or about 3.4 mg/kg once during a lead-in period.
- the lead-in dose of belantamab mafodotin is about 1.4 mg/kg once during a lead- in period.
- the lead-in period is four weeks ⁇ 3 days and belantamab mafodotin is administered on day 1 of the lead-in period.
- the method or use further comprises administering at least one additional cancer treatment to the patient during the lead-in period, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
- the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
- the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time.
- lenalidomide is administered to the patient on days 1-21 of the lead-in period. In an embodiment, lenalidomide is administered to the patient on days 1-21 of the lead-in period and the lead-in period is four weeks ⁇ 3 days. In an embodiment, lenalidomide is administered to the patient on days 1-21 of the lead-in period and the lead-in period is 28 days.
- the additional cancer treatment is dexamethasone. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly. In an embodiment, dexamethasone is administered to the patient on days 1, 8, 15, and 22 of the lead-in period.
- dexamethasone is administered to the patient on days 1, 8, 15, and 22 of the lead-in period and the lead-in period is four weeks ⁇ 3 days. In an embodiment, dexamethasone is administered to the patient on days 1, 8, 15, and 22 of the lead-in period and the lead-in period is 28 days. In an embodiment, (i) the patient is less than 75 years old and dexamethasone is administered to the patient at a dose of 40 mg once weekly; or (ii) the patient is at least 75 years old and dexamethasone is administered to the patient at a dose of 20 mg once weekly.
- the patient has a BMI of at least 18.5 and dexamethasone is administered to the patient at a dose of 40 mg once weekly; or (ii) the patient has a BMI less than 18.5 and dexamethasone is administered to the patient at a dose of 20 mg once weekly.
- the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering to a patient belantamab mafodotin at a dose of about 1.4 mg/kg to about 3.4 mg/kg once every eight weeks ⁇ 3 days, such as about 1.4 mg/kg to about 1.9 mg/kg once every eight weeks ⁇ 3 days.
- BCMA B-cell maturation antigen
- the disclosure provides the use of belantamab mafodotin in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) by administration of belantamab mafodotin at a dose of about 1.4 mg/kg to about 3.4 mg/kg once every eight weeks ⁇ 3 days, such as about 1.4 mg/kg to about 1.9 mg/kg once every eight weeks ⁇ 3 days.
- BCMA B-cell maturation antigen
- the disclosure provides use of belantamab mafodotin in the manufacture of a medicament for use in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) by administration of belantamab mafodotin at a dose of about 1.4 mg/kg to about 3.4 mg/kg once every eight weeks ⁇ 3 days, such as about 1.4 mg/kg to about 1.9 mg/kg once every eight weeks ⁇ 3 days.
- BCMA B-cell maturation antigen
- the dose is about 1.4 mg/kg, about 1.9 mg/kg, about 2.5 mg/kg, or about 3.4 mg/kg once every eight weeks ⁇ 3 days.
- the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering a therapeutically effective amount of a combination comprising a first BCMA antagonist and a second BCMA antagonist to the patient.
- the disclosure provides the use of a combination comprising a first BCMA antagonist and a second BCMA antagonist to the patient in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA).
- the disclosure provides use of a combination comprising a first BCMA antagonist and a second BCMA antagonist in the manufacture of a medicament for use in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA).
- BCMA B-cell maturation antigen
- the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti- BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- the first BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is belantamab.
- the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
- the anti-BCMA antibody-drug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab.
- the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering a therapeutically effective amount of a combination comprising belantamab mafodotin and belantamab to the patient.
- BCMA B-cell maturation antigen
- the disclosure provides the use of a combination comprising belantamab mafodotin and belantamab in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA).
- BCMA B-cell maturation antigen
- the disclosure provides use of a combination comprising belantamab mafodotin and belantamab in the manufacture of a medicament for use in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA).
- BCMA B-cell maturation antigen
- the method or use further comprises administering at least one additional cancer treatment to the patient, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
- the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
- the disclosure provides a kit comprising: (i) a first B-cell maturation antigen (BCMA) antagonist; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking BCMA when combined with a second BCMA antagonist.
- BCMA B-cell maturation antigen
- the disclosure provides a kit comprising: (i) belantamab mafodotin; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) when combined with belantamab.
- BCMA B-cell maturation antigen
- the disclosure provides a kit comprising: (i) belantamab; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) when combined with belantamab mafodotin.
- BCMA B-cell maturation antigen
- the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with a first BCMA antagonist, the method comprising administering a therapeutically effective amount of a second BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
- BCMA B-cell maturation antigen
- the disclosure provides the use of a second BCMA antagonist in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with a first BCMA antagonist wherein administration of the first BCMA antagonist is discontinued prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
- BCMA B-cell maturation antigen
- the disclosure provides use of a second BCMA antagonist in the manufacture of a medicament for the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with a first BCMA antagonist wherein administration of the first BCMA antagonist is discontinued prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
- BCMA B-cell maturation antigen
- the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti- BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- the first BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is belantamab.
- the second BCMA antagonist is belantamab mafodotin.
- the second BCMA antagonist is belantamab.
- the first BCMA antagonist is an anti- BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
- the anti-BCMA antibody-drug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab.
- the second BCMA antagonist is an anti-BCMA antibody-drug conjugate and the first BCMA antagonist is the corresponding unconjugated anti- BCMA antibody.
- the anti-BCMA antibody-drug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
- the second BCMA antagonist is belantamab mafodotin and the first BCMA antagonist is belantamab.
- the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab mafodotin, the method comprising administering a therapeutically effective amount of belantamab to the patient, wherein the patient discontinued administration of belantamab mafodotin prior to beginning administration of belantamab.
- BCMA B-cell maturation antigen
- the disclosure provides the use of belantamab in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab mafodotin, wherein administration of belantamab mafodotin is discontinued prior to beginning administration of belantamab.
- BCMA B-cell maturation antigen
- the disclosure provides use of belantamab for use in the manufacture of a medicament for use in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab mafodotin, wherein administration of belantamab mafodotin is discontinued prior to beginning administration of belantamab.
- BCMA B-cell maturation antigen
- the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab, the method comprising administering a therapeutically effective amount of belantamab mafodotin to the patient, wherein the patient discontinued administration of belantamab prior to beginning administration of belantamab mafodotin.
- BCMA B-cell maturation antigen
- the disclosure provides the use of belantamab mafodotin in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab wherein administration of belantamab is discontinued prior to beginning administration of belantamab mafodotin.
- BCMA B-cell maturation antigen
- the disclosure provides use of belantamab mafodotin in the manufacture of a medicament for use in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab wherein administration of belantamab is discontinued prior to beginning administration of belantamab mafodotin.
- BCMA B-cell maturation antigen
- the methods or uses further comprise administering at least one additional cancer treatment to the patient, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
- the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
- the disclosure provides a method of reducing corneal toxicity in a patient previously treated with a first B-cell maturation antigen (BCMA) antagonist, the method comprising administering a therapeutically effective amount of a second BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
- BCMA B-cell maturation antigen
- the disclosure provides the use of a second BCMA antagonist for the reduction of corneal toxicity in a patient previously treated with a first B-cell maturation antigen (BCMA) antagonist, wherein administration of the first BCMA antagonist is discontinued prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
- BCMA B-cell maturation antigen
- the disclosure provides use of a second BCMA antagonist in the manufacture of a medicament for use in the reduction of corneal toxicity in a patient previously treated with a first B-cell maturation antigen (BCMA) antagonist, wherein administration of the first BCMA antagonist is discontinued prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
- BCMA B-cell maturation antigen
- the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti- BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- the first BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is belantamab.
- the second BCMA antagonist is belantamab mafodotin.
- the second BCMA antagonist is belantamab.
- the first BCMA antagonist is an anti- BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
- the anti-BCMA antibody-drug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab.
- the second BCMA antagonist is an anti-BCMA antibody-drug conjugate and the first BCMA antagonist is the corresponding unconjugated anti- BCMA antibody.
- the anti-BCMA antibody-drug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
- the second BCMA antagonist is belantamab mafodotin and the first BCMA antagonist is belantamab.
- the disclosure provides the use of belantamab for the reduction of corneal toxicity in a patient previously treated with belantamab mafodotin, wherein the patient discontinued administration of belantamab mafodotin prior to beginning administration of belantamab.
- the disclosure provides use of belantamab in the manufacture of a medicament for use in the reduction of corneal toxicity in a patient previously treated with belantamab mafodotin, wherein the patient discontinued administration of belantamab mafodotin prior to beginning administration of belantamab.
- the disclosure provides a method of reducing corneal toxicity in a patient previously treated with belantamab, the method comprising administering a therapeutically effective amount of belantamab mafodotin to the patient, wherein the patient discontinued administration of belantamab prior to beginning administration of belantamab mafodotin.
- the disclosure provides the use of belantamab mafodotin for the reduction of corneal toxicity in a patient previously treated with belantamab, wherein the patient discontinued administration of belantamab prior to beginning administration of belantamab mafodotin.
- the disclosure provides use of belantamab mafodotin in the manufacture of a medicament for use in the reduction of corneal toxicity in a patient previously treated with belantamab, wherein the patient discontinued administration of belantamab prior to beginning administration of belantamab mafodotin.
- the methods and uses further comprise administering at least one additional cancer treatment to the patient, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
- the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
- the disclosure provides a method of treating a disease or disorder in a patient, the method comprising administering a therapeutically effective amount of a combination comprising an antibody-drug conjugate and the corresponding unconjugated antibody.
- the disclosure provides the use of a combination comprising an antibodydrug conjugate and the corresponding unconjugated antibody in the treatment of a disease or disorder.
- the disclosure provides use of a combination comprising an antibodydrug conjugate and the corresponding unconjugated antibody for use in the manufacture of a medicament for the treatment of a disease or disorder.
- the disclosure provides a method of treating a disease or disorder in a patient previously treated with an antibody-drug conjugate, the method comprising administering a therapeutically effective amount of the corresponding unconjugated antibody to the patient, wherein the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody.
- the disclosure provides the use of an antibody in the treatment of a disease or disorder in a patient previously treated with an antibody-drug conjugate, wherein the antibody is the corresponding unconjugated antibody and the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody.
- the disclosure provides use of an antibody in the manufacture of a medicament for use in the treatment of a disease or disorder in a patient previously treated with an antibody-drug conjugate, wherein the antibody is the corresponding unconjugated antibody and the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody.
- the antibody-drug conjugate is selected from gemtuzumab ozogamicin, brentuximab vedotin, ado-trastuzumab emtansine, inotuzumab ozogamicin, polatuzumab vedotin, enfortumab vedotin, fam-trastuzumab deruxtecan, sacituzumab govitecan, belantamab mafodotin, loncastuximab tesirine, tisotumab vedotin, moxetumomab pasudotox, MEDI2228, or CC99712.
- the disease or disorder is a plasma cell disorder or a B-cell disorder. In an embodiment, the disease or disorder is a BCMA-expressing cancer. In an embodiment, the disease or disorder is multiple myeloma (MM). In an embodiment, the MM is relapsed and/or refractory MM, newly-diagnosed MM, transplant-ineligible MM, or transplant-ineligible newly- diagnosed MM. In an embodiment, the MM is relapsed and/or refractory MM, newly-diagnosed MM, transplant-ineligible MM, or transplant-ineligible newly-diagnosed MM.
- MM is relapsed and/or refractory MM, newly-diagnosed MM, transplant-ineligible MM, or transplant-ineligible newly-diagnosed MM.
- the disclosure provides a method of treating cancer in a patient, wherein the patient has a Grade 1 corneal adverse reaction resulting from belantamab mafadotin administration, the method comprising temporarily discontinuing administration of belantamab mafadotin; administering to the patient a therapeutically effective amount of belantamab for a lead- in period; and resuming administration of belantamab mafadotin after the lead-in period.
- the disclosure provides the use of belantamab in the treatment of cancer in a patient, wherein the patient has a Grade 1 corneal adverse reaction resulting from belantamab mafadotin administration, wherein belantamab mafadotin is temporarily discontinued for a lead- in period during which belantamab is administered, followed by resuming administration of belantamab mafadotin after the lead-in period.
- the disclosure provides use of belantamab in the manufacture of a medicament for use in the treatment of cancer in a patient, wherein the patient has a Grade 1 corneal adverse reaction resulting from belantamab mafadotin administration, wherein belantamab mafadotin is temporarily discontinued for a lead-in period during which belantamab is administered, followed by resuming administration of belantamab mafadotin after the lead-in period.
- the disclosure provides a method of treating cancer in a patient, wherein the patient has a Grade 2 or above corneal adverse reaction resulting from belantamab mafodotin administration, the method comprising temporarily discontinuing administration of belantamab mafadotin; administering to the patient a therapeutically effective amount of belantamab for a lead- in period; and resuming administration of belantamab mafadotin after the lead-in period.
- the disclosure provides the use of belantamab in the treatment of cancer in a patient, wherein the patient has a Grade 2 or above corneal adverse reaction resulting from belantamab mafadotin administration, wherein belantamab mafadotin is temporarily discontinued for a lead-in period during which belantamab is administered, followed by resuming administration of belantamab mafadotin after the lead-in period.
- the disclosure provides use of belantamab in the manufacture of a medicament for use in the treatment of cancer in a patient, wherein the patient has a Grade 2 or above corneal adverse reaction resulting from belantamab mafadotin administration, wherein belantamab mafadotin is temporarily discontinued for a lead-in period during which belantamab is administered, followed by resuming administration of belantamab mafadotin after the lead-in period.
- FIG. 1 is a graph depicting tumor volume growth curves for all treatment groups as a function of study day, as described in Example 1.
- FIG. 2 is a graph depicting Kaplan-Meier survival curves for all treatment groups as a function of study day, as described in Example 1.
- FIG. 3 is a graph depicting tumor volume growth with different drug to antibody ratios (DARs) as a function of study day, as described in Example 3.
- DARs drug to antibody ratios
- FIG. 4 are graphs depicting progression free survival of patients grouped according to sBCMA levels for the belantamab mafodotin treatment arm (left) and pom/dex treatment arm (right), as described in Example 4.
- FIG. 5 is a graph depicting the level of reduction of sBCMA from pre-dosing with belantamab mafodotin to end of infusion (EOI) for cycle 1, day 1 of belantamab mafodotin treatment, as described in Example 4.
- ETI end of infusion
- FIG. 6 is a graph depicting level of sBCMA 24 hours post-end of infusion (EOI) of belantamab mafodotin, as described in Example 4.
- FIGs. 7A and 7B are graphs depicting sBCMA levels in patients grouped according to response to treatment with belantamab mafodotin, as described in Example 4.
- FIG. 7A shows baseline sBCMA levels prior to administration of belantamab mafodotin; and
- FIG. 7B shows sBCMA levels 24 hours post-EOI of belantamab mafodotin.
- CR complete response;
- MR /SD minimal response/stable disease ;
- PD/NE progressive disease/non-evaluable.
- FIG. 8 is a graph depicting the mean tumor volume curves of vehicle control and treatment groups between randomization and study termination of the in vivo efficacy study of belantamab and belantamab mafodotin in human multiple myeloma xenograft NOG mice, as described in Example 5.
- FIG. 9 is a graph showing the Kaplan-Meier survival curves for all treatment groups as a function of study day of the in vivo efficacy study of belantamab and belantamab mafodotin in human multiple myeloma xenograft NOG mice, as described in Example 5.
- composition “comprising” encompasses “including” or “consisting,” e.g., a composition “comprising” X may consist exclusively of X or may include something additional, e.g., X + Y.
- Ranges provided herein include all values within a particular range described and values about an endpoint for a particular range.
- the figures and tables of the disclosure also describe ranges, and discrete values, which may constitute an element of any of the methods and uses disclosed herein.
- Concentrations described herein are determined at ambient temperature and pressure. This may be, for example, the temperature and pressure at room temperature or within a particular portion of a process stream. Preferably, concentrations are determined at a standard state of 25 °C and 1 bar of pressure.
- antigen binding protein refers to antibodies and other protein constructs, such as domains, which are capable of binding to the antigen.
- antibody is used herein in the broadest sense to refer to molecules with an immunoglobulin-like domain (for example IgG, IgM, IgA, IgD or IgE) and includes monoclonal, recombinant, polyclonal, chimeric, human, humanised, multispecific antibodies, including bispecific antibodies, and heteroconjugate antibodies; a single variable domain (e.g., a domain antibody (DAB)), antigen binding antibody fragments, Fab, F(ab’)2, Fv, disulphide linked Fv, single chain Fv, disulphide-linked scFv, diabodies, TANDABS, etc. and modified versions of any of the foregoing (for a summary of alternative “antibody” formats see Holliger and Hudson, Nature Biotechnology, 2005, Vol 23, No. 9, 1126-1136).
- DAB domain antibody
- the term, full, whole or intact antibody refers to a heterotetrameric glycoprotein with an approximate molecular weight of 150,000 daltons.
- An intact antibody is composed of two identical heavy chains (HCs) and two identical light chains (LCs) linked by covalent disulphide bonds. This H2L2 structure folds to form three functional domains comprising two antigen-binding fragments, known as ‘Fab’ fragments, and a ‘Fc’ crystallisable fragment.
- the Fab fragment is composed of the variable domain at the amino-terminus, variable heavy (VH) or variable light (VL), and the constant domain at the carboxyl terminus, CHI (heavy) and CL (light).
- the Fc fragment is composed of two domains formed by dimerization of paired CH2 and CH3 regions.
- the Fc may elicit effector functions by binding to receptors on immune cells or by binding Clq, the first component of the classical complement pathway.
- the five classes of antibodies IgM, IgA, IgG, IgE and IgD are defined by distinct heavy chain amino acid sequences, which are called p, a, y, s and 5 respectively, each heavy chain can pair with either a K or X light chain.
- the majority of antibodies in the serum belong to the IgG class, there are four isotypes of human IgG (IgGl, IgG2, IgG3 and IgG4), the sequences of which differ mainly in their hinge region.
- Fully human antibodies can be obtained using a variety of methods, for example using yeast-based libraries or transgenic animals (e.g. mice) that are capable of producing repertoires of human antibodies.
- yeast-based libraries or transgenic animals e.g. mice
- Yeast presenting human antibodies on their surface that bind to an antigen of interest can be selected using FACS (Fluorescence-Activated Cell Sorting) based methods or by capture on beads using labelled antigens.
- Transgenic animals that have been modified to express human immunoglobulin genes can be immunized with an antigen of interest and antigen-specific human antibodies isolated using B-cell sorting techniques. Human antibodies produced using these techniques can then be characterized for desired properties such as affinity, developability and selectivity.
- Alternative antibody formats include alternative scaffolds in which the one or more CDRs of the antigen binding protein can be arranged onto a suitable non-immunoglobulin protein scaffold or skeleton, such as an affibody, a SpA scaffold, an LDL receptor class A domain, an avimer (see, e.g., U.S. Patent Application Publication Nos. 2005/0053973, 2005/0089932, 2005/0164301) or an EGF domain.
- a suitable non-immunoglobulin protein scaffold or skeleton such as an affibody, a SpA scaffold, an LDL receptor class A domain, an avimer (see, e.g., U.S. Patent Application Publication Nos. 2005/0053973, 2005/0089932, 2005/0164301) or an EGF domain.
- anti-BCMA antigen binding protein refers to antibodies and other protein constructs, such as domains, which are capable of binding to BCMA.
- BCMA binding protein and “anti-BCMA antigen binding protein” are used interchangeably herein.
- the anti-BCMA antigen binding proteins described herein may bind to human BCMA having, including, for example, human BCMA containing the amino acid sequence of GenBank Accession Number Q02223.2, or genes encoding human BCMA having at least 90 percent homology or at least 90 percent identity thereto.
- Exemplary anti-BCMA antigen binding proteins and methods of making the same are disclosed in International Publication No. WO2012/163805 which is incorporated by reference herein in its entirety. Additional exemplary anti-BCMA antigen binding proteins include those described in WO2016/014789, WO2016/090320, WO2016/090327, W02016/020332, WO2016/079177, WO2014/122143, WO2014/122144, WO2017/021450, WO2016/014565, WO20 14/068079, WO2015/166649, WO2015/158671, WO2015/052536, WO2014/140248, WO2013/072415, WO2013/072406, WO2014/089335, US2017/165373, WO2013/154760, W02018/201051 and W02017/051068, each of which is incorporated by reference herein in its entirety.
- a BCMA binding protein disclosed herein may be derived from rat, mouse, primate (e.g., cynomolgus, Old World monkey or Great Ape) or human.
- the BCMA binding protein may be a human, humanized or chimeric antibody.
- the BCMA binding protein may comprise a constant region, which may be of any isotype or subclass.
- the constant region may be of the IgG isotype, for example IgGl, IgG2, IgG3, IgG4 or variants thereof.
- the BCMA binding protein constant region may be IgGl .
- a BCMA binding protein which can comprise any one or a combination of the following CDRs: CDRH1 of SEQ ID NO: 5, CDRH2 of SEQ ID NO: 6, CDRH3 of SEQ ID NO: 7, CDRL1 of SEQ ID NO: 8, CDRL2 of SEQ ID NO: 9, CDRL3 of SEQ ID NO: 10.
- CDRs may be modified by at least one amino acid substitution, deletion or addition, wherein the variant antigen binding protein substantially retains the biological characteristics of the unmodified protein, such as binding to the antigen.
- the anti-BCMA antigen binding protein comprises CDRH1 according to SEQ ID NO: 5, CDRH2 according to SEQ ID NO: 6, CDRH3 according to SEQ ID NO: 7, CDRL1 according to SEQ ID NO: 8, CDRL2 according to SEQ ID NO: 9, and CDRL3 according to SEQ ID NO: 10.
- the anti-BCMA antigen binding protein comprises a heavy chain variable region (VH) according to SEQ ID NO: 3 and a light chain variable region (VL) according to SEQ ID NO: 4.
- the anti-BCMA antigen binding protein comprises a heavy chain (H) according to SEQ ID NO: 1 and a light chain (L) according to SEQ ID NO: 2.
- the anti-BCMA antigen binding protein is a T-cell redirecting antibody (BiTE) with dual inhibition of BCMA and CD3 receptors, such as teclistamab (Pillarisetti et al., Blood Advances 4, 4538-49, 2020) and blinatumomab, AMG 424, GBR 1342, BFR4350A, AMG 420, AMG 701, elranatamab (PF-06863135), REGN5458, TNB-383B (Alhallak et al., Cancers 13, 2853, 2021).
- teclistamab Pillarisetti et al., Blood Advances 4, 4538-49, 2020
- blinatumomab AMG 424, GBR 1342, BFR4350A, AMG 420, AMG 701, elranatamab (PF-06863135), REGN5458, TNB-383B (Alhallak et al., Cancers 13, 2853, 202
- the anti-BCMA antigen binding protein is a non- fucosylated BCMA-directed antibody, such as SEA-BCMA (Van Epps et al., Cancer Res 2018;78(13 Suppl) Abstract nr 3833).
- the anti-BCMA antigen binding protein is a CAR-T cell Therapeutic.
- the anti-BCMA antigen binding protein is used in an immunoconjugate.
- An “immunoconjugate” (interchangeably referred to as an “antibody-drug conjugate,” “ADC,” or “antigen binding protein-drug conjugate) comprises an anti-BCMA antigen binding protein conjugated to one or more drugs, such as a cytotoxic agent, such as a chemotherapeutic agent, an immunotherapeutic agent, a growth inhibitory agent, a toxin (e.g., a protein toxin, such as an enzymatically active toxin of bacterial, fungal, plant, or animal origin, or fragments thereof), an antiviral agent, a radioactive isotope (i.e., a radioconjugate), an antibiotic, or a small interfering RNA (siRNA).
- drugs such as a cytotoxic agent, such as a chemotherapeutic agent, an immunotherapeutic agent, a growth inhibitory agent, a toxin (e.g.,
- the anti-BCMA antigen binding protein can be an immunoconjugate having the following general structure:
- ABP is an antigen binding protein
- Linker is either absent or any a cleavable or non-cleavable linker
- Ctx is any cytotoxic agent described herein n is 0, 1 , 2, or 3 and m is 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10.
- Exemplary linkers may include 6- maleimidocaproyl (MC), maleimidopropanoyl (MP), valine-citrulline (val-cit), alanine- phenylalanine (ala-phe), p-aminobenzyloxycarbonyl (PAB), N-Succinimidyl 4-(2- pyridylthio)pentanoate (SPP), N-succinimidyl 4-(N- maleimidomethyl)cyclohexane-l carboxylate (SMCC), and N-succinimidyl (4-iodo-acetyl) aminobenzoate (SIAB).
- MC 6- maleimidocaproyl
- MP maleimidopropanoyl
- val-cit valine-citrulline
- ala-phe p-aminobenzyloxycarbonyl
- PAB p-aminobenzyloxycarbonyl
- SPP N-Succ
- the anti-BCMA antigen binding protein can be an immunoconjugate containing a monoclonal antibody linked to MMAE or MMAF.
- the anti- BCMA antigen binding protein can be an immunoconjugate containing a monoclonal antibody linked to MMAE or MMAF by an MC linker as depicted in the following structures:
- the anti-BCMA antigen binding protein can be the antibody belantamab. In another embodiment, the anti-BCMA antigen binding protein can be the immunoconjugate belantamab mafodotin.
- a BCMA antagonist is a BCMA-targeted chimeric antigen receptor (CAR)-T cell therapy.
- CAR chimeric antigen receptor
- CAR refers to an engineered receptor that consists of an extracellular antigen binding domain (usually derived from a monoclonal antibody, or antigen binding fragment thereof, e.g. a VH domain and a VL domain in the form of a scFv), optionally a spacer region, a transmembrane region, and one or more intracellular effector domains.
- CARs have also been referred to as chimeric T cell receptors or chimeric immunoreceptors (CIRs).
- CARs are genetically introduced into hematopoietic cells, such as T cells, to redirect T cell specificity for a desired cell-surface antigen, resulting in a CAR-T therapeutic.
- spacer region refers to an oligo- or polypeptide that functions to link the transmembrane domain to the target binding domain. This region may also be referred to as a “hinge region” or “stalk region”. The size of the spacer can be varied depending on the position of the target epitope in order to maintain a set distance (e.g. 14 nm) upon CAR: target binding.
- transmembrane domain refers to the part of the CAR molecule that traverses the cell membrane.
- intracellular effector domain refers to the domain in the CAR that is responsible for intracellular signalling following the binding of the antigen binding domain to the target.
- the intracellular effector domain is responsible for the activation of at least one of the normal effector functions of the immune cell in which the CAR is expressed.
- the effector function of a T cell can be a cytolytic activity or helper activity including the secretion of cytokines.
- VH and/or VL domains disclosed herein may be incorporated, e.g. in the form of a scFv, into CAR-T therapeutics.
- CDRs are defined as the complementarity determining region amino acid sequences of an antigen binding protein. These are the hypervariable regions of immunoglobulin heavy and light chains. There are three heavy chain and three light chain CDRs (or CDR regions) in the variable portion of an immunoglobulin. Thus, “CDRs” as used herein refers to all three heavy chain CDRs, all three light chain CDRs, all heavy and light chain CDRs, or at least two CDRs.
- variable domain sequences and variable domain regions within full-length antigen binding sequences are numbered according to the Kabat numbering convention.
- CDR Kabat et al., Sequences of Proteins of Immunological Interest, 4 th Ed., U.S. Department of Health and Human Services, National Institutes of Health (1987).
- Table 1 represents one definition using each numbering convention for each CDR or binding unit. It should be noted that some of the CDR definitions may vary depending on the individual publication used. Table 1
- An immunoconjugate (interchangeably referred to as an “antibody-drug conjugate,” “ADC” or “antigen binding protein-drug conjugate”) comprises an antigen binding protein (e.g., an antibody or antigen binding fragment thereof) conjugated to one or more drugs, such as a cytotoxic agent, such as a chemotherapeutic agent, an immunotherapeutic agent, a growth inhibitory agent, a toxin (e.g., a protein toxin, such as an enzymatically active toxin of bacterial, fungal, plant, or animal origin, or fragments thereof), an antiviral agent, a radioactive isotope (i.e., a radioconjugate), an antibiotic, or a small interfering RNA (siRNA).
- drugs such as a cytotoxic agent, such as a chemotherapeutic agent, an immunotherapeutic agent, a growth inhibitory agent, a toxin (e.g., a protein toxin, such as an enzymatic
- Immunoconjugates have been used for the local delivery of cytotoxic agents, i.e., drugs that kill or inhibit the growth or proliferation of cells, in the treatment of cancer (Lambert, J. (2005) Curr. Opinion in Pharmacology 5:543-549; Wu et al. (2005) Nature Biotechnology 23(9): 1137- 1146; Payne, G. (2003) Cancer Cell 3:207-212; Syrigos andEpenetos (1999) Anticancer Research 19:605-614; Niculescu-Duvaz and Springer (1997) Adv. Drug Deliv. Rev. 26:151-172; U.S. Pat. No. 4,975,278).
- cytotoxic agents i.e., drugs that kill or inhibit the growth or proliferation of cells
- Immunoconjugates allow for, inter alia, the targeted delivery of a drug moiety to a tumor, and intracellular accumulation therein, where systemic administration of unconjugated drugs may result in unacceptable levels of toxicity to normal cells (Tsuchikama and An, Protein and Cell, (2016) 9: 33-46).
- Immunoconjugates can enable selective delivery of a potent cytotoxic payload to target cancer cells, resulting in improved efficacy, reduced systemic toxicity, and preferable pharmacokinetics (PK)/pharmacodynamics (PD) and biodistribution compared to traditional chemotherapy (Tsuchikama and An 2018); Beck A. et al (2017) Nature Rev. Drug Disc. 16: 315-337).
- an immunoconjugate comprises an antigen binding protein, such as an antibody, and a drug, such as toxin, such as a chemotherapeutic agent.
- the drug can be modified (e.g., via standard synthetic chemistry) to allow its chemical attachment (e.g., to contain a reaction handle to allow its chemical attachment) to a reactive end of a linker that joins the drug to the antigen binding protein.
- Drugs such as chemotherapeutic agents, useful in the generation of immunoconjugates are described herein.
- Enzymatically active toxins and fragments thereof that can be used include diphtheria A chain, nonbinding active fragments of diphtheria toxin, exotoxin A chain (from Pseudomonas aeruginosa), ricin A chain, abrin A chain, modeccin A chain, alpha-sarcin, Aleurites fordii proteins, dianthin proteins, Phytolaca americana proteins (PAPI, PAPII, and PAP-S), momordica charantia inhibitor, curcin, crotin, sapaonaria officinalis inhibitor, gelonin, mitogellin, restrictocin, phenomycin, enomycin, and the tricothecenes. See, e.g., WO 93/21232 published Oct. 28, 1993.
- a radioactive material such as a radionucleotide
- a radionucleotide may be used as the drug in an ADC.
- a variety of radionucleotides are available for the production of radioconjugated antibodies. Examples include 212Bi, 1311, 131In, 90Y, and 186Re.
- Antigen binding proteins may also be conjugated to one or more toxins, including, but not limited to, a calicheamicin, a maytansinoid, a dolastatin, an aurostatin, a trichothecene, and CC1065, and a derivative of these toxins that have toxin activity.
- toxins including, but not limited to, a calicheamicin, a maytansinoid, a dolastatin, an aurostatin, a trichothecene, and CC1065, and a derivative of these toxins that have toxin activity.
- Suitable cytotoxic agents include, but are not limited to, an auristatin including dovaline-valine- dolaisoleunine-dolaproine-phenylalanine (MMAF) and monomethyl auristatin E (MMAE) as well as an ester form of MMAE, a DNA minor groove binding agent, a DNA minor groove alkylating agent, an enediyne, a lexitropsin, a duocarmycin, a taxane (such as paclitaxel and docetaxel), a puromycin, a dolastatin, a maytansinoid, and a vinca alkaloid.
- an auristatin including dovaline-valine- dolaisoleunine-dolaproine-phenylalanine (MMAF) and monomethyl auristatin E (MMAE) as well as an ester form of MMAE
- a DNA minor groove binding agent e.g., a DNA minor groove alkylating
- cytotoxic agents include topotecan, morpholino-doxorubicin, rhizoxin, cyanomorpholino-doxorubicin, dolastatin- 10, 1 echinomycin, combretatstatin, chalicheamicin, maytansine, DM-1, DM-4, and netropsin.
- Other suitable cytotoxic agents include anti-tubulin agents, such as an auristatin, a vinca alkaloid, a podophyllotoxin, a taxane, a baccatin derivative, a cryptophysin, a maytansinoid, a combretastatin, or a dolastatin.
- Antitubulin agents include dimethylvaline-valine-dolaisoleuine-dolaproine- phenylalanine-p-phenylenediamine (AFP), MMAF, MMAE, auristatin E, vincristine, vinblastine, vindesine, vinorelbine, VP- 16, camptothecin, paclitaxel, docetaxel, epothilone A, epothilone B, nocodazole, colchicines, colcimid, estramustine, cemadotin, discodermolide, maytansine, DM-1, DM-4, and eleutherobin.
- AFP dimethylvaline-valine-dolaisoleuine-dolaproine- phenylalanine-p-phenylenediamine
- MMAF methylvaline-valine-dolaisoleuine-dolaproine- phenylalanine-p-phenylenediamine
- Antibody drug conjugates can be produced by conjugating the anti-tubulin agent monomethylauristatin E (MMAE) or monomethylauristatin F (MMAF) to an antigen binding protein (such as an antibody).
- the linker can consist of a thiol-reactive maleimide, a caproyl spacer, the dipeptide valine-citrulline, or p-aminobenzyloxy carbonyl, a self- immolative fragmenting group.
- MMAF a protease-resistant maleimidocaproyl linker can be used.
- the conjugation process leads to heterogeneity in drug-antibody attachment, varying in both the number of drugs bound to each antibody molecule (drug-antibody ratio [DAR]) and the site of attachment.
- DAR drug-antibody ratio
- the overall average drug-to-antibody ratio (DAR) is approximately 4.
- progression of tumor growth or a “progressive disease” (“PD”) as used herein in reference to cancer status indicates an increase in the sum of the diameters of the target lesions (tumors).
- progressive disease is measured and defined as per International Myeloma Working Group (IMWG) criteria (see, e.g., Kumar S, Paiva B, Anderson KC., et al. International myeloma working group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 2016;17(8):e328-46.).
- IMWG International Myeloma Working Group
- progression of tumor growth refers to at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study).
- the sum of diameters of target lesions in addition to a relative increase of 20%, must also demonstrate an absolute increase of at least 5 mm. An appearance of one or more new lesions may also be factored into the determination of progression of tumor growth.
- “Treating” as used herein refers to alleviating one or more symptoms or effects associated with a disorder and/or slowing the progression of the disorder.
- the disclosed therapies reduce ocular toxicity.
- “Ocular toxicity” refers to any unintended exposure of a therapeutic agent to ocular tissue, and includes changes in corneal epithelium, dry eyes, irritation, redness, blurred vision, dry eyes, photophobia, and/or changes in visual acuity. Detection of ocular toxicity may be determined by ophthalmic examination by an ophthalmologist or optometrist, before, during, and/or after treatment.
- An ophthalmic examination may include one or more of the following:
- Anterior segment (slit lamp) examination including fluorescein staining of the cornea and lens examination,
- OSDI ocular surface disease index
- the disclosure provides methods of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering belantamab to the patient.
- BCMA B-cell maturation antigen
- belantamab is administered at a dose of about 300 mg to about 2000 mg. In an embodiment, belantamab is administered at a dose of about 300 mg to about 900 mg. In an embodiment, belantamab is administered at a dose of about 900 mg to about 2000 mg. In an embodiment, belantamab is administered at a dose of about 300 mg. In an embodiment, belantamab is administered at a dose of about 900 mg. In an embodiment, belantamab is administered at a dose of about 2000 mg.
- the dose of belantamab is administered at a regular interval for a period of time. In an embodiment, the dose of belantamab is administered on day 1 of the regular interval. In an embodiment, the regular interval is at least once every 8 weeks ⁇ 3 days, at least once every 6 weeks ⁇ 3 days, at least once every 4 weeks ⁇ 3 days, at least once every 3 weeks ⁇ 3 days, at least once every 2 weeks ⁇ 3 days, at least once every week ⁇ 3 days, once every week ⁇ 3 days to once every 8 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 6 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 4 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 3 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 2 weeks ⁇ 3 days, once every 2 weeks ⁇ 3 days to once every 3 weeks ⁇ 3 days, once every 3 weeks ⁇ 3 days to once every 4 weeks ⁇ 3 days, once every 4 weeks ⁇ 3 days to once every 3 days to once every every 3
- the dose of belantamab is administered at least once every 8 weeks ⁇ 3 days, at least once every 6 weeks ⁇ 3 days, at least once every 4 weeks ⁇ 3 days, at least once every 3 weeks ⁇ 3 days, at least once every 2 weeks ⁇ 3 days, at least once every week ⁇ 3 days, once every week ⁇ 3 days to once every 8 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 6 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 4 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 3 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 2 weeks ⁇ 3 days, once every 2 weeks ⁇ 3 days to once every 3 weeks ⁇ 3 days, once every 3 weeks ⁇ 3 days to once every 4 weeks ⁇ 3 days, once every 4 weeks ⁇ 3 days to once every 5 weeks ⁇ 3 days, once every 5 weeks ⁇ 3 days to once every 6 weeks ⁇ 3 days, once every 6 weeks ⁇ 3 days to once every 7 weeks ⁇ 3
- the dose of belantamab is administered once every week ⁇ 3 days to once every 4 weeks ⁇ 3 days. In an embodiment, the dose of belantamab is administered once every 2 weeks ⁇ 3 days to once every 4 weeks ⁇ 3 days. In an embodiment, the dose of belantamab is administered once every 2 weeks ⁇ 3 days. In an embodiment, the dose of belantamab is administered once every 3 weeks ⁇ 3 days. In an embodiment, the dose of belantamab is administered once every 4 weeks ⁇ 3 days.
- the dose of belantamab is administered by parenteral administration, i.e., subcutaneously (s.c. or SC), intrathecally, intraperitoneally, intramuscularly (i.m. or IM) or intravenously (i.v. or IV), including by intravenous infusion.
- parenteral administration i.e., subcutaneously (s.c. or SC), intrathecally, intraperitoneally, intramuscularly (i.m. or IM) or intravenously (i.v. or IV), including by intravenous infusion.
- the dose of belantamab is administered intravenously.
- the dose of belantamab is administered through an intravenous infusion.
- the dose of belantamab is administered subcutaneously.
- belantamab is administered as a first line of treatment for the disease or disorder. In an embodiment, belantamab is administered after one or more prior lines of treatment for the disease or disorder. In an embodiment, belantamab is administered after at least 1 prior line of treatment, after at least 2 prior lines of treatment, after at least 3 prior lines of treatment, after at least 4 prior lines of treatment, after 1 to 4 prior lines of treatment, after 2 to 4 prior lines of treatment, after 1 to 2 prior lines of treatment, after 2 to 3 prior lines of treatment, after 3 to 4 prior lines of treatment, after 1 prior line of treatment, after 2 prior lines of treatment, after 3 prior lines of treatment, or after 4 prior lines of treatment for the disease or disorder.
- belantamab is administered as a first line of cancer treatment. In an embodiment, belantamab is administered after one or more prior lines of cancer treatment. In an embodiment, belantamab is administered after at least 1 prior line of cancer treatment, after at least 2 prior lines of cancer treatment, after at least 3 prior lines of cancer treatment, after at least 4 prior lines of cancer treatment, after 1 to 4 prior lines of cancer treatment, after 2 to 4 prior lines of cancer treatment, after 1 to 2 prior lines of cancer treatment, after 2 to 3 prior lines of cancer treatment, after 3 to 4 prior lines of cancer treatment, after 1 prior line of cancer treatment, after 2 prior lines of cancer treatment, after 3 prior lines of cancer treatment, or after 4 prior lines of cancer treatment.
- the patient has not been treated with a prior treatment for the disease or disorder. In an embodiment, the patient has been treated with at least one prior treatment for the disease or disorder. In an embodiment, the patient has been treated with at least 1 prior line of treatment, at least 2 prior lines of treatment, at least 3 prior lines of treatment, at least 4 prior lines of treatment, 1 to 4 prior lines of treatment, 2 to 4 prior lines of treatment, 1 to 2 prior lines of treatment, 2 to 3 prior lines of treatment, 3 to 4 prior lines of treatment, 1 prior line of treatment, 2 prior lines of treatment, 3 prior lines of treatment, or 4 prior lines of treatment for the disease or disorder. [00134] In an embodiment, the patient has relapsed or refractory multiple myeloma and had previously received at least four prior therapies to treat the multiple myeloma.
- the prior lines of cancer treatments are selected from an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or a combination thereof.
- a patient that has had 0, 1, 2, 3, or 4 or more prior lines of treatment before being treated as described herein can have previously been treated with an immunomodulatory agent (e.g., an immunomodulatory imide drug (ImiD)), a proteasome inhibitor (PI), an anti-CD38 treatment or combinations thereof.
- an immunomodulatory agent e.g., an immunomodulatory imide drug (ImiD)
- PI proteasome inhibitor
- the prior lines of cancer treatments include an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent.
- anti-CD38 antibodies useful in the methods described herein include, but are not limited to, isatuximab or isatuximab-irfc (e.g., SARCLISA®) and daratumumab (e.g, DARZALEX®, DARZALEX FASPRO®).
- the anti-CD38 monoclonal antibody is selected from daratumumab or isatuximab.
- proteasome inhibitors useful in the methods described herein include, but are not limited to, bortezomib (e.g., VELCADE®), ixazomib (e.g., NINLARO®), carfilzomib (e.g., KYPROLIS®), oprozomib, and delanzomib.
- the proteasome inhibitor is selected from bortezomib, carfilzomib, or ixazomib.
- the proteasome inhibitor is bortezomib.
- immunomodulatory imide drugs useful in the methods described herein include, but are not limited to, thalidomide (e.g., THALOMID®), lenalidomide (e.g., REVLIMID®), and pomalidomide (e.g., POMALYST®).
- the immunomodulatory agent is selected from thalidomide, lenalidomide, or pomalidomide.
- the immunomodulatory agent is lenalidomide or pomalidomide.
- the immunomodulatory agent is lenalidomide.
- belantamab is administered as a monotherapy. In an embodiment, belantamab is administered in combination with at least one additional treatment. In an embodiment, belantamab is administered in combination with at least one additional cancer treatment. In an embodiment, belantamab is administered on day 1 of a treatment cycle. In an embodiment, belantamab is administered on day 1 of a 28-day treatment cycle. In an embodiment, belantamab is administered on day 1 and day 15 of a 28-day treatment cycle. In an embodiment, belantamab is administered on day 1 of a 21 -day treatment cycle.
- the additional cancer treatment is selected from an anti-CD38 monoclonal antibody, a gamma-secretase inhibitor, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
- anti-CD38 antibodies useful in the methods described herein include, but are not limited to, isatuximab or isatuximab-irfc (e.g., SARCLISA®) and daratumumab (e.g, DARZALEX®, DARZALEX FASPRO®).
- the anti-CD38 monoclonal antibody is selected from daratumumab or isatuximab.
- Examples of gamma-secretase inhibitors useful in the methods described herein include, but are not limited to, nirogacestat (PF-0308014), crenigacestat (LY3039478), CB-103, tarenflurbil, semagacestat (LY450139), RG-4733, EVP-0962, avagacestat, MK-0752, and BMS- 906024, as well as derivatives and polymorphs thereof.
- proteasome inhibitors useful in the methods described herein include, but are not limited to, bortezomib (e.g., VELCADE®), ixazomib (e.g., NINLARO®), carfilzomib (e.g., KYPROLIS®), oprozomib, and delanzomib.
- the proteasome inhibitor is selected from bortezomib, carfilzomib, or ixazomib.
- the proteasome inhibitor is bortezomib.
- immunomodulatory imide drugs useful in the methods described herein include, but are not limited to, thalidomide (e.g., THALOMID®), lenalidomide (e.g., REVLIMID®), and pomalidomide (e.g., POMALYST®).
- the immunomodulatory agent is selected from thalidomide, lenalidomide, or pomalidomide.
- the immunomodulatory agent is lenalidomide or pomalidomide.
- the immunomodulatory agent is lenalidomide.
- the immunomodulatory agent is pomalidomide.
- anti-PD-1 monoclonal antibodies useful in the methods described herein include, but are not limited to, pembroluzimab and dostarlimab.
- the anti-PD-1 monoclonal antibody is selected from pembroluzimab or dostarlimab.
- corticosteroids examples include, but are not limited to, dexamethasone (e.g., DECADRON®, DEXASONE®, DIODEX®, HEXADROL®, MAXIDEX®), prednisone (e.g., DELTASONE®), and methylprednisolone (e.g., MEDROL®).
- the additional cancer treatment is selected from lenalidomide, pomalidomide, dexamethasone, or a combination thereof.
- the additional cancer treatments are lenalidomide and dexamethasone.
- the additional cancer treatments are pomalidomide and dexamethasone. In an embodiment, the additional cancer treatments are bortezomib and dexamethasone. In an embodiment, the additional cancer treatments are pomalidomide, bortezomib, and dexamethasone. In an embodiment, the additional cancer treatments are lenalidomide, bortezomib, and dexamethasone.
- the additional cancer treatment is standard of care treatment.
- the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time. In an embodiment, the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily administered on days 1-21 of a 28 day cycle. [00150] In an embodiment, the additional cancer treatment is dexamethasone. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 40 mg once weekly if the patient is less than 75 years old.
- the additional cancer treatment is dexamethasone at a dose of 20 mg once weekly if the patient is at least 75 years old. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 40 mg once weekly if the patient has a BMI of at least 18.5. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg once weekly if the patient has a BMI less than 18.5. In an embodiment, the dexamethasone is administered on days 1, 8, 15, and 22 of a 28 day cycle.
- the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 20 mg to 40 mg administered on days 1, 8, 15, and 22 of a 28 day cycle.
- the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 40 mg administered on days 1, 8, 15, and 22 of a 28 day cycle if the patient is less than 75 years old or has a BMI of at least 18.5.
- the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 20 mg administered on days 1, 8, 15, and 22 of a 28 day cycle if the patient is at least 75 years old or has a BMI of less than 18.5.
- a patient is receiving an initial therapy or combination of initial therapies, referred to as a lead-in doses, prior to administration of a subsequent therapy or combination of therapies.
- the “lead-in period” refers to a period of time in which a specified initial therapy or combination of initial therapies is administered prior to administration of a subsequent therapy or combination of therapies.
- the method further comprises administering a lead-in dose of belantamab mafodotin prior to beginning administration of belantamab.
- the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 3.4 mg/kg once during a lead- in period.
- the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 1.9 mg/kg once during a lead-in period.
- the lead-in dose of belantamab mafodotin is about 1.4 mg/kg, about 1.5 mg/kg, about 1.6 mg/kg, about 1.7 mg/kg, about 1.8 mg/kg, about 1.9 mg/kg, about 2.0 mg/kg, about 2.5 mg/kg, about 3.0 mg/kg, or about 3.4 mg/kg once during a lead-in period.
- the lead-in dose of belantamab mafodotin is about 1.4 mg/kg once during a lead-in period.
- the lead-in dose of belantamab mafodotin is about 1.9 mg/kg once during a lead-in period.
- the lead-in period is four weeks ⁇ 3 days and belantamab mafodotin is administered on day 1 of the lead-in period.
- the dose of belantamab mafodotin is administered by parenteral administration, i.e., subcutaneously (s.c. or SC), intrathecally, intraperitoneally, intramuscularly (i.m. or IM) or intravenously (i.v. or IV), including by intravenous infusion.
- parenteral administration i.e., subcutaneously (s.c. or SC), intrathecally, intraperitoneally, intramuscularly (i.m. or IM) or intravenously (i.v. or IV), including by intravenous infusion.
- the dose of belantamab mafodotin is administered intravenously.
- the dose of belantamab mafodotin is administered through an intravenous infusion.
- belantamab mafodotin is administered as a monotherapy during the lead-in period. In an embodiment, belantamab mafodotin is administered in combination with at least one additional treatment during the lead-in period. In an embodiment, belantamab mafodotin is administered in combination with at least one additional cancer treatment during the lead-in period.
- the additional cancer treatment for administration during the lead- in period is selected from an anti-CD38 monoclonal antibody, a gamma-secretase inhibitor, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
- anti-CD38 antibodies useful in the methods described herein include, but are not limited to, isatuximab or isatuximab-irfc (e.g., SARCLISA®) and daratumumab (e.g, DARZALEX®, DARZALEX FASPRO®).
- the anti-CD38 monoclonal antibody for administration during the lead-in period is selected from daratumumab or isatuximab.
- gamma-secretase inhibitors useful in the methods described herein include, but are not limited to, nirogacestat (PF-0308014), crenigacestat (LY3039478), CB-103, tarenflurbil, semagacestat (LY450139), RG-4733, EVP-0962, avagacestat, MK-0752, and BMS- 906024, as well as derivatives and polymorphs thereof.
- proteasome inhibitors useful in the methods described herein include, but are not limited to, bortezomib (e.g., VELCADE®), ixazomib (e.g., NINLARO®), carfilzomib (e.g., KYPROLIS®), oprozomib, and delanzomib.
- the proteasome inhibitor for administration during the lead-in period is selected from bortezomib, carfilzomib, or ixazomib.
- the proteasome inhibitor for administration during the lead-in period is bortezomib.
- immunomodulatory imide drugs useful in the methods described herein include, but are not limited to, thalidomide (e.g., THALOMID®), lenalidomide (e.g., REVLIMID®), and pomalidomide (e.g., POMALYST®).
- the immunomodulatory agent for administration during the lead-in period is selected from thalidomide, lenalidomide, or pomalidomide.
- the immunomodulatory agent for administration during the lead-in period is lenalidomide or pomalidomide.
- the immunomodulatory agent for administration during the lead-in period is lenalidomide.
- the immunomodulatory agent for administration during the lead-in period is pomalidomide.
- anti-PD-1 monoclonal antibodies useful in the methods described herein include, but are not limited to, pembroluzimab and dostarlimab.
- the anti-PD-1 monoclonal antibody is selected from pembroluzimab or dostarlimab.
- corticosteroids include corticosteroids.
- corticosteroids include, but are not limited to, dexamethasone (e.g., DECADRON®, DEXASONE®, DIODEX®, HEXADROL®, MAXIDEX®), prednisone (e.g., DELTASONE®), and methylprednisolone (e.g., MEDROL®).
- the additional cancer treatment for administration during the lead- in period is selected from lenalidomide, pomalidomide, dexamethasone, or a combination thereof.
- the additional cancer treatments for administration during the lead-in period are lenalidomide and dexamethasone.
- the additional cancer treatments for administration during the lead-in period are pomalidomide and dexamethasone. In an embodiment, the additional cancer treatments for administration during the lead-in period are lenalidomide and dexamethasone. In an embodiment, the additional cancer treatments for administration during the lead-in period are bortezomib and dexamethasone. In an embodiment, the additional cancer treatments for administration during the lead-in period are pomalidomide, bortezomib, and dexamethasone. In an embodiment, the additional cancer treatments for administration during the lead-in period are lenalidomide, bortezomib, and dexamethasone.
- the additional cancer treatment for administration during the lead- in period is standard of care treatment.
- the additional cancer treatment for administration during the lead- in period is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time. In an embodiment, the additional cancer treatment for administration during the lead-in period is lenalidomide at a dose of 10 mg to 25 mg once daily administered on days 1-21 of a 28 day lead- in period.
- the additional cancer treatment for administration during the lead- in period is dexamethasone.
- the additional cancer treatment for administration during the lead-in period is dexamethasone at a dose of 20 mg to 40 mg once weekly.
- the additional cancer treatment for administration during the lead-in period is dexamethasone at a dose of 40 mg once weekly if the patient is less than 75 years old.
- the additional cancer treatment for administration during the lead-in period is dexamethasone at a dose of 20 mg once weekly if the patient is at least 75 years old.
- the additional cancer treatment for administration during the lead-in period is dexamethasone at a dose of 40 mg once weekly if the patient has a BMI of at least 18.5. In an embodiment, the additional cancer treatment for administration during the lead-in period is dexamethasone at a dose of 20 mg once weekly if the patient has a BMI less than 18.5. In an embodiment, the dexamethasone is administered on days 1, 8, 15, and 22 of a 28 day lead-in period.
- the additional cancer treatments for administration during the lead- in period are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day lead-in period and dexamethasone at a dose of 20 mg to 40 mg administered on days 1, 8, 15, and 22 of a 28 day lead-in period.
- the additional cancer treatments for administration during the lead-in period are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day lead-in period and dexamethasone at a dose of 40 mg administered on days 1, 8, 15, and 22 of a 28 day lead-in period if the patient is less than 75 years old or has a BMI of at least 18.5.
- the additional cancer treatments for administration during the lead-in period are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day lead-in period and dexamethasone at a dose of 20 mg administered on days 1, 8, 15, and 22 of a 28 day lead-in period if the patient is at least 75 years old or has a BMI of less than 18.5.
- the method comprises administering a lead-in dose of belantamab mafodotin during a lead-in period, followed by administering belantamab during a subsequent treatment period.
- the method comprises administering a lead-in dose of belantamab mafodotin at a dose of about 1.4 mg/kg to about 3.4 mg/kg once during a lead-in period, followed by administering belantamab at a dose of about 300 mg to about 2000 mg during a subsequent treatment period.
- the method comprises administering a lead-in dose of belantamab mafodotin at a dose of about 1.4 mg/kg, about 1.9 mg/kg, about 2.5 mg/kg, or about 3.4 mg/kg once during a lead-in period, followed by administering belantamab at a dose of about 300 mg, 900 mg, or about 2000 mg during a subsequent treatment period.
- the method further comprises application of a bandage contact lens during the lead-in period and/or subsequent treatment period.
- a bandage contact lens is a therapeutic contact lens made of soft, flexible plastics that allow oxygen to pass through to the cornea which is worn in one or both eyes for a period of time to protect the cornea and/or treat ocular toxicities, e.g., ocular toxicities resulting from treatment with a therapeutic agent such as belantamab mafodotin.
- a bandage contact lens is comprised of N-carboxy vinyl ester (NCVE), N-vinyl pyrrolidone (NVE), poly[dimethylsiloxyl] di [silylbutanol] bis[vinyl carbamate] (PBVC) and/or tris-(trimethylsiloxysilyl) propylvinyl carbamate (TPVC).
- NVE N-carboxy vinyl ester
- NVE N-vinyl pyrrolidone
- PBVC poly[dimethylsiloxyl] di [silylbutanol] bis[vinyl carbamate]
- TPVC tris-(trimethylsiloxysilyl) propylvinyl carbamate
- a bandage contact lens of comprises of NCVE, NVE, PBVC, and TPVC.
- a bandage contact lens of comprises of NCVE, NVE, PBVC, and TPVC and has a water content of 30% to 40%, such as 30%, 3
- a bandage contact lens of comprises of NCVE, NVE, PBVC, and TPVC and has a water content of about 36%.
- a bandage contact lens is made of balafilcon A.
- Balafilcon A is a copolymer of silicone vinyl carbamate, N-vinyl-pyrrolidone, a siloxane crosslinker and a vinyl alanine wetting monomer, and is 36% water by weight when immersed in solution, e.g., saline solution.
- the method further comprises discontinuing administration of belantamab and subsequently administering belantamab mafodotin.
- belantamab mafodotin is administered at a dose of 2.5 mg/kg once every three weeks ⁇ 3 days.
- administration of belantamab is discontinued after the patient demonstrates progressive disease.
- the method further comprises administering belantamab mafodotin and subsequently discontinuing administration of belantamab.
- belantamab mafodotin is administered at a dose of 2.5 mg/kg once every three weeks ⁇ 3 days.
- administration of belantamab is discontinued after the patient demonstrates progressive disease.
- the disclosure provides methods of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering belantamab mafodotin to the patient.
- BCMA B-cell maturation antigen
- belantamab mafodotin is administered at a dose of about 1.4 mg/kg to about 3.4 mg/kg. In an embodiment, belantamab mafodotin is administered at a dose of about 1.4 mg/kg to about 1.9 mg/kg. In an embodiment, belantamab mafodotin is administered at a dose of about 1.4 mg/kg, about 1.5 mg/kg, about 1.6 mg/kg, about 1.7 mg/kg, about 1.8 mg/kg, about 1.9 mg/kg, about 2.0 mg/kg, about 2.5 mg/kg, about 3.0 mg/kg, or about 3.4 mg/kg.
- belantamab mafodotin is administered at a dose of about 1.4 mg/kg. In an embodiment, belantamab mafodotin is administered at a dose of about 1.9 mg/kg. In an embodiment, belantamab is administered once every eight weeks ⁇ 3 days. [00175] In an embodiment, belantamab mafodotin is administered at a dose of about 1.4 mg/kg to about 3.4 mg/kg once every eight weeks ⁇ 3 days. In an embodiment, belantamab mafodotin is administered at a dose of about 1.4 mg/kg to about 1.9 mg/kg once every eight weeks ⁇ 3 days.
- belantamab mafodotin is administered at a dose of about 1.4 mg/kg, about 1.5 mg/kg, about 1.6 mg/kg, about 1.7 mg/kg, about 1.8 mg/kg, about 1.9 mg/kg, about 2.0 mg/kg, about 2.5 mg/kg, about 3.0 mg/kg, or about 3.4 mg/kg once every eight weeks ⁇ 3 days.
- belantamab mafodotin is administered at a dose of about 1.4 mg/kg once every eight weeks ⁇ 3 days.
- belantamab mafodotin is administered at a dose of about 1.9 mg/kg once every eight weeks ⁇ 3 days.
- the method further comprises application of a bandage contact lens.
- BCMA-inhibiting or blocking therapies are also described.
- kits comprising BCMA-inhibiting or blocking therapies and instructions for use.
- the disclosure provides methods of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering a therapeutically effective amount of a combination comprising a first BCMA antagonist and a second BCMA antagonist to the patient.
- BCMA antagonist refers to a molecule that specifically binds B-cell maturation antigen (BCMA) and inhibits the binding of BAFF and/or APRIL to the BCMA receptor.
- BCMA antagonists include, but are not limited to, anti-BCMA antibodies or antigen binding fragments thereof, anti-BCMA antibody-drug conjugates, bispecific anti-BCMA antibodies or antigen binding fragments thereof, and BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- CAR T BCMA-targeted chimeric antigen receptor T
- the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti- BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- the first BCMA-antagonist differs from the second BCMA-antagonist.
- the first and second BCMA-antagonists are both anti-BCMA antibodies or fragments thereof, both anti-BCMA antibody-drug conjugates, both bispecific anti-BCMA antibodies or fragments thereof, or both BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapies.
- the first BCMA-antagonist is an anti-BCMA antibody or antigen binding fragment thereof and the second BCMA-antagonist is a different anti-BCMA antibody or antigen binding fragment thereof.
- the first BCMA-antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA-antagonist is a different anti-BCMA antibody-drug conjugate.
- the first BCMA-antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof and the second BCMA-antagonist is a different bispecific anti-BCMA antibody or antigen binding fragment thereof.
- the first BCMA-antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy and the second BCMA-antagonist is a different BCMA- targeted chimeric antigen receptor T (CAR T)-cell therapy.
- CAR T BCMA-targeted chimeric antigen receptor T
- CAR T BCMA-targeted chimeric antigen receptor T
- the bispecific anti-BCMA antibody or antigen binding fragment thereof comprises an anti-BCMA antibody or antigen binding fragment thereof and an anti-CD38 antibody or antigen binding fragment thereof. In an embodiment, the bispecific anti-BCMA antibody or antigen binding fragment thereof specifically binds both BCMA and CD3.
- the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- the first BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is belantamab.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is an anti-BCMA antibody-drug conjugate.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- CAR T BCMA-targeted chimeric antigen receptor T
- the first BCMA antagonist is belantamab and the second BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is an anti-BCMA antibody-drug conjugate.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- CAR T BCMA-targeted chimeric antigen receptor T
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is idecabtagene vicleucel. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is ciltacabtagene autoleucel. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is teclistamab. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is REGN5458. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is SEA-BCMA.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is ABBV-383. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is elrantamab. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is pavurutumab. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is alnuctamab. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is MEDI2228. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is CC99712.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is idecabtagene vicleucel. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is ciltacabtagene autoleucel. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is teclistamab. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is REGN5458. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is SEA- BCMA. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is ABBV-383.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is elrantamab. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is pavurutumab. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is alnuctamab. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is MEDI2228. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is and CC99712.
- the combination further comprises a third BCMA antagonist.
- the third BCMA antagonist is selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- the third BCMA-antagonist differs from the first and second BCMA-antagonists.
- the third BCMA antagonist is selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- the combination comprises belantamab mafodotin, belantamab, and an anti-BCMA antibody or antigen binding fragment thereof.
- the combination comprises belantamab mafodotin, belantamab, and an anti-BCMA antibody-drug conjugate.
- the combination comprises belantamab mafodotin, belantamab, and a bispecific anti- BCMA antibody or antigen binding fragment thereof.
- the combination comprises belantamab mafodotin, belantamab, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- CAR T BCMA-targeted chimeric antigen receptor T
- the combination comprises belantamab mafodotin, belantamab, and idecabtagene vicleucel. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and ciltacabtagene autoleucel. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and teclistamab. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and REGN5458. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and SEA-BCMA.
- the combination comprises belantamab mafodotin, belantamab, and ABBV-383. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and elrantamab. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and pavurutumab. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and alnuctamab. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and MEDI2228. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and CC99712.
- the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab.
- the first and second BCMA antagonists, and the third BCMA antagonist, if present are administered simultaneously, such as on the same day of a treatment cycle.
- the first and second BCMA antagonists, and the third BCMA antagonist, if present are administered on the same day of a treatment cycle.
- the first and second BCMA antagonists, and the third BCMA antagonist, if present are administered during the same treatment cycle on different days of the treatment cycle.
- the first and second BCMA antagonists, and the third BCMA antagonist, if present, are independently administered at least once every 8 weeks ⁇ 3 days, at least once every 6 weeks ⁇ 3 days, at least once every 4 weeks ⁇ 3 days, at least once every 3 weeks ⁇ 3 days, at least once every 2 weeks ⁇ 3 days, at least once every week ⁇ 3 days, once every week ⁇ 3 days to once every 8 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 6 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 4 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 3 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 2 weeks ⁇ 3 days, once every 2 weeks ⁇ 3 days to once every 3 weeks ⁇ 3 days, once every 3 weeks ⁇ 3 days to once every 4 weeks ⁇ 3 days, once every 4 weeks ⁇ 3 days to once every 5 weeks ⁇ 3 days, once every 5 weeks ⁇ 3 days to once every 6 weeks ⁇ 3 days, once every 4 weeks ⁇ 3 days,
- the first and second BCMA antagonists, and the third BCMA antagonist, if present are administered in combination with application of a bandage contact lens.
- the first and second BCMA antagonists, and the third BCMA antagonist, if present are administered in combination with at least one additional treatment.
- the additional cancer treatment is selected from an anti-CD38 monoclonal antibody, a gamma-secretase inhibitor, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD- 1 monoclonal antibody.
- anti-CD38 antibodies useful in the methods described herein include, but are not limited to, isatuximab or isatuximab-irfc (e.g., SARCLISA®) and daratumumab (e.g, DARZALEX®, DARZALEX FASPRO®).
- the anti-CD38 monoclonal antibody is selected from daratumumab or isatuximab.
- Examples of gamma-secretase inhibitors useful in the methods described herein include, but are not limited to, nirogacestat (PF-0308014), crenigacestat (LY3039478), CB-103, tarenflurbil, semagacestat (LY450139), RG-4733, EVP-0962, avagacestat, MK-0752, and BMS- 906024, as well as derivatives and polymorphs thereof.
- proteasome inhibitors useful in the methods described herein include, but are not limited to, bortezomib (e.g., VELCADE®), ixazomib (e.g., NINLARO®), carfilzomib (e.g., KYPROLIS®), oprozomib, and delanzomib.
- the proteasome inhibitor is selected from bortezomib, carfilzomib, or ixazomib.
- the proteasome inhibitor is bortezomib.
- immunomodulatory imide drugs useful in the methods described herein include, but are not limited to, thalidomide (e.g., THALOMID®), lenalidomide (e.g., REVLIMID®), and pomalidomide (e.g., POMALYST®).
- the immunomodulatory agent is selected from thalidomide, lenalidomide, or pomalidomide.
- the immunomodulatory agent is lenalidomide or pomalidomide.
- the immunomodulatory agent is lenalidomide.
- anti-PD-1 monoclonal antibodies useful in the methods described herein include, but are not limited to, pembroluzimab and dostarlimab.
- the anti-PD-1 monoclonal antibody is selected from pembroluzimab or dostarlimab.
- corticosteroids include, but are not limited to, dexamethasone (e.g., DECADRON®, DEXASONE®, DIODEX®, HEXADROL®, MAXIDEX®), prednisone (e.g., DELTASONE®), and methylprednisolone (e.g., MEDROL®).
- dexamethasone e.g., DECADRON®, DEXASONE®, DIODEX®, HEXADROL®, MAXIDEX®
- prednisone e.g., DELTASONE®
- methylprednisolone e.g., MEDROL®
- the additional cancer treatment is selected from lenalidomide, pomalidomide, dexamethasone, or a combination thereof.
- the additional cancer treatments are lenalidomide and dexamethasone.
- the additional cancer treatments are pomalidomide and dexamethasone.
- the additional cancer treatments are bortezomib and dexamethasone.
- the additional cancer treatments are pomalidomide, bortezomib, and dexamethasone.
- the additional cancer treatments are lenalidomide, bortezomib, and dexamethasone.
- the additional cancer treatment is standard of care treatment.
- the first and second BCMA antagonists, and the third BCMA antagonist, if present, are administered on day 1 of a treatment cycle. In an embodiment, the first and second BCMA antagonists, and the third BCMA antagonist, if present, are administered on day 1 of a 28-day treatment cycle.
- the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time. In an embodiment, the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily administered on days 1-21 of a 28 day cycle.
- the additional cancer treatment is dexamethasone. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly.
- the additional cancer treatment is dexamethasone at a dose of 40 mg once weekly if the patient is less than 75 years old. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg once weekly if the patient is at least 75 years old. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 40 mg once weekly if the patient has a BMI of at least 18.5. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg once weekly if the patient has a BMI less than 18.5. In an embodiment, the dexamethasone is administered on days 1, 8, 15, and 22 of a 28 day cycle.
- the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 20 mg to 40 mg administered on days 1, 8, 15, and 22 of a 28 day cycle.
- the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 40 mg administered on days 1, 8, 15, and 22 of a 28 day cycle if the patient is less than 75 years old or has a BMI of at least 18.5.
- the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 20 mg administered on days 1, 8, 15, and 22 of a 28 day cycle if the patient is at least 75 years old or has a BMI of less than 18.5.
- the disclosure provides a kit comprising: (i) a first B-cell maturation antigen (BCMA) antagonist; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking BCMA when combined with a second BCMA antagonist.
- the kit further comprises a third BCMA antagonist.
- the instructions further describe use in treating a disease or disorder responsive to inhibiting or blocking BCMA when combined with second and third BCMA antagonist.
- the first, second, and third BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- an anti-BCMA antibody or antigen binding fragment thereof an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- CAR T BCMA-targeted chimeric antigen receptor T
- the first, second, and third BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- the disclosure provides a kit comprising: (i) belantamab mafodotin; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking BCMA when combined with belantamab.
- the disclosure provides a kit comprising: (i) belantamab; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking BCMA when combined with belantamab mafodotin.
- BCMA-inhibiting or blocking therapies are also described.
- kits comprising BCMA-inhibiting or blocking therapies and instructions for use.
- the disclosure provides methods of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with a first BCMA antagonist, the method comprising administering a therapeutically effective amount of a second BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
- BCMA B-cell maturation antigen
- the disclosure provides methods of reducing corneal toxicity in a patient previously treated with a first B-cell maturation antigen (BCMA) antagonist, the method comprising administering a therapeutically effective amount of a second BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
- BCMA B-cell maturation antigen
- Corneal toxicity” or “corneal adverse reaction” refers to changes in the cornea, including keratopathy (e.g., mild superficial keratopathy, moderate superficial keratopathy, severe superficial keratopathy) and corneal epithelial defect, such as corneal ulcers.
- corneal toxicity or corneal adverse reaction refers to keratopathy, and the severity or grade of such corneal adverse reaction can be determined using the keratopathy visual acuity (KVA) scale for treatment-related corneal toxicities according to Table 2.
- KVA keratopathy visual acuity
- a patient has a Grade 1 corneal adverse reaction.
- a patient has a Grade 2 corneal adverse reaction.
- a patient has a Grade 3 corneal adverse reaction.
- a patient has a Grade 4 corneal adverse reaction.
- reducing ocular toxicity refers to reducing the severity of a corneal adverse reaction or the grade of a treatment related corneal toxicity as determined according to the KVA scale.
- the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti- BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- the first BCMA-antagonist differs from the second BCMA-antagonist.
- the first and second BCMA-antagonists are both anti-BCMA antibodies or fragments thereof, both anti-BCMA antibody-drug conjugates, both bispecific anti-BCMA antibodies or fragments thereof, or both BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapies.
- the first BCMA-antagonist is an anti-BCMA antibody or antigen binding fragment thereof and the second BCMA-antagonist is a different anti-BCMA antibody or antigen binding fragment thereof.
- the first BCMA-antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA-antagonist is a different anti-BCMA antibody-drug conjugate.
- the first BCMA-antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof and the second BCMA-antagonist is a different bispecific anti-BCMA antibody or antigen binding fragment thereof.
- the first BCMA-antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy and the second BCMA-antagonist is a different BCMA- targeted chimeric antigen receptor T (CAR T)-cell therapy.
- CAR T BCMA-targeted chimeric antigen receptor T
- CAR T BCMA-targeted chimeric antigen receptor T
- the bispecific anti-BCMA antibody or antigen binding fragment thereof comprises an anti-BCMA antibody or antigen binding fragment thereof and an anti-CD38 antibody or antigen binding fragment thereof. In an embodiment, the bispecific anti-BCMA antibody or antigen binding fragment thereof comprises an anti-BCMA antibody or antigen binding fragment thereof and an anti-CD3 antibody or antigen binding fragment thereof.
- the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- the first BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is belantamab. In an embodiment, the second BCMA antagonist is belantamab mafodotin. In an embodiment, the second BCMA antagonist is belantamab.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is an anti-BCMA antibody-drug conjugate.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- CAR T BCMA-targeted chimeric antigen receptor T
- the first BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy and the second BCMA antagonist is belantamab mafodotin.
- CAR T BCMA-targeted chimeric antigen receptor T
- the first BCMA antagonist is belantamab and the second BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is an anti-BCMA antibody-drug conjugate.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- the first BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof and the second BCMA antagonist is belantamab.
- the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is belantamab.
- the first BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof and the second BCMA antagonist is belantamab.
- the first BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy and the second BCMA antagonist is belantamab.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is idecabtagene vicleucel. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is ciltacabtagene autoleucel. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is teclistamab. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is REGN5458. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is SEA-BCMA.
- the first BCMA antagonist is idecabtagene vicleucel and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is ciltacabtagene autoleucel and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is teclistamab and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is REGN5458 and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is SEA-BCMA and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is ABBV-383 and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is elrantamab and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is pavurutumab and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is alnuctamab and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is MEDI2228 and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is CC99712 and the second BCMA antagonist is belantamab mafodotin.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is idecabtagene vicleucel.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is ciltacabtagene autoleucel.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is teclistamab.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is REGN5458.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is SEA- BCMA.
- the first BCMA antagonist is idecabtagene vicleucel and the second BCMA antagonist is belantamab.
- the first BCMA antagonist is ciltacabtagene autoleucel and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is teclistamab and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is REGN5458 and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is SEA-BCMA and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is ABBV-383 and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is elrantamab and the second BCMA antagonist is belantamab.
- the first BCMA antagonist is pavurutumab and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is alnuctamab and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is MEDI2228 and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is CC99712 and the second BCMA antagonist is belantamab.
- the method further comprises administering a therapeutically effective amount of a third BCMA antagonist to the patient in combination with the second BCMA antagonist, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second and third BCMA antagonists and the third BCMA antagonist is not the same as the first and second BCMA antagonists.
- the first BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is an anti-BCMA antibody-drug conjugate
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is idecabtagene vicleucel
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is ciltacabtagene autoleucel
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is teclistamab
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is REGN5458
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is SEA-BCMA
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is ABBV-383
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is elrantamab
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is pavurutumab
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is alnuctamab
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is MEDI2228
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is CC99712
- the second BCMA antagonist is belantamab mafodotin
- the third BCMA antagonist is belantamab.
- the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
- the second BCMA antagonist is an anti-BCMA antibody-drug conjugate and the first BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
- the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab.
- the first BCMA antagonist is belantamab and the second BCMA antagonist is belantamab mafodotin.
- the second BCMA antagonist, and the third BCMA antagonist are independently administered at least once every 8 weeks ⁇ 3 days, at least once every 6 weeks ⁇ 3 days, at least once every 4 weeks ⁇ 3 days, at least once every 3 weeks ⁇ 3 days, at least once every 2 weeks ⁇ 3 days, at least once every week ⁇ 3 days, once every week ⁇ 3 days to once every 8 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 6 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 4 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 3 weeks ⁇ 3 days, once every week ⁇ 3 days to once every 2 weeks ⁇ 3 days, once every 2 weeks ⁇ 3 days to once every 3 weeks ⁇ 3 days, once every 3 weeks ⁇ 3 days to once every 4 weeks ⁇ 3 days, once every 4 weeks ⁇ 3 days to once every 5 weeks ⁇ 3 days, once every 5 weeks ⁇ 3 days to once every 3 days to once every
- the second BCMA antagonist and the third BCMA antagonist are administered in combination with application of bandage contact lens.
- the second BCMA antagonist, and the third BCMA antagonist, if present, are administered in combination with at least one additional treatment.
- the additional cancer treatment is selected from an anti-CD38 monoclonal antibody, a gamma- secretase inhibitor, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
- anti-CD38 antibodies useful in the methods described herein include, but are not limited to, isatuximab or isatuximab-irfc (e.g., SARCLISA®) and daratumumab (e.g, DARZALEX®, DARZALEX FASPRO®).
- the anti-CD38 monoclonal antibody is selected from daratumumab or isatuximab.
- Examples of gamma-secretase inhibitors useful in the methods described herein include, but are not limited to, nirogacestat (PF-0308014), crenigacestat (LY3039478), CB-103, tarenflurbil, semagacestat (LY450139), RG-4733, EVP-0962, avagacestat, MK-0752, and BMS- 906024, as well as derivatives and polymorphs thereof.
- proteasome inhibitors useful in the methods described herein include, but are not limited to, bortezomib (e.g., VELCADE®), ixazomib (e.g., NINLARO®), carfilzomib (e.g., KYPROLIS®), oprozomib, and delanzomib.
- the proteasome inhibitor is selected from bortezomib, carfilzomib, or ixazomib.
- the proteasome inhibitor is bortezomib.
- immunomodulatory imide drugs useful in the methods described herein include, but are not limited to, thalidomide (e.g., THALOMID®), lenalidomide (e.g., REVLIMID®), and pomalidomide (e.g., POMALYST®).
- the immunomodulatory agent is selected from thalidomide, lenalidomide, or pomalidomide.
- the immunomodulatory agent is lenalidomide or pomalidomide.
- the immunomodulatory agent is lenalidomide.
- anti-PD-1 monoclonal antibodies useful in the methods described herein include, but are not limited to, pembroluzimab and dostarlimab.
- the anti-PD-1 monoclonal antibody is selected from pembroluzimab or dostarlimab.
- corticosteroids include, but are not limited to, dexamethasone (e.g., DECADRON®, DEXASONE®, DIODEX®, HEXADROL®, MAXIDEX®), prednisone (e.g., DELTASONE®), and methylprednisolone (e.g., MEDROL®).
- dexamethasone e.g., DECADRON®, DEXASONE®, DIODEX®, HEXADROL®, MAXIDEX®
- prednisone e.g., DELTASONE®
- methylprednisolone e.g., MEDROL®
- the additional cancer treatment is selected from lenalidomide, pomalidomide, dexamethasone, or a combination thereof.
- the additional cancer treatments are lenalidomide and dexamethasone.
- the additional cancer treatments are pomalidomide and dexamethasone.
- the additional cancer treatments are bortezomib and dexamethasone.
- the additional cancer treatments are pomalidomide, bortezomib, and dexamethasone.
- the additional cancer treatments are lenalidomide, bortezomib, and dexamethasone.
- the additional cancer treatment is standard of care treatment.
- the second BCMA antagonist, and the third BCMA antagonist, if present, are administered on day 1 of a treatment cycle. In an embodiment, the second BCMA antagonist, and the third BCMA antagonist, if present, are administered on day 1 of a 28-day treatment cycle.
- the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time. In an embodiment, the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily administered on days 1-21 of a 28 day cycle.
- the additional cancer treatment is dexamethasone. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly.
- the additional cancer treatment is dexamethasone at a dose of 40 mg once weekly if the patient is less than 75 years old. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg once weekly if the patient is at least 75 years old. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 40 mg once weekly if the patient has a BMI of at least 18.5. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg once weekly if the patient has a BMI less than 18.5. In an embodiment, the dexamethasone is administered on days 1, 8, 15, and 22 of a 28 day cycle.
- the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 20 mg to 40 mg administered on days 1, 8, 15, and 22 of a 28 day cycle.
- the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 40 mg administered on days 1, 8, 15, and 22 of a 28 day cycle if the patient is less than 75 years old or has a BMI of at least 18.5.
- the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 20 mg administered on days 1, 8, 15, and 22 of a 28 day cycle if the patient is at least 75 years old or has a BMI of less than 18.5.
- the first BCMA antagonist is discontinued after the patient demonstrates progressive disease.
- an immunoconjugate or antibody-drug conjugate is used in combination with its corresponding unconjugated antibody.
- a corresponding unconjugated antibody refers to the antibody portion of the immunoconjugate or ADC that lacks the cytotoxic payload and optionally any linker portion of the immunoconjugate or ADC.
- the disclosure provides methods of treating a disease or disorder in a patient, the method comprising administering a therapeutically effective amount of a combination comprising an antibody-drug conjugate and the corresponding unconjugated antibody to the patient.
- the disclosure provides methods of reducing toxicity of an antibody-drug conjugate, the method comprising administering to a patient in need thereof a therapeutically effective amount of a combination comprising the antibody-drug conjugate and the corresponding unconjugated antibody to the patient.
- the disclosure provides methods of treating a disease or disorder in a patient previously treated with an antibody-drug conjugate, the method comprising administering a therapeutically effective amount of the corresponding unconjugated antibody to the patient, wherein the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody.
- the disclosure provides methods of reducing toxicity in a patient previously treated with an antibody-drug conjugate, the method comprising administering a therapeutically effective amount of the corresponding unconjugated antibody to the patient, wherein the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody.
- the antibody-drug conjugate is selected from gemtuzumab ozogamicin, brentuximab vedotin, ado-trastuzumab emtansine, inotuzumab ozogamicin, polatuzumab vedotin, enfortumab vedotin, fam-trastuzumab deruxtecan, sacituzumab govitecan, belantamab mafodotin, loncastuximab tesirine, tisotumab vedotin, moxetumomab pasudotox, MEDI2228, or CC99712. Diseases and Disorders
- BCMA-inhibiting or blocking therapies in the treatment of a disease or disorder in a patient.
- the disease or disorder is a plasma cell disorder or a B-cell disorder.
- B-cell disorders can be divided into defects of B-cell development/immunoglobulin production (immunodeficiencies) and excessive/uncontrolled proliferation (lymphomas, leukemias).
- B-cell disorder refers to both types of diseases, and methods are provided for treating B- cell disorders.
- the cancer can be a B cell cancer (e.g., leukemias and lymphomas).
- MM Multiple Myeloma
- CLL chronic lymphocytic leukemia
- FL Follicular Lymphoma
- Non-secretory multiple myeloma Smoldering multiple myeloma
- Monoclonal gammopathy of undetermined significance MGUS
- Solitary plasmacytoma Bone, Extramedullary
- Lymphoplasmacytic lymphoma LPL
- Waldenstrom’s Macroglobulinemia Plasma cell leukemia, Primary Amyloidosis (AL), Heavy chain disease, Systemic lupus erythematosus (SLE), POEMS syndrome / osteosclerotic myeloma, Type I and II cryoglobulinemia, Light chain deposition disease, Goodpasture’s syndrome, Idiopathic thrombocytopenic purpura (ITP), Acute glomerulonep
- the disease or disorder can be selected from the group consisting of Multiple Myeloma (MM), Non-Hodgkin’s Lymphoma B- cell leukemia (NHL), Follicular Lymphoma (FL), and Diffuse Large B-Cell Lymphoma (DLBCL).
- MM Multiple Myeloma
- NHL Non-Hodgkin’s Lymphoma B- cell leukemia
- FL Follicular Lymphoma
- the disease can be Multiple Myeloma or Non-Hodgkin’s Lymphoma B-cell leukemia (NHL).
- the disease can be Multiple Myeloma.
- the disease or disorder is a BCMA-expressing cancer.
- the disease or disorder is multiple myeloma (MM).
- the MM is relapsed and/or refractory MM, newly-diagnosed MM, transplant-ineligible MM, or transplant- ineligible newly-diagnosed MM.
- the disease or disorder is multiple myeloma previously treated with at least one, at least two, at least three, or at least four therapeutics to treat the multiple myeloma.
- the disease or disorder is relapsed and/or refractory multiple myeloma previously treated with at least one, at least two, at least three or at least four therapeutics to treat the multiple myeloma.
- the disease or disorder is relapsed and/or refractory multiple myeloma previously treated with at least 3 prior lines of therapy that may include the following: an immunomodulatory drug (ImiD), a proteasome inhibitor (PI) and anti-CD38 treatment (e.g., daratumumab) or combinations thereof. Lines of therapy may be defined by consensus panel of the International Myeloma Workshop (IMWG).
- a patient that had prior lines of treatment may have a cancer that is recurrent, relapsed and/or refractory.
- a cancer can be a primary cancer.
- a cancer can be metastatic cancer.
- a cancer can be chemo-resistant cancer.
- the disease or disorder is an autoimmune disease or disorder.
- the disease or disorder is systemic lupus erythematosus (SLE), idiopathic thrombocytopenic purpura (ITP), rheumatoid arthritis, Type 1 diabetes mellitus, multiple sclerosis, or psoriasis.
- belantamab refers to a B-cell maturation antigen (BCMA)-blocking antibody (“anti-BCMA antibody”) or a functional fragment or functional variant thereof which specifically binds to BCMA and which inhibits the binding of BAFF and/or APRIL to the BCMA receptor, comprising an immunoglobulin heavy chain variable domain (VH) comprising a complementary determining region (CDR) Hl comprising the amino acid sequence of SEQ ID NO 5; a CDRH2 comprising the amino acid sequence of SEQ ID NO: 6; a CDRH3 comprising the amino acid sequence of SEQ ID NO: 7; and an immunoglobulin light chain variable domain (VL) comprising a CDRL1 comprising the amino acid sequence of SEQ ID NO: 8; a CDRL2 comprising the amino acid sequence of SEQ ID NO: 9; and a CDRL3 comprising the amino acid sequence of SEQ ID NO: 10.
- VH immunoglobulin heavy chain variable domain
- CDR complementary determining region
- VL immunoglobulin light chain
- the VH comprises an amino acid sequence of SEQ ID NO: 3.
- the VL comprises an amino acid sequence of SEQ ID NO 4.
- the heavy chain comprises the amino acid sequence of SEQ ID NO 1.
- the light chain comprises the amino acid sequence of SEQ ID NO 2.
- belantamab comprises a VH comprising an amino acid sequence of SEQ ID NO: 3 and a VL comprising an amino acid sequence of SEQ ID NO: 4.
- belantamab comprises the heavy and light chain sequences of SEQ ID NO: 1 and SEQ ID NO: 2, respectively.
- belantamab mafodotin and “belamaf ’ are used interchangeably and refer to an immunoconjugate comprising belantamab conjugated to monomethyl auristatin F (MMAF) via a 6- maleimidocaproyl (MC) linker.
- MMAF monomethyl auristatin F
- MC 6- maleimidocaproyl
- biosimilar refers to a biopharmaceutical or a biologic product that is highly similar to a reference biologic product (e.g., belantamab or belantamab mafodotin) notwithstanding minor differences in clinically inactive components, and for which there are no clinically meaningful differences between the biologic product and the reference product in terms of the safety, purity, and potency of the product (Section 351 (i) of the Public Health Service Act (42 U.S.C. 262(i)).
- a reference biologic product e.g., belantamab or belantamab mafodotin
- biosimilar refers to a biologic product that is highly similar to the reference product (e.g., belantamab or belantamab mafodotin) approved by a regulatory agency (e.g., the Federal Drug Administration (FDA) or the European Medicines Agency (EMA)) based on data from (a) analytical studies demonstrating that the biologic product is highly similar to the reference product notwithstanding minor differences in clinically inactive components; (b) animal studies (including the assessment of toxicity); and/or (c) a clinical study or studies (including the assessment of immunogenicity and pharmacokinetics or pharmacodynamics) that are sufficient to demonstrate safety, purity, and potency in one or more appropriate conditions of use for which the reference product is approved and intended to be used and for which approval is sought (e.g., that there are no clinically meaningful differences between the biologic product and the reference product in terms of the safety, purity and potency of the product).
- the biosimilar product is an interchangeable product as determined by a regulatory agency (e.g., the Federal Drug Administration (
- the biosimilar may comprise one or more molecular differences, such as post-translational modifications, for example, although not limited to, glycosylation, oxidation, deamidation, and/or truncation which is/are different to the post-translational modifications of the reference medicinal product (e.g., belantamab or belantamab mafodotin) provided that the differences do not result in a significant change in safety and/or efficacy of the medicinal product.
- the reference medicinal product e.g., belantamab or belantamab mafodotin
- the biosimilar may have an identical or different glycosylation pattern to the reference medicinal product (e.g., belantamab or belantamab mafodotin).
- the biosimilar e.g., a biosimilar of belantamab or belantamab mafodotin
- the biosimilar may have a different glycosylation pattern, such as, if the differences address or are intended to address safety concerns associated with the reference medicinal product (e.g., belantamab or belantamab mafodotin).
- biosimilar e.g., a biosimilar of belantamab or belantamab mafodotin
- the reference medicinal product e.g., belantamab or belantamab mafodotin
- the biosimilar e.g., a biosimilar of belantamab or belantamab mafodotin
- the biosimilar may comprise differences in, for example, pharmacokinetic (PK) and/or pharmacodynamic (PD) profiles as compared to the reference medicinal product (e.g., belantamab or belantamab mafodotin) but is still deemed sufficiently similar to the reference medicinal product as to be authorized or considered suitable for authorization.
- PK pharmacokinetic
- PD pharmacodynamic
- the biosimilar e.g., a biosimilar of belantamab or belantamab mafodotin
- the reference medicinal product e.g., belantamab or belantamab mafodotin
- biosimilar is also used synonymously by other national and regional regulatory agencies.
- a drug’s international nonproprietary name (e.g., belantamab or belantamab mafodotin)
- INN international nonproprietary name
- a drug’s INN optionally includes, but is not limited to, glycosylation variants of belantamab or belantamab mafodotin, and biosimilars thereof.
- Embodiment 1 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering to the patient belantamab at a dose of about 300 mg to about 2000 mg.
- Embodiment 2 is the method of embodiment 1, wherein the dose is about 300 mg, about 900 mg, or about 2000 mg.
- Embodiment 3 is the method of embodiment 1 or 2, wherein the dose is administered at a regular interval for a period of time.
- Embodiment 4 is the method of embodiment 1 or 2, wherein the dose is administered once every week ⁇ 3 days to once every four weeks ⁇ 3 days.
- Embodiment 5 is the method of embodiment 1 or 2, wherein the dose is administered once every two weeks ⁇ 3 days.
- Embodiment 6 is the method of embodiment 1 or 2, wherein the dose is administered once every three weeks ⁇ 3 days.
- Embodiment 7 is the method of embodiment 1 or 2, wherein the dose is administered once every four weeks ⁇ 3 days.
- Embodiment 8 is the method of embodiment 1 or 2, wherein the dose is administered on days 1 and 15 of a 28 day cycle.
- Embodiment 9 is the method of embodiment 1 or 2, wherein the dose is administered on day 1 of a 21 day cycle.
- Embodiment 10 is the method of any one of the preceding embodiments, wherein the patient has been treated with at least one prior line of cancer treatment.
- Embodiment 11 is the method of any one of the preceding embodiments, wherein the patient has been treated with one, two, three, or four prior lines of cancer treatments.
- Embodiment 12 is the method of embodiment 11, wherein the prior lines of cancer treatments include an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent.
- Embodiment 13 is the method of any one of the preceding embodiments, wherein belantamab is administered through an intravenous infusion or a subcutaneous injection.
- Embodiment 14 is the method of any one of the preceding embodiments, wherein the patient is further receiving at least one additional cancer treatment, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
- additional cancer treatment such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
- Embodiment 15 is the method of embodiment 14, wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
- Embodiment 16 is the method of embodiment 15, wherein the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time.
- Embodiment 17 is the method of embodiment 16, wherein the patient is receiving lenalidomide on days 1-21 of a 28 day cycle.
- Embodiment 18 is the method of any one of embodiments 14 to 17, wherein the additional cancer treatment is dexamethasone.
- Embodiment 19 is the method of embodiment 18, wherein the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly.
- Embodiment 20 is the method of embodiment 19, wherein the patient is receiving dexamethasone on days 1, 8, 15, and 22 of a 28 day cycle.
- Embodiment 21 is the method of embodiment 19, wherein (i) the patient is less than 75 years old and is receiving dexamethasone at a dose of 40 mg once weekly; or (ii) the patient is at least 75 years old and is receiving dexamethasone at a dose of 20 mg once weekly.
- Embodiment 22 is the method of embodiment 19, wherein (i) the patient has a BMI of at least 18.5 and is receiving dexamethasone at a dose of 40 mg once weekly; or (ii) the patient has a BMI less than 18.5 and is receiving dexamethasone at a dose of 20 mg once weekly.
- Embodiment 23 is the method of any one of the preceding embodiments, further comprising discontinuing administration of belantamab and subsequently administering belantamab mafodotin.
- Embodiment 24 is the method of any one of embodiments 1 to 22, further comprising administering belantamab mafodotin and subsequently discontinuing administration of belantamab.
- Embodiment 25 is the method of embodiment 23 or 24, wherein belantamab mafodotin is administered at a dose of 2.5 mg/kg once every three weeks ⁇ 3 days.
- Embodiment 26 is the method of any one of the preceding embodiments, further comprising administering a lead-in dose of belantamab mafodotin prior to beginning administration of belantamab, wherein the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 3.4 mg/kg once during a lead-in period.
- Embodiment 27 is the method of embodiment 26, wherein the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 1.9 mg/kg once during a lead-in period.
- Embodiment 28 is the method of embodiment 26, wherein the lead-in dose of belantamab mafodotin is about 1.4 mg/kg, about 1.9 mg/kg, about 2.5 mg/kg, or about 3.4 mg/kg once during a lead-in period.
- Embodiment 29 is the method of embodiment 26, wherein the lead-in dose of belantamab mafodotin is about 1.4 mg/kg once during a lead-in period.
- Embodiment 30 is the method of any one of embodiments 26 to 29, wherein the lead- in period is four weeks ⁇ 3 days and belantamab mafodotin is administered on day 1 of the lead- in period.
- Embodiment 31 is the method of any one of embodiments 26 to 30, further comprising administering at least one additional cancer treatment to the patient during the lead-in period, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
- at least one additional cancer treatment such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
- Embodiment 32 is the method of embodiment 31, wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
- Embodiment 33 is the method of embodiment 32, wherein the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time.
- Embodiment 34 is the method of embodiment 33, wherein lenalidomide is administered to the patient on days 1-21 of the lead-in period.
- Embodiment 35 is the method of any one of embodiments 32 to 34, wherein the additional cancer treatment is dexamethasone.
- Embodiment 36 is the method of embodiment 35, wherein the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly.
- Embodiment 37 is the method of embodiment 36, wherein dexamethasone is administered to the patient on days 1, 8, 15, and 22 of the lead-in period.
- Embodiment 38 is the method of embodiment 36, wherein (i) the patient is less than 75 years old and dexamethasone is administered to the patient at a dose of 40 mg once weekly; or (ii) the patient is at least 75 years old and dexamethasone is administered to the patient at a dose of 20 mg once weekly.
- Embodiment 39 is the method of embodiment 36, wherein (i) the patient has a BMI of at least 18.5 and dexamethasone is administered to the patient at a dose of 40 mg once weekly; or (ii) the patient has a BMI less than 18.5 and dexamethasone is administered to the patient at a dose of 20 mg once weekly.
- Embodiment 40 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering to a patient belantamab mafodotin at a dose of about 1.4 mg/kg to about 3.4 mg/kg once every eight weeks ⁇ 3 days, such as about 1.4 mg/kg to about 1.9 mg/kg once every eight weeks ⁇ 3 days.
- BCMA B-cell maturation antigen
- Embodiment 41 is the method of embodiment 40, wherein the dose is about 1.4 mg/kg, about 1.9 mg/kg, about 2.5 mg/kg, or about 3.4 mg/kg once every eight weeks ⁇ 3 days.
- Embodiment 42 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering a therapeutically effective amount of a combination comprising a first BCMA antagonist and a second BCMA antagonist to the patient.
- BCMA B-cell maturation antigen
- Embodiment 43 is the method of embodiment 42, wherein the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- Embodiment 44 is the method of embodiment 42 or 43, wherein the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- Embodiment 45 is the method of any one of embodiments 42 to 44, wherein the first BCMA antagonist is belantamab mafodotin.
- Embodiment 46 is the method of any one of embodiments 42 to 44, wherein the first BCMA antagonist is belantamab.
- Embodiment 47 is the method of embodiment 42, wherein the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
- Embodiment 48 is the method of embodiment 47, wherein the anti-BCMA antibodydrug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
- Embodiment 49 is the method of embodiment 48, wherein the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab.
- Embodiment 50 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering a therapeutically effective amount of a combination comprising belantamab mafodotin and belantamab to the patient.
- BCMA B-cell maturation antigen
- Embodiment 51 is the method of any one of embodiments 42 to 50, further comprising administering at least one additional cancer treatment to the patient, such as an anti- CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD- 1 monoclonal antibody.
- at least one additional cancer treatment such as an anti- CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD- 1 monoclonal antibody.
- Embodiment 52 is the method of embodiment 51 , wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
- Embodiment 53 is a kit comprising: (i) a first B-cell maturation antigen (BCMA) antagonist; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking BCMA when combined with a second BCMA antagonist.
- BCMA B-cell maturation antigen
- Embodiment 54 is a kit comprising: (i) belantamab mafodotin; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) when combined with belantamab.
- BCMA B-cell maturation antigen
- Embodiment 55 is a kit comprising: (i) belantamab; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) when combined with belantamab mafodotin.
- BCMA B-cell maturation antigen
- Embodiment 56 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with a first BCMA antagonist, the method comprising administering a therapeutically effective amount of a second BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
- BCMA B-cell maturation antigen
- Embodiment 57 is the method of embodiment 56, wherein the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- Embodiment 58 is the method of embodiment 56 or 57, wherein the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- Embodiment 59 is the method of any one of embodiments 56 to 58, wherein the first BCMA antagonist is belantamab mafodotin.
- Embodiment 60 is the method of any one of embodiments 56 to 58, wherein the first BCMA antagonist is belantamab.
- Embodiment 61 is the method of any one of embodiments 56 to 58, wherein the second BCMA antagonist is belantamab mafodotin.
- Embodiment 62 is the method of any one of embodiments 56 to 58, wherein the second BCMA antagonist is belantamab.
- Embodiment 63 is the method of embodiment 56, wherein the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
- Embodiment 64 is the method of embodiment 63, wherein the anti-BCMA antibodydrug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
- Embodiment 65 is the method of embodiment 63, wherein the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab.
- Embodiment 66 is the method of embodiment 56, wherein the second BCMA antagonist is an anti-BCMA antibody-drug conjugate and the first BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
- Embodiment 67 is the method of embodiment 66, wherein the anti-BCMA antibodydrug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
- Embodiment 68 is the method of embodiment 66, wherein the second BCMA antagonist is belantamab mafodotin and the first BCMA antagonist is belantamab.
- Embodiment 69 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab mafodotin, the method comprising administering a therapeutically effective amount of belantamab to the patient, wherein the patient discontinued administration of belantamab mafodotin prior to beginning administration of belantamab.
- BCMA B-cell maturation antigen
- Embodiment 70 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab, the method comprising administering a therapeutically effective amount of belantamab mafodotin to the patient, wherein the patient discontinued administration of belantamab prior to beginning administration of belantamab mafodotin.
- BCMA B-cell maturation antigen
- Embodiment 71 is the method of any one of embodiments 56 to 70, further comprising administering at least one additional cancer treatment to the patient, such as an anti- CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD- 1 monoclonal antibody.
- at least one additional cancer treatment such as an anti- CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD- 1 monoclonal antibody.
- Embodiment 72 is the method of embodiment 71, wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
- the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
- Embodiment 73 is a method of reducing corneal toxicity in a patient previously treated with a first B-cell maturation antigen (BCMA) antagonist, the method comprising administering a therapeutically effective amount of a second BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
- BCMA B-cell maturation antigen
- Embodiment 74 is the method of embodiment 73, wherein the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
- Embodiment 75 is the method of embodiment 73 or 74, wherein the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
- Embodiment 76 is the method of any one of embodiments 73 to 75, wherein the first BCMA antagonist is belantamab mafodotin.
- Embodiment 77 is the method of any one of embodiments 73 to 75, wherein the first BCMA antagonist is belantamab.
- Embodiment 78 is the method of any one of embodiments 73 to 75, wherein the second BCMA antagonist is belantamab mafodotin.
- Embodiment 79 is the method of any one of embodiments 73 to 75, wherein the second BCMA antagonist is belantamab.
- Embodiment 80 is the method of embodiment 73, wherein the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
- Embodiment 81 is the method of embodiment 80, wherein the anti-BCMA antibodydrug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
- Embodiment 82 is the method of embodiment 80, wherein the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab.
- Embodiment 83 is the method of embodiment 73, wherein the second BCMA antagonist is an anti-BCMA antibody-drug conjugate and the first BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
- Embodiment 84 is the method of embodiment 83, wherein the anti-BCMA antibodydrug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
- Embodiment 85 is the method of embodiment 83, wherein the second BCMA antagonist is belantamab mafodotin and the first BCMA antagonist is belantamab.
- Embodiment 86 is a method of reducing corneal toxicity in a patient previously treated with belantamab mafodotin, the method comprising administering a therapeutically effective amount of belantamab to the patient, wherein the patient discontinued administration of belantamab mafodotin prior to beginning administration of belantamab.
- Embodiment 87 is a method of reducing corneal toxicity in a patient previously treated with belantamab, the method comprising administering a therapeutically effective amount of belantamab mafodotin to the patient, wherein the patient discontinued administration of belantamab prior to beginning administration of belantamab mafodotin.
- Embodiment 88 is the method of any one of embodiments 73 to 87, further comprising administering at least one additional cancer treatment to the patient, such as an anti- CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD- 1 monoclonal antibody.
- at least one additional cancer treatment such as an anti- CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD- 1 monoclonal antibody.
- Embodiment 89 is the method of embodiment 88, wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
- Embodiment 90 is a method of treating a disease or disorder in a patient, the method comprising administering a therapeutically effective amount of a combination comprising an antibody-drug conjugate and the corresponding unconjugated antibody.
- Embodiment 91 is a method of treating a disease or disorder in a patient previously treated with an antibody-drug conjugate, the method comprising administering a therapeutically effective amount of the corresponding unconjugated antibody to the patient, wherein the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody.
- Embodiment 92 is the method of embodiment 90 or 91, wherein the antibody-drug conjugate is selected from gemtuzumab ozogamicin, brentuximab vedotin, ado-trastuzumab emtansine, inotuzumab ozogamicin, polatuzumab vedotin, enfortumab vedotin, fam-trastuzumab deruxtecan, 66andomized66 govitecan, belantamab mafodotin, loncastuximab tesirine, tisotumab vedotin, moxetumomab pasudotox, MEDI2228, or CC99712.
- the antibody-drug conjugate is selected from gemtuzumab ozogamicin, brentuximab vedotin, ado-trastuzumab
- Embodiment 93 is the method of any one of embodiments 1 to 52 or 56 to 92, or the kit of any one of embodiments 53 to 55, wherein the disease or disorder is a plasma cell disorder or a B-cell disorder.
- Embodiment 94 is the method any one of embodiments 1 to 52 or 56 to 92, or the kit of any one of embodiments 53 to 55, wherein the disease or disorder is a BCMA-expressing cancer.
- Embodiment 95 is the method any one of embodiments 1 to 52 or 56 to 92, or the kit of any one of embodiments 53 to 55, wherein the disease or disorder is multiple myeloma (MM).
- Embodiment 96 is the method of embodiment 95, wherein the MM is relapsed and/or refractory MM, newly-diagnosed MM, transplant-ineligible MM, or transplant-ineligible newly- diagnosed MM.
- Embodiment 97 is the kit of embodiment 95, wherein the MM is relapsed and/or refractory MM, newly-diagnosed MM, transplant-ineligible MM, or transplant-ineligible newly- diagnosed MM.
- Embodiment 98 is a method of treating cancer in a patient, wherein the patient has a Grade 1 corneal adverse reaction resulting from belantamab mafadotin administration, the method comprising temporarily discontinuing administration of belantamab mafadotin; administering to the patient a therapeutically effective amount of belantamab for a lead-in period; and resuming administration of belantamab mafadotin after the lead-in period.
- Embodiment 99 is a method of treating cancer in a patient, wherein the patient has a Grade 2 or above corneal adverse reaction resulting from belantamab mafodotin administration, the method comprising temporarily discontinuing administration of belantamab mafadotin; administering to the patient a therapeutically effective amount of belantamab I Ifor a lead-in period; and resuming administration of belantamab mafadotin after the lead-in period.
- Example 1 In Vivo Efficacy of Belantamab in the Treatment of Subcutaneous NCI-H929 Human Multiple Myeloma Model in NOD/SCID Mice.
- NCI-H929 tumor cells were maintained in vitro with RPMI1640 medium supplemented with 10% fetal bovine serum and 0.05mM 0-ME at 37°C in an atmosphere of 5% C0 2 in air. Cells in an exponential growth phase were harvested and counted for tumor inoculation. Each mouse was inoculated subcutaneously in the right front flank region with NCI-H929 tumor cells (5x 10 6 ) in 0.1 ml of PBS mixed with matrigel (1: 1) for tumor development. The randomization started when the mean tumor size reached 121 mm 3 . 80 mice were enrolled in the study. All animals were randomly allocated to 8 study groups.
- Randomization was performed based on “Matched distribution” method (Study DirectorTM software, version 3.1.399.19) randomized block design. The date of randomization was denoted as day 0. The treatment was initiated on the same day of randomization (day 0) per study design.
- the survival time was analyzed by Kaplan-Meier method.
- the event of interest was the animal death.
- the survival time was defined as the time from the day of randomization to the day when the tumor volume reached to 2500 mm 3 .
- MST median survival time
- ILS increased in life-span
- the Kaplan-Meier curves was constructed for each group and the log-rank test was used to compare survival curves between groups. All data were analyzed using SPSS 18.0. P ⁇ 0.05 was considered to be statistically significant.
- Results The tumor volume analysis showed that GSK2857916 at 4 mg/kg and GSK2857914 at 8 mg/kg as the single agent or in combination with different dosing schedules (G2-G8) demonstrated significant anti-tumor efficacy in NCLH929 Xenograft model compared with vehicle (Gl).
- GSK2857916 in combination with GSK2857914 (G4 and G6) showed significant improved anti-tumor efficacy compared with the single agent of GSK2857916 (G2).
- the tumor volume growth curves between randomization grouping and study termination are shown in FIG. 1.
- Tumor growth inhibition (TGI) from data collected on day 24 is provided in Table 5.
- GSK2857916 at 4 mg/kg and GSK2857914 at 8 mg/kg as the single agent or in combination with different dosing schedules significantly increased the life-span of mice in NCI-H929 Xenograft model compared with vehicle (Gl).
- GSK2857916 in combination with GSK2857914 (G4 and G6) could further increase the life-span of mice compared with the single agent of GSK2857916 (G2).
- Kaplan-Meier survival curves for all treatment groups as a function of study day are shown in FIG. 2. Median survival day for mice in each group is provided in Table 6.
- Example 2 Phase 1/2 Study to Evaluate the Safety and Efficacy of Belantamab in Multiple Myeloma .
- Part 1 is a Phase 1 open-label study evaluating the safety, tolerability, and clinical activity of escalating doses of single agent belantamab in participants with RRMM who have received at least 3 prior lines of treatment to determine the recommended part 2 dose.
- Belantamab is dosed twice a cycle on Days 1 and 15 of a 28-day cycle, starting at a dose of 300 mg IV.
- Dose escalation is guided by modified toxicity probability interval to 900 mg and then to the maximum dose of 2000 mg according to a dose escalation plan and as directed by a dose escalation committee.
- the exploration of an additional intermediate dose is allowed if suggested by the dose escalation committee and agreed upon by the Medical Monitor and treating investigators.
- the progression from one dose level to another and the recommended Part 2 doses are based on the totality of available data from Part 1 of belantamab treatment; the dose escalation committee takes into consideration, in particular, the safety and tolerability of each dose level, available PK and PD data and preliminary efficacy to recommend two dose levels to further characterize in Part 2.
- Participants are dosed until progressive disease (PD) after which they have the option to receive treatment with single agent belantamab mafodotin (Part IB) at 2.5 mg/kg Q3W.
- Participants who opt to be treated with belantamab mafodotin following the first PD proceed with an end of treatment (EOT) visit before starting belantamab mafodotin treatment, and then continue to be monitored for safety, tolerability and disease response during belantamab mafodotin treatment until the next PD.
- EOT end of treatment
- Participants who opt out of belantamab mafodotin treatment after the first PD terminate the treatment and proceed with the EOT visit and follow-up safety monitoring.
- the belantamab treatment duration is until first PD (followed by optional belantamab mafodotin treatment until second PD), unacceptable toxicity, or any other treatment termination criteria.
- the treatment duration could be up to approximately 8 months.
- the visit frequency is every 2 weeks from Cycle 3 forward. More visits are scheduled in Cycles 1 and 2.
- Part 2 is a 2-arm safety run-in randomized, open-label study evaluating the safety, tolerability, and clinical activity of 1 cycle of belantamab mafodotin-xRd (belantamab mafodotin, treatment x, lenalidomide, and dexamethasone) followed by continuous treatment with belantamab-xRd (belantamab, treatment x, lenalidomide, and dexamethasone) in participants with recurrent MM who have received at least 1 prior line of treatment (2L+).
- belantamab mafodotin-xRd belantamab mafodotin, treatment x, lenalidomide, and dexamethasone
- treatment x includes, but is not limited to, a combination of an anti-CD38 antibody such as daratumumab or isatuximab) and a gamma secretase inhibitor such as nirogacestat. In some cases, treatment x includes, but is not limited to, a proteasome inhibitor such as bortezomib.
- the combination treatment xRd includes lenalidomide (R) and dexamethasone (d).
- the selection of treatment x is based on data from on-going belantamab mafodotin clinical studies and is either a standard of care or an emerging treatment for MM.
- the belantamab doses are based on the totality of available Part 1 data. Two different dose levels of belantamab (Arms A and B) are dosed every 4 weeks. More frequent dosing is used if justified by Part 1 data based on safety, tolerability, PK/PD modelling or other data.
- Part 2 of the study assesses overall safety events and tolerability and corneal adverse events for 10 parti cipants/ Arm after 3 cycles of treatment. Participants are considered evaluable for safety and tolerability if they have completed at least 3 cycles of treatment including one cycle of belantamab mafodotin-xRd followed by 2 cycles of belantamab-xRd. Participants not meeting the definition of evaluable may be replaced if they withdraw for reason other than treatment related adverse event, death or PD. The totality of data from Part 1 and Part 2 are used to determine the belantamab recommended Phase 2 dose(s) to be used in Part 3.
- the treatment duration is until PD, unacceptable toxicity, or any other treatment termination criteria.
- the treatment duration could be up to approximately 15 months.
- the visit frequency is every 4 weeks from Cycle 3 unless data from Part 1 and from on-going belantamab mafodotin clinical trials suggest more frequent dosing with administration of belantamab-xRd. More visits are planned during Cycles 1 and 2.
- Part 3 is a 4-arm Phase 2 randomized, open-label study evaluating the safety and efficacy of continuous belantamab-xRd following treatment with 1 cycle of belantamab mafodotin-xRd in participants with TI-NDMM. Cycle length is 4 weeks. Two different doses of belantamab (Arms A and B) are dosed every 4 weeks. The belantamab dose levels are selected based on the totality of available data from Parts 1 and 2 and may be different to the ones administered in Part 2; the selection process by the dose escalation committee takes into consideration the overall safety and tolerability of the combination, available PK/PD data and evidence of efficacy of the different dose levels.
- belantamab mafodotin and xRd doses are the same in Arms A and B: a single dose of belantamab mafodotin at 1.4 mg/kg administered in combination with treatment x, lenalidomide at 25 or 10 mg once daily (on days 1-21 of the cycle), and dexamethasone at 40 mg once daily (on days 1, 8, 15, and 22 of the cycle) (or 20 mg if age ⁇ 75 years or BMI ⁇ 18.5).
- Part 3 also tests the outcome of: 1) treatment with continuous dosing of belantamab mafodotin-xRd (Arm C), and 2) treatment with a continuous dosing of belantamab-xRd in absence of the belantamab mafodotin-xRd initial dose (Arm D).
- belantamab mafodotin is dosed once every two 28-days cycles (Q8W) at a dose of 1.4 mg/kg in combination with treatment x, lenalidomide at 25 or 10 mg once daily (on days 1-21 of the cycle), and dexamethasone at 40 mg once daily (on days 1, 8, 15, and 22 of the cycle) (or 20 mg if age ⁇ 75 years or BMI ⁇ 18.5).
- belantamab is administered once per 28-day cycle in combination with treatment x, lenalidomide at 25 or 10 mg once daily (on days 1-21 of the cycle), and dexamethasone at 40 mg once daily (on days 1, 8, 15, and 22 of the cycle) (or 20 mg if age ⁇ 75 years or BMI ⁇ 18.5).
- participant A or B or C or D are randomised 1 : 1 : 1 : 1 to either Arm A or B or C or D with the aim to obtain data on 20 evaluable participants per arm. Participants are considered evaluable if they have completed at least 4 cycles of treatment, including one cycle of belantamab mafodotin-xRd followed by 3 cycles of belantamab-xRd. Participants not meeting the definition of evaluable may be replaced if they withdraw for reason other than treatment related adverse event, death or disease progression.
- the xRd doses are the same in all four arms of the study, while the belantamab mafodotin and belantamab doses and dosing frequencies may differ in Arm C and Arm D, respectively, compared to the ones in Arms A and B.
- the study terminates 18 months after last subject first dose. At that time, data collection for all recruited participants who no longer receive study treatment stops and the clinical trial database is closed. If the disease has not progressed at time of study termination, participants who continue benefitting by the treatment as suggested by the investigator are transferred in a post- analysis-continual-treatment study to continue receiving treatment. Under these circumstances, the
- the visit frequency is every 4 weeks starting from Cycle 3, unless data from Parts 1 and 2 and from on-going belantamab mafodotin clinical trials suggest more frequent dosing with belantamab-xRd. More visits are planned during Cycles 1 and 2.
- a standard of care (SoC) treatment or emerging MM treatment is also administered as provided in Table 8.
- the infusion duration may be adjusted to 30-60 mins.
- Premedication e.g., systemic corticosteroids
- Premedication is not required unless deemed medically necessary by the investigator, in which case it should be administered according to institutional recommendations.
- Infusions may be prolonged in the event of an infusion reaction. If multiple participants experience clinically significant infusion reactions, the infusion rate may be slowed for all future administrations of study treatment for all participants. Should this global change in infusion rate be required, it will be communicated to the sites in writing.
- Part 3 Arm C continuous belantamab mafodotin is administered 1.4 mg/kg Q8W, and based on emerging data from ongoing belantamab mafodotin trials, the dose level may be increased to 1.9 mg/kg Q8W unless data supports more frequent administration.
- the initial dose(s) match Parts A and B with the ongoing dose selected based on considerations of data from other studies and clinical experience with belantamab mafodotin.
- Lenalidomide is administered as 25 mg PO daily on days 1-21 of each 28-day cycle, in participants with CLcr of >60 mL/min (by Cockcroft-Gault). The dose of lenalidomide will be reduced to 10 mg daily on Days 1 to 21 in participants with CLcr of 30-60 mL/min. Lenalidomide is administered at a fixed dose level, with no adjustments needed for body weight or BSA.
- lenalidomide On lenalidomide and belantamab/belantamab mafodotin co-administration days, lenalidomide should be administered as close as possible to the end of the 1-2 hours rest period after administration of belantamab/belantamab mafodotin, and on PK days no later than 6 hours after the end of the rest period after administration of belantamab/belantamab mafodotin.
- Dexamethasone will be given at 40 mg (or 20 mg if age ⁇ 75 years or BMI ⁇ 18.5 kg/m 2 ) weekly PO on Days 1, 8, 15 and 22 of each cycle.
- Part 1 Participants who have received at least 3 prior lines of anti-myeloma treatments, and have already received an immunomodulating agent, a proteasome inhibitor, and an anti-CD38 mAb (unless contraindicated or unavailable). Lines of therapy are defined by consensus panel of the International Myeloma Workshop.
- Part 2 Participants who meet all of the following: (1) have undergone autologous stem cell transplant (ASCT) or are considered transplant ineligible; (2) have been previously treated with at least one prior line of MM therapy; (3) have documented disease progression during or after their most recent therapy.
- ASCT autologous stem cell transplant
- Part 3 Participants who meet both of the following: (1) NDMM with a requirement for treatment as documented per IMWG criteria; and (2) not considered a candidate for high dose chemotherapy with ASCT due to: (a) Age 65 years; or (b) age 18-65 years with presence of comorbid condition(s) likely to have a negative impact on tolerability of high-dose chemotherapy with ASCT or who refuse high-dose chemotherapy with ASCT as an initial treatment.
- [00392] 4. Eastern cooperative oncology group-performance status (ECOG-PS) of 0-2. [00393] 5. Measurable disease defined as at least ONE of the following: (a) serum M-protein concentration 0.5 g/dL ( ⁇ 5 g/L); (b) urine M-protein excretion -'200 mg/24 hours ( '0.2 g/24 hours); or (c) serum free light chain (FLC) assay: involved FLC level ⁇ 10 mg/dL ( ' 100 mg/L) and an abnormal serum FLC ratio ( ⁇ 0.26 or >1.65).
- FLC serum free light chain
- Laboratory results obtained during screening should be used to determine eligibility criteria. In situations where laboratory results are outside the permitted range, the investigator may re-test the participant and the subsequent within range screening result may be used to confirm eligibility.
- Grade ⁇ 1 at the time of screening except for alopecia any grade
- neuropathy Grade ⁇ 2
- endocrinopathy managed with replacement therapy any grade
- Participant is exhibiting signs of meningeal or central nervous system involvement with MM.
- Evidence of cardiovascular risk including any of the following: (a) Evidence of current clinically significant untreated arrhythmias, including, but not limited to, clinically significant ECG abnormalities such as 2nd degree (Mobiz Type II) or 3rd degree AV block; (b) QTcF interval >450 msec (QT interval corrected for heart rate according to Fridericia’s formula), and/or hypokalemia, and/or family history of long QT syndrome (for Part 1); (c) History of MI, acute coronary syndromes (including unstable angina), coronary angioplasty, stenting or bypass grafting, all within three months of screening; (d) Class III or IV heart failure as defined by the NYHA functional classification system; (e) Uncontrolled hypertension.
- ECG abnormalities such as 2nd degree (Mobiz Type II) or 3rd degree AV block
- Part 1 and 2 Refractory to belantamab mafodotin (confirmed PD as per IMWG criteria while on belantamab mafodotin therapy or within 60 days of completing that treatment). Prior belantamab mafodotin is allowed if it was discontinued due to toxicity which subsequently resolved. Note: Prior treatment with other Anti-BCMA directed agents is allowed.
- Part 1 and 2 Refractoriness to prior standard anti-myeloma therapies including lenalidomide is allowed for other mAbs within 30 days or systemic anti-myeloma therapy within 14 days of first dose of study drug.
- Focal palliative radiation is permitted prior to enrolment, provided it occurred at least 2 weeks prior to the first dose of study intervention, that the participant has recovered from radiation-related toxicities, and that the participant did not require corticosteroids for radiation- induced AEs.
- [00427] 25 Has received transfusion of blood products (including platelets or red blood cells) or administration of colony stimulating factors (including G-CSF, GMCSF, recombinant erythropoietin) or any thrombopoietin receptor agonists within 2 weeks before the first dose of study drug.
- blood products including platelets or red blood cells
- colony stimulating factors including G-CSF, GMCSF, recombinant erythropoietin
- any thrombopoietin receptor agonists within 2 weeks before the first dose of study drug.
- live vaccines include, but are not limited to the following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, BCG, and typhoid vaccine.
- Seasonal influenza and COVID-19 vaccines for injection are not live or attenuated virus vaccines and are allowed; however, intranasal influenza vaccines (for example, FluMist) are live attenuated vaccines and are not allowed.
- Lenalidomide capsules should be swallowed whole with water; the capsules should not be opened, broken, or chewed.
- Lenalidomide should be taken orally at approximately the same time each day.
- Lenalidomide capsules contain lactose. The risk-benefit of should be evaluated in participants with lactose intolerance.
- Participants will abstain from ingesting caffeine- or xanthine- containing products (e.g., coffee, tea, cola drinks, and chocolate) for 24 hours before clinic visits on days scheduled for periodic PK and pharmacodynamic sample collection throughout the study.
- caffeine- or xanthine- containing products e.g., coffee, tea, cola drinks, and chocolate
- Dose modifications may be made for individual participants, based on safety findings for that participant. After Cycle 1, participants may have their belantamab or belantamab mafodotin dose reduced or delayed due to toxicities, including corneal events/toxicity. [00439] If a dose is delayed, the participant should wait for the next scheduled dose to resume treatment. In individual cases, where in the judgment of the investigator waiting a full cycle to resume treatment after delay (skipping dose) related to toxicity which has resolved would be detrimental to the participant’s health, the investigator should contact the Medical Monitor to discuss an earlier re-start. An earlier re-start may be considered only for participants who have recovered from toxicity to at most Grade 1.
- Part 1 the decision to proceed to the next dose level of belantamab (either an increase or a decrease) will be made by the DEC based on safety, tolerability, and preliminary PK data obtained in participants at the prior dose level.
- mice Female severe combined immunodeficient (SCID) mice were nine weeks old with a body weight range of 15.6 to 23.8 grams on Day 1 of the study.
- H929 human plasmacytoma cell line was obtained from the American Type Culture Collection (ATCC). The cells were maintained as exponentially growing suspension cultures in RPMI 1640 medium supplemented with 20% fetal bovine serum, 2 mM glutamine, 50 pM mercaptoethanol, 100 units/mL sodium penicillin G, 100 pg/mL streptomycin sulfate, and 25 pg/mL gentamicin.
- the tumor cells were cultured in tissue culture flasks in a humidified incubator at 37 °C, in an atmosphere of 5% CO2 and 95% air.
- Example 4 Evaluation of soluble BCMA (sBCMA) levels in relapsed/refractory multiple myeloma (RRMM) patients treated with belantamab mafodotin
- Soluble BCMA (sBCMA) levels were analyzed as an exploratory endpoint in patients enrolled in a phase III open-label randomized clinical trial evaluating the safety and efficacy of single agent belantamab mafodotin compared to a combination of pomalidomide dexamethasone in participants with RRMM (DREAMM-3 study; NCT04162210).
- sBCMA Soluble BCMA
- Serum samples were obtained from patients in both study arms at the following timepoints relative to belantamab mafodotin infusion: pre-dose, at end of infusion, 2 hours postinfusion, 24 hours post-infusion, 4 days post- infusion, and 8-15 days post- infusion.
- sBCMA levels in cell supernatants were measured using a validated electrochemiluminescent immunoassay.
- sBCMA levels are impacted by treatment with belantamab mafodotin.
- Analysis of sBCMA levels in patients treated with belantamab mafodotin versus pom/dex demonstrated a difference in sBCMA levels between the two treatment arms with sBCMA levels being impacted specifically by belantamab mafodotin treatment compared to pom/dex treatment.
- progression free survival (PFS) of patients in the highest quartile (Q4) of baseline sBCMA levels was the lowest in both treatment arms, indicating a worse response to treatment.
- Belantamab mafodotin binds sBCMA in patient samples.
- sBCMA levels were measured at the end of infusion (EOI) of belantamab mafodotin in participants in the belantamab mafodotin treatment arm.
- EOI end of infusion
- Patient samples were obtained within 30 minutes following the end of infusion of belantamab mafodotin and sBCMA levels in the samples were measured. Based on sBCMA levels detected at EOI, it was determined that belantamab mafodotin substantially bound all sBCMA in the periphery at a dose level of 2.5 mg/kg. See FIG.
- sBCMA is immediately bound following belantamab mafodotin infusion, but sBCMA levels rebound 24 hours later.
- sBCMA levels were detected to be increasing in participants treated with belantamab mafodotin at 24 hours post-end of infusion (EOI) of belantamab mafodotin. While a linear decrease in sBCMA levels was observed, an exponential increase in sBCMA levels was observed 24 hours later suggesting that sBCMA rebound is non-linear with baseline level of sBCMA and follows a different pattern than the decrease of sBCMA levels (FIG. 6).
- sBCMA levels observed at 24 hours post-EOI is not due solely to dissociation of sBCMA from belantamab mafodotin because the half-life of sBCMA is approximately 24 hours suggesting that the majority of the increase in sBCMA levels is due to fresh shedding from tumor cells.
- patients with progressive disease (PD) had the highest baseline sBCMA levels, but there was a large overlap observed in baseline sBCMA levels between responders and nonresponders (FIG. 7A).
- Example 5 In Vivo Efficacy of Belantamab and Belantamab Mafodotin in the Treatment of Human Multiple Myeloma Xenograft Model in NOG Mice
- MM.1 S-Luc cancer cells were maintained in vitro with RMPI1640 medium supplemented with 10% fetal bovine serum and 1% sodium pyruvate + 1% L-glutamine + 1% penicillin-streptomycin at 37°C in an atmosphere of 5% CO2. The cells in exponential growth phase were harvested and quantitated by cell counter before tumor inoculation.
- Tumor inoculation Each mouse was inoculated intravenously via tail vein with MM.1S-Luc tumor cells (1 x 10 7 ) in 0.1 mL PBS for tumor development. Mice were imaged 7 days after tumor cell inoculation and randomly allocated to seven study groups.
- mice were dosed by intraperitoneal (ip) administration in the amount and at the frequency and duration shown in Table 11.
- Tumor monitoring Tumor growth was imaged twice per week by bioluminescent imaging. At 15 minutes prior to imaging, mice were injected subcutaneously with D-Luciferin (PerkinElmer, Catalog Number 122799) at 150 mg/kg. Mice were imaged on a PerkinElmer IVIS Lumina Series III in vivo imaging system.
- GSK2857916 in combination with GSK2857914 (Groups 3 and 4) and GSK2857916 in combination with nirogacestat (Group 5) significantly prolonged animals’ survival (Median Survival Day 54.5, 58.00, and 53.50, respectively), compared with vehicle control group (Median Survival Day 25.00).
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Abstract
The disclosure provides methods of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) by the administration of one or more BCMA antagonists.
Description
METHODS OF TREATMENT USING B-CELL MATURATION ANTIGEN
ANTAGONISTS
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application claims priority from U.S. Provisional Application No. 63/430,249, filed December 5, 2022, the entire contents of which is incorporated herein by reference.
FIELD
[0002] The present disclosure generally relates to methods of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) by the administration of one or more BCMA antagonists.
BACKGROUND
[0003] B-cell maturation antigen (BCMA) is a cell surface receptor expressed in the plasmablast lineage and upregulated on various disease cell types including multiple myeloma (MM) cells. MM is an incurable malignant clonal plasma cell disorder and accounts for 1% of all cancers and for 10% of all hematologic malignancies globally. Patients with newly-diagnosed multiple myeloma (NDMM) have several treatment options available. Although almost 100% of patients will respond to first line treatment, the disease will eventually relapse, and patients will require further treatment. Duration of response and response rates decline dramatically with every subsequent line of treatment for this malignancy. Most patients with MM will ultimately develop resistance to existing therapies and die of relapse.
[0004] Belantamab mafodotin is a BCMA-directed antibody-drug conjugate (ADC) that is conjugated to a microtubule disrupting agent, monomethyl auristatin-F (MMAF) and has demonstrated antitumor activity in MM cells. Belantamab mafodotin is produced in an afucosylated form, which enhances interaction with the FcyRIIIa receptor. This enhanced interaction increases antibody-dependent cellular cytotoxicity (ADCC) and antibody-dependent cellular phagocytosis (ADCP) activities, including against MM cells. Thus, belantamab mafodotin possesses a dual anti-tumor activity via delivery of the MMAF cytotoxin, as well as through
ADCC/ADCP. Ocular toxicity has been reported for belantamab mafodotin, as well as in other MMAF containing ADCs, leading to dose delays and dose reductions. Therefore, there is a need for additional therapies for treatment of MM and other diseases associated with abnormal BCMA expression with manageable toxicity.
SUMMARY
[0005] In one aspect, the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering to the patient belantamab at a dose of about 300 mg to about 2000 mg.
[0006] In one aspect, the disclosure provides the use of belantamab in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) by administration of belantamab at a dose of about 300 mg to about 2000 mg.
[0007] In one aspect, the disclosure provides use of belantamab in the manufacture of a medicament for use in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) by administration of belantamab at a dose of about 300 mg to about 2000 mg.
[0008] In an embodiment, the dose is about 300 mg, about 900 mg, or about 2000 mg. In an embodiment, the dose is administered at a regular interval for a period of time. In an embodiment, the dose is administered once every week ± 3 days to once every four weeks ± 3 days. In an embodiment, the dose is administered once every two weeks ± 3 days. In an embodiment, the dose is administered once every three weeks ± 3 days. In an embodiment, the dose is administered once every four weeks ± 3 days. In an embodiment, the dose is administered on days 1 and 15 of a 28 day cycle. In an embodiment, the dose is administered on day 1 of a 21 day cycle.
[0009] In an embodiment, the patient has been treated with at least one prior line of cancer treatment. In an embodiment, the patient has been treated with one, two, three, or four prior lines of cancer treatments. In an embodiment, the prior lines of cancer treatments include an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent.
[0010] In an embodiment, belantamab is administered through an intravenous infusion or a subcutaneous injection.
[0011] In an embodiment, the patient is further receiving at least one additional cancer treatment, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an
immunomodulatory agent, or an anti-PD-1 monoclonal antibody. In an embodiment, the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone. In an embodiment, the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time. In an embodiment, the patient is receiving lenalidomide on days 1-21 of a 28 day cycle. In an embodiment, the additional cancer treatment is dexamethasone. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly. In an embodiment, the patient is receiving dexamethasone on days 1, 8, 15, and 22 of a 28 day cycle. In an embodiment, (i) the patient is less than 75 years old and is receiving dexamethasone at a dose of 40 mg once weekly; or (ii) the patient is at least 75 years old and is receiving dexamethasone at a dose of 20 mg once weekly. In an embodiment, (i) the patient has a BMI of at least 18.5 and is receiving dexamethasone at a dose of 40 mg once weekly; or (ii) the patient has a BMI less than 18.5 and is receiving dexamethasone at a dose of 20 mg once weekly. [0012] In an embodiment, the method or use further comprises discontinuing administration of belantamab and subsequently administering belantamab mafodotin. In an embodiment, the method or use further comprises administering belantamab mafodotin and subsequently discontinuing administration of belantamab. In an embodiment, belantamab mafodotin is administered at a dose of 2.5 mg/kg once every three weeks ± 3 days.
[0013] In an embodiment, the method or use further comprises administering a lead-in dose of belantamab mafodotin prior to beginning administration of belantamab, wherein the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 3.4 mg/kg once during a lead-in period. In an embodiment, the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 1.9 mg/kg once during a lead-in period. In an embodiment, the lead-in dose of belantamab mafodotin is about 1.4 mg/kg, about 1.9 mg/kg, about 2.5 mg/kg, or about 3.4 mg/kg once during a lead-in period. In an embodiment, the lead-in dose of belantamab mafodotin is about 1.4 mg/kg once during a lead- in period. In an embodiment, the lead-in period is four weeks ± 3 days and belantamab mafodotin is administered on day 1 of the lead-in period.
[0014] In an embodiment, the method or use further comprises administering at least one additional cancer treatment to the patient during the lead-in period, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody. In an embodiment, the additional cancer treatment is selected from
lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone. In an embodiment, the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time. In an embodiment, lenalidomide is administered to the patient on days 1-21 of the lead-in period. In an embodiment, lenalidomide is administered to the patient on days 1-21 of the lead-in period and the lead-in period is four weeks ± 3 days. In an embodiment, lenalidomide is administered to the patient on days 1-21 of the lead-in period and the lead-in period is 28 days. In an embodiment, the additional cancer treatment is dexamethasone. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly. In an embodiment, dexamethasone is administered to the patient on days 1, 8, 15, and 22 of the lead-in period. In an embodiment, dexamethasone is administered to the patient on days 1, 8, 15, and 22 of the lead-in period and the lead-in period is four weeks ± 3 days. In an embodiment, dexamethasone is administered to the patient on days 1, 8, 15, and 22 of the lead-in period and the lead-in period is 28 days. In an embodiment, (i) the patient is less than 75 years old and dexamethasone is administered to the patient at a dose of 40 mg once weekly; or (ii) the patient is at least 75 years old and dexamethasone is administered to the patient at a dose of 20 mg once weekly. In an embodiment, (i) the patient has a BMI of at least 18.5 and dexamethasone is administered to the patient at a dose of 40 mg once weekly; or (ii) the patient has a BMI less than 18.5 and dexamethasone is administered to the patient at a dose of 20 mg once weekly.
[0015] In one aspect, the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering to a patient belantamab mafodotin at a dose of about 1.4 mg/kg to about 3.4 mg/kg once every eight weeks ± 3 days, such as about 1.4 mg/kg to about 1.9 mg/kg once every eight weeks ± 3 days.
[0016] In one aspect, the disclosure provides the use of belantamab mafodotin in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) by administration of belantamab mafodotin at a dose of about 1.4 mg/kg to about 3.4 mg/kg once every eight weeks ± 3 days, such as about 1.4 mg/kg to about 1.9 mg/kg once every eight weeks ± 3 days.
[0017] In one aspect, the disclosure provides use of belantamab mafodotin in the manufacture of a medicament for use in the treatment of a disease or disorder responsive to inhibiting or
blocking B-cell maturation antigen (BCMA) by administration of belantamab mafodotin at a dose of about 1.4 mg/kg to about 3.4 mg/kg once every eight weeks ± 3 days, such as about 1.4 mg/kg to about 1.9 mg/kg once every eight weeks ± 3 days.
[0018] In an embodiment, the dose is about 1.4 mg/kg, about 1.9 mg/kg, about 2.5 mg/kg, or about 3.4 mg/kg once every eight weeks ± 3 days. In one aspect, the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering a therapeutically effective amount of a combination comprising a first BCMA antagonist and a second BCMA antagonist to the patient. [0019] In one aspect, the disclosure provides the use of a combination comprising a first BCMA antagonist and a second BCMA antagonist to the patient in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA).
[0020] In one aspect, the disclosure provides use of a combination comprising a first BCMA antagonist and a second BCMA antagonist in the manufacture of a medicament for use in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA).
[0021] In an embodiment, the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti- BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy. In an embodiment, the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712. In an embodiment, the first BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody. In an embodiment, the anti-BCMA antibody-drug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab.
[0022] In one aspect, the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method
comprising administering a therapeutically effective amount of a combination comprising belantamab mafodotin and belantamab to the patient.
[0023] In one aspect, the disclosure provides the use of a combination comprising belantamab mafodotin and belantamab in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA).
[0024] In one aspect, the disclosure provides use of a combination comprising belantamab mafodotin and belantamab in the manufacture of a medicament for use in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA).
[0025] In an embodiment, the method or use further comprises administering at least one additional cancer treatment to the patient, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody. In an embodiment, the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
[0026] In one aspect, the disclosure provides a kit comprising: (i) a first B-cell maturation antigen (BCMA) antagonist; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking BCMA when combined with a second BCMA antagonist.
[0027] In one aspect, the disclosure provides a kit comprising: (i) belantamab mafodotin; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) when combined with belantamab.
[0028] In one aspect, the disclosure provides a kit comprising: (i) belantamab; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) when combined with belantamab mafodotin.
[0029] In one aspect, the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with a first BCMA antagonist, the method comprising administering a therapeutically effective amount of a second BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist. [0030] In one aspect, the disclosure provides the use of a second BCMA antagonist in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen
(BCMA) in a patient previously treated with a first BCMA antagonist wherein administration of the first BCMA antagonist is discontinued prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
[0031] In one aspect, the disclosure provides use of a second BCMA antagonist in the manufacture of a medicament for the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with a first BCMA antagonist wherein administration of the first BCMA antagonist is discontinued prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
[0032] In an embodiment, the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti- BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy. In an embodiment, the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712. In an embodiment, the first BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is belantamab. In an embodiment, the second BCMA antagonist is belantamab mafodotin. In an embodiment, the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is an anti- BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody. In an embodiment, the anti-BCMA antibody-drug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab. In an embodiment, the second BCMA antagonist is an anti-BCMA antibody-drug conjugate and the first BCMA antagonist is the corresponding unconjugated anti- BCMA antibody. In an embodiment, the anti-BCMA antibody-drug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712. In an embodiment, the second BCMA antagonist is belantamab mafodotin and the first BCMA antagonist is belantamab. [0033] In one aspect, the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously
treated with belantamab mafodotin, the method comprising administering a therapeutically effective amount of belantamab to the patient, wherein the patient discontinued administration of belantamab mafodotin prior to beginning administration of belantamab.
[0034] In one aspect, the disclosure provides the use of belantamab in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab mafodotin, wherein administration of belantamab mafodotin is discontinued prior to beginning administration of belantamab.
[0035] In one aspect, the disclosure provides use of belantamab for use in the manufacture of a medicament for use in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab mafodotin, wherein administration of belantamab mafodotin is discontinued prior to beginning administration of belantamab.
[0036] In one aspect, the disclosure provides a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab, the method comprising administering a therapeutically effective amount of belantamab mafodotin to the patient, wherein the patient discontinued administration of belantamab prior to beginning administration of belantamab mafodotin.
[0037] In one aspect, the disclosure provides the use of belantamab mafodotin in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab wherein administration of belantamab is discontinued prior to beginning administration of belantamab mafodotin.
[0038] In one aspect, the disclosure provides use of belantamab mafodotin in the manufacture of a medicament for use in the treatment of a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab wherein administration of belantamab is discontinued prior to beginning administration of belantamab mafodotin.
[0039] In an embodiment, the methods or uses further comprise administering at least one additional cancer treatment to the patient, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody. In an embodiment, the additional cancer treatment is selected from lenalidomide, dexamethasone,
daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
[0040] In one aspect, the disclosure provides a method of reducing corneal toxicity in a patient previously treated with a first B-cell maturation antigen (BCMA) antagonist, the method comprising administering a therapeutically effective amount of a second BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
[0041] In one aspect, the disclosure provides the use of a second BCMA antagonist for the reduction of corneal toxicity in a patient previously treated with a first B-cell maturation antigen (BCMA) antagonist, wherein administration of the first BCMA antagonist is discontinued prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
[0042] In one aspect, the disclosure provides use of a second BCMA antagonist in the manufacture of a medicament for use in the reduction of corneal toxicity in a patient previously treated with a first B-cell maturation antigen (BCMA) antagonist, wherein administration of the first BCMA antagonist is discontinued prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
[0043] In an embodiment, the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti- BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy. In an embodiment, the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712. In an embodiment, the first BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is belantamab. In an embodiment, the second BCMA antagonist is belantamab mafodotin. In an embodiment, the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is an anti- BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody. In an embodiment, the anti-BCMA antibody-drug conjugate
is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab. In an embodiment, the second BCMA antagonist is an anti-BCMA antibody-drug conjugate and the first BCMA antagonist is the corresponding unconjugated anti- BCMA antibody. In an embodiment, the anti-BCMA antibody-drug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712. In an embodiment, the second BCMA antagonist is belantamab mafodotin and the first BCMA antagonist is belantamab. [0044] In one aspect, the disclosure provides a method of reducing corneal toxicity in a patient previously treated with belantamab mafodotin, the method comprising administering a therapeutically effective amount of belantamab to the patient, wherein the patient discontinued administration of belantamab mafodotin prior to beginning administration of belantamab.
[0045] In one aspect, the disclosure provides the use of belantamab for the reduction of corneal toxicity in a patient previously treated with belantamab mafodotin, wherein the patient discontinued administration of belantamab mafodotin prior to beginning administration of belantamab.
[0046] In one aspect, the disclosure provides use of belantamab in the manufacture of a medicament for use in the reduction of corneal toxicity in a patient previously treated with belantamab mafodotin, wherein the patient discontinued administration of belantamab mafodotin prior to beginning administration of belantamab.
[0047] In one aspect, the disclosure provides a method of reducing corneal toxicity in a patient previously treated with belantamab, the method comprising administering a therapeutically effective amount of belantamab mafodotin to the patient, wherein the patient discontinued administration of belantamab prior to beginning administration of belantamab mafodotin.
[0048] In one aspect, the disclosure provides the use of belantamab mafodotin for the reduction of corneal toxicity in a patient previously treated with belantamab, wherein the patient discontinued administration of belantamab prior to beginning administration of belantamab mafodotin.
[0049] In one aspect, the disclosure provides use of belantamab mafodotin in the manufacture of a medicament for use in the reduction of corneal toxicity in a patient previously treated with belantamab, wherein the patient discontinued administration of belantamab prior to beginning administration of belantamab mafodotin.
[0050] In an embodiment, the methods and uses further comprise administering at least one additional cancer treatment to the patient, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody. In an embodiment, the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
[0051] In one aspect, the disclosure provides a method of treating a disease or disorder in a patient, the method comprising administering a therapeutically effective amount of a combination comprising an antibody-drug conjugate and the corresponding unconjugated antibody.
[0052] In one aspect, the disclosure provides the use of a combination comprising an antibodydrug conjugate and the corresponding unconjugated antibody in the treatment of a disease or disorder.
[0053] In one aspect, the disclosure provides use of a combination comprising an antibodydrug conjugate and the corresponding unconjugated antibody for use in the manufacture of a medicament for the treatment of a disease or disorder.
[0054] In one aspect, the disclosure provides a method of treating a disease or disorder in a patient previously treated with an antibody-drug conjugate, the method comprising administering a therapeutically effective amount of the corresponding unconjugated antibody to the patient, wherein the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody.
[0055] In one aspect, the disclosure provides the use of an antibody in the treatment of a disease or disorder in a patient previously treated with an antibody-drug conjugate, wherein the antibody is the corresponding unconjugated antibody and the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody.
[0056] In one aspect, the disclosure provides use of an antibody in the manufacture of a medicament for use in the treatment of a disease or disorder in a patient previously treated with an antibody-drug conjugate, wherein the antibody is the corresponding unconjugated antibody and the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody.
[0057] In an embodiment, the antibody-drug conjugate is selected from gemtuzumab ozogamicin, brentuximab vedotin, ado-trastuzumab emtansine, inotuzumab ozogamicin, polatuzumab vedotin, enfortumab vedotin, fam-trastuzumab deruxtecan, sacituzumab govitecan, belantamab mafodotin, loncastuximab tesirine, tisotumab vedotin, moxetumomab pasudotox, MEDI2228, or CC99712.
[0058] In an embodiment, the disease or disorder is a plasma cell disorder or a B-cell disorder. In an embodiment, the disease or disorder is a BCMA-expressing cancer. In an embodiment, the disease or disorder is multiple myeloma (MM). In an embodiment, the MM is relapsed and/or refractory MM, newly-diagnosed MM, transplant-ineligible MM, or transplant-ineligible newly- diagnosed MM. In an embodiment, the MM is relapsed and/or refractory MM, newly-diagnosed MM, transplant-ineligible MM, or transplant-ineligible newly-diagnosed MM.
[0059] In one aspect, the disclosure provides a method of treating cancer in a patient, wherein the patient has a Grade 1 corneal adverse reaction resulting from belantamab mafadotin administration, the method comprising temporarily discontinuing administration of belantamab mafadotin; administering to the patient a therapeutically effective amount of belantamab for a lead- in period; and resuming administration of belantamab mafadotin after the lead-in period.
[0060] In one aspect, the disclosure provides the use of belantamab in the treatment of cancer in a patient, wherein the patient has a Grade 1 corneal adverse reaction resulting from belantamab mafadotin administration, wherein belantamab mafadotin is temporarily discontinued for a lead- in period during which belantamab is administered, followed by resuming administration of belantamab mafadotin after the lead-in period.
[0061] In one aspect, the disclosure provides use of belantamab in the manufacture of a medicament for use in the treatment of cancer in a patient, wherein the patient has a Grade 1 corneal adverse reaction resulting from belantamab mafadotin administration, wherein belantamab mafadotin is temporarily discontinued for a lead-in period during which belantamab is administered, followed by resuming administration of belantamab mafadotin after the lead-in period.
[0062] In one aspect, the disclosure provides a method of treating cancer in a patient, wherein the patient has a Grade 2 or above corneal adverse reaction resulting from belantamab mafodotin administration, the method comprising temporarily discontinuing administration of belantamab
mafadotin; administering to the patient a therapeutically effective amount of belantamab for a lead- in period; and resuming administration of belantamab mafadotin after the lead-in period.
[0063] In one aspect, the disclosure provides the use of belantamab in the treatment of cancer in a patient, wherein the patient has a Grade 2 or above corneal adverse reaction resulting from belantamab mafadotin administration, wherein belantamab mafadotin is temporarily discontinued for a lead-in period during which belantamab is administered, followed by resuming administration of belantamab mafadotin after the lead-in period.
[0064] In one aspect, the disclosure provides use of belantamab in the manufacture of a medicament for use in the treatment of cancer in a patient, wherein the patient has a Grade 2 or above corneal adverse reaction resulting from belantamab mafadotin administration, wherein belantamab mafadotin is temporarily discontinued for a lead-in period during which belantamab is administered, followed by resuming administration of belantamab mafadotin after the lead-in period.
[0065] It is understood that any and all embodiments of the present disclosure may be taken in combination with any other embodiment or embodiments to describe additional more preferred embodiments. It is also to be understood that each individual element of the preferred embodiments is its own independent preferred embodiment. Furthermore, any element of an embodiment is meant to be combined with any and all other elements from any embodiment to describe an additional embodiment.
BRIEF DESCRIPTION OF THE FIGURES
[0066] FIG. 1 is a graph depicting tumor volume growth curves for all treatment groups as a function of study day, as described in Example 1.
[0067] FIG. 2 is a graph depicting Kaplan-Meier survival curves for all treatment groups as a function of study day, as described in Example 1.
[0068] FIG. 3 is a graph depicting tumor volume growth with different drug to antibody ratios (DARs) as a function of study day, as described in Example 3.
[0069] FIG. 4 are graphs depicting progression free survival of patients grouped according to sBCMA levels for the belantamab mafodotin treatment arm (left) and pom/dex treatment arm (right), as described in Example 4.
[0070] FIG. 5 is a graph depicting the level of reduction of sBCMA from pre-dosing with belantamab mafodotin to end of infusion (EOI) for cycle 1, day 1 of belantamab mafodotin treatment, as described in Example 4.
[0071] FIG. 6 is a graph depicting level of sBCMA 24 hours post-end of infusion (EOI) of belantamab mafodotin, as described in Example 4.
[0072] FIGs. 7A and 7B are graphs depicting sBCMA levels in patients grouped according to response to treatment with belantamab mafodotin, as described in Example 4. FIG. 7A shows baseline sBCMA levels prior to administration of belantamab mafodotin; and FIG. 7B shows sBCMA levels 24 hours post-EOI of belantamab mafodotin. CR= complete response; VGPR= very good partial response; PR= partial response; MR /SD = minimal response/stable disease ; PD/NE = progressive disease/non-evaluable.
[0073] FIG. 8 is a graph depicting the mean tumor volume curves of vehicle control and treatment groups between randomization and study termination of the in vivo efficacy study of belantamab and belantamab mafodotin in human multiple myeloma xenograft NOG mice, as described in Example 5.
[0074] FIG. 9 is a graph showing the Kaplan-Meier survival curves for all treatment groups as a function of study day of the in vivo efficacy study of belantamab and belantamab mafodotin in human multiple myeloma xenograft NOG mice, as described in Example 5.
DETAILED DESCRIPTION
Definitions
[0075] As used herein and in the claims, the term “comprising” encompasses “including” or “consisting,” e.g., a composition “comprising” X may consist exclusively of X or may include something additional, e.g., X + Y.
[0076] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure pertains. Although any compositions and methods similar or equivalent to those described herein can be used in the practice or testing of the methods of the disclosure, exemplary compositions and methods are described herein. Any of the aspects and embodiments of the disclosure described herein may also be combined. For example, the subject matter of any dependent or independent claim disclosed herein may be multiply combined (e.g., one or more recitations from each
dependent claim may be combined into a single claim based on the independent claim on which they depend).
[0077] Ranges provided herein include all values within a particular range described and values about an endpoint for a particular range. The figures and tables of the disclosure also describe ranges, and discrete values, which may constitute an element of any of the methods and uses disclosed herein.
[0078] Concentrations described herein are determined at ambient temperature and pressure. This may be, for example, the temperature and pressure at room temperature or within a particular portion of a process stream. Preferably, concentrations are determined at a standard state of 25 °C and 1 bar of pressure.
[0079] The term “antigen binding protein” as used herein refers to antibodies and other protein constructs, such as domains, which are capable of binding to the antigen.
[0080] The term “antibody” is used herein in the broadest sense to refer to molecules with an immunoglobulin-like domain (for example IgG, IgM, IgA, IgD or IgE) and includes monoclonal, recombinant, polyclonal, chimeric, human, humanised, multispecific antibodies, including bispecific antibodies, and heteroconjugate antibodies; a single variable domain (e.g., a domain antibody (DAB)), antigen binding antibody fragments, Fab, F(ab’)2, Fv, disulphide linked Fv, single chain Fv, disulphide-linked scFv, diabodies, TANDABS, etc. and modified versions of any of the foregoing (for a summary of alternative “antibody” formats see Holliger and Hudson, Nature Biotechnology, 2005, Vol 23, No. 9, 1126-1136).
[0081] The term, full, whole or intact antibody, used interchangeably herein, refers to a heterotetrameric glycoprotein with an approximate molecular weight of 150,000 daltons. An intact antibody is composed of two identical heavy chains (HCs) and two identical light chains (LCs) linked by covalent disulphide bonds. This H2L2 structure folds to form three functional domains comprising two antigen-binding fragments, known as ‘Fab’ fragments, and a ‘Fc’ crystallisable fragment. The Fab fragment is composed of the variable domain at the amino-terminus, variable heavy (VH) or variable light (VL), and the constant domain at the carboxyl terminus, CHI (heavy) and CL (light). The Fc fragment is composed of two domains formed by dimerization of paired CH2 and CH3 regions. The Fc may elicit effector functions by binding to receptors on immune cells or by binding Clq, the first component of the classical complement pathway. The five classes of antibodies IgM, IgA, IgG, IgE and IgD are defined by distinct heavy chain amino acid
sequences, which are called p, a, y, s and 5 respectively, each heavy chain can pair with either a K or X light chain. The majority of antibodies in the serum belong to the IgG class, there are four isotypes of human IgG (IgGl, IgG2, IgG3 and IgG4), the sequences of which differ mainly in their hinge region.
[0082] Fully human antibodies can be obtained using a variety of methods, for example using yeast-based libraries or transgenic animals (e.g. mice) that are capable of producing repertoires of human antibodies. Yeast presenting human antibodies on their surface that bind to an antigen of interest can be selected using FACS (Fluorescence-Activated Cell Sorting) based methods or by capture on beads using labelled antigens. Transgenic animals that have been modified to express human immunoglobulin genes can be immunized with an antigen of interest and antigen-specific human antibodies isolated using B-cell sorting techniques. Human antibodies produced using these techniques can then be characterized for desired properties such as affinity, developability and selectivity.
[0083] Alternative antibody formats include alternative scaffolds in which the one or more CDRs of the antigen binding protein can be arranged onto a suitable non-immunoglobulin protein scaffold or skeleton, such as an affibody, a SpA scaffold, an LDL receptor class A domain, an avimer (see, e.g., U.S. Patent Application Publication Nos. 2005/0053973, 2005/0089932, 2005/0164301) or an EGF domain.
[0084] The term “anti-BCMA antigen binding protein” as used herein refers to antibodies and other protein constructs, such as domains, which are capable of binding to BCMA. The terms “BCMA binding protein” and “anti-BCMA antigen binding protein” are used interchangeably herein.
[0085] The anti-BCMA antigen binding proteins described herein may bind to human BCMA having, including, for example, human BCMA containing the amino acid sequence of GenBank Accession Number Q02223.2, or genes encoding human BCMA having at least 90 percent homology or at least 90 percent identity thereto.
[0086] Exemplary anti-BCMA antigen binding proteins and methods of making the same are disclosed in International Publication No. WO2012/163805 which is incorporated by reference herein in its entirety. Additional exemplary anti-BCMA antigen binding proteins include those described in WO2016/014789, WO2016/090320, WO2016/090327, W02016/020332, WO2016/079177, WO2014/122143, WO2014/122144, WO2017/021450, WO2016/014565,
WO20 14/068079, WO2015/166649, WO2015/158671, WO2015/052536, WO2014/140248, WO2013/072415, WO2013/072406, WO2014/089335, US2017/165373, WO2013/154760, W02018/201051 and W02017/051068, each of which is incorporated by reference herein in its entirety.
[0087] In some embodiments, a BCMA binding protein disclosed herein may be derived from rat, mouse, primate (e.g., cynomolgus, Old World monkey or Great Ape) or human. The BCMA binding protein may be a human, humanized or chimeric antibody. The BCMA binding protein may comprise a constant region, which may be of any isotype or subclass. The constant region may be of the IgG isotype, for example IgGl, IgG2, IgG3, IgG4 or variants thereof. The BCMA binding protein constant region may be IgGl .
[0088] Accordingly, a BCMA binding protein is provided, which can comprise any one or a combination of the following CDRs: CDRH1 of SEQ ID NO: 5, CDRH2 of SEQ ID NO: 6, CDRH3 of SEQ ID NO: 7, CDRL1 of SEQ ID NO: 8, CDRL2 of SEQ ID NO: 9, CDRL3 of SEQ ID NO: 10. CDRs may be modified by at least one amino acid substitution, deletion or addition, wherein the variant antigen binding protein substantially retains the biological characteristics of the unmodified protein, such as binding to the antigen.
[0089] In some embodiments, the anti-BCMA antigen binding protein comprises CDRH1 according to SEQ ID NO: 5, CDRH2 according to SEQ ID NO: 6, CDRH3 according to SEQ ID NO: 7, CDRL1 according to SEQ ID NO: 8, CDRL2 according to SEQ ID NO: 9, and CDRL3 according to SEQ ID NO: 10.
[0090] In some embodiments, the anti-BCMA antigen binding protein comprises a heavy chain variable region (VH) according to SEQ ID NO: 3 and a light chain variable region (VL) according to SEQ ID NO: 4.
[0091] In some embodiments, the anti-BCMA antigen binding protein comprises a heavy chain (H) according to SEQ ID NO: 1 and a light chain (L) according to SEQ ID NO: 2.
[0092] In some embodiments, the anti-BCMA antigen binding protein is a T-cell redirecting antibody (BiTE) with dual inhibition of BCMA and CD3 receptors, such as teclistamab (Pillarisetti et al., Blood Advances 4, 4538-49, 2020) and blinatumomab, AMG 424, GBR 1342, BFR4350A, AMG 420, AMG 701, elranatamab (PF-06863135), REGN5458, TNB-383B (Alhallak et al., Cancers 13, 2853, 2021). In some embodiments, the anti-BCMA antigen binding protein is a non-
fucosylated BCMA-directed antibody, such as SEA-BCMA (Van Epps et al., Cancer Res 2018;78(13 Suppl) Abstract nr 3833).
[0093] In some embodiments, the anti-BCMA antigen binding protein is a CAR-T cell Therapeutic.
[0094] In some embodiments, the anti-BCMA antigen binding protein is used in an immunoconjugate. An “immunoconjugate” (interchangeably referred to as an “antibody-drug conjugate,” “ADC,” or “antigen binding protein-drug conjugate) comprises an anti-BCMA antigen binding protein conjugated to one or more drugs, such as a cytotoxic agent, such as a chemotherapeutic agent, an immunotherapeutic agent, a growth inhibitory agent, a toxin (e.g., a protein toxin, such as an enzymatically active toxin of bacterial, fungal, plant, or animal origin, or fragments thereof), an antiviral agent, a radioactive isotope (i.e., a radioconjugate), an antibiotic, or a small interfering RNA (siRNA).
[0095] In some cases, the anti-BCMA antigen binding protein can be an immunoconjugate having the following general structure:
ABP-((Linker)n-Ctx)m wherein
ABP is an antigen binding protein
Linker is either absent or any a cleavable or non-cleavable linker
Ctx is any cytotoxic agent described herein n is 0, 1 , 2, or 3 and m is 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10.
[0096] Exemplary linkers may include 6- maleimidocaproyl (MC), maleimidopropanoyl (MP), valine-citrulline (val-cit), alanine- phenylalanine (ala-phe), p-aminobenzyloxycarbonyl (PAB), N-Succinimidyl 4-(2- pyridylthio)pentanoate (SPP), N-succinimidyl 4-(N- maleimidomethyl)cyclohexane-l carboxylate (SMCC), and N-succinimidyl (4-iodo-acetyl) aminobenzoate (SIAB).
[0097] In some cases, the anti-BCMA antigen binding protein can be an immunoconjugate containing a monoclonal antibody linked to MMAE or MMAF. In another embodiment, the anti- BCMA antigen binding protein can be an immunoconjugate containing a monoclonal antibody linked to MMAE or MMAF by an MC linker as depicted in the following structures:
wherein “p” is the drug-antibody ratio (DAR) and is an integer of 1 to 8, such as 2, 4, 6, or 8. [0098] In some cases, the anti-BCMA antigen binding protein can be the antibody belantamab. In another embodiment, the anti-BCMA antigen binding protein can be the immunoconjugate belantamab mafodotin.
[0099] In some embodiments, a BCMA antagonist is a BCMA-targeted chimeric antigen receptor (CAR)-T cell therapy. The term “chimeric antigen receptor” (“CAR”) as used herein, refers to an engineered receptor that consists of an extracellular antigen binding domain (usually derived from a monoclonal antibody, or antigen binding fragment thereof, e.g. a VH domain and a VL domain in the form of a scFv), optionally a spacer region, a transmembrane region, and one or more intracellular effector domains. CARs have also been referred to as chimeric T cell receptors or chimeric immunoreceptors (CIRs). CARs are genetically introduced into hematopoietic cells, such as T cells, to redirect T cell specificity for a desired cell-surface antigen, resulting in a CAR-T therapeutic.
[00100] The term “spacer region” as used herein, refers to an oligo- or polypeptide that functions to link the transmembrane domain to the target binding domain. This region may also be referred to as a “hinge region” or “stalk region”. The size of the spacer can be varied depending on the position of the target epitope in order to maintain a set distance (e.g. 14 nm) upon CAR: target binding.
[00101] The term “transmembrane domain” as used herein, refers to the part of the CAR molecule that traverses the cell membrane.
[00102] The term “intracellular effector domain” (also referred to as the “signalling domain”) as used herein refers to the domain in the CAR that is responsible for intracellular signalling
following the binding of the antigen binding domain to the target. The intracellular effector domain is responsible for the activation of at least one of the normal effector functions of the immune cell in which the CAR is expressed. For example, the effector function of a T cell can be a cytolytic activity or helper activity including the secretion of cytokines.
[00103] It will be appreciated by a person skilled in the art that VH and/or VL domains disclosed herein may be incorporated, e.g. in the form of a scFv, into CAR-T therapeutics.
[00104] “ CDRs” are defined as the complementarity determining region amino acid sequences of an antigen binding protein. These are the hypervariable regions of immunoglobulin heavy and light chains. There are three heavy chain and three light chain CDRs (or CDR regions) in the variable portion of an immunoglobulin. Thus, “CDRs” as used herein refers to all three heavy chain CDRs, all three light chain CDRs, all heavy and light chain CDRs, or at least two CDRs.
[00105] Throughout this specification, amino acid residues in variable domain sequences and variable domain regions within full-length antigen binding sequences, e.g. within an antibody heavy chain sequence or antibody light chain sequence, are numbered according to the Kabat numbering convention. Similarly, the terms “CDR”, “CDRL1”, “CDRL2”, “CDRL3”, “CDRH1”, “CDRH2”, “CDRH3” follow the Kabat numbering convention. For further information, see Kabat et al., Sequences of Proteins of Immunological Interest, 4th Ed., U.S. Department of Health and Human Services, National Institutes of Health (1987).
[00106] It will be apparent to those skilled in the art that there are alternative numbering conventions for amino acid residues in variable domain sequences and full-length antibody sequences. There are also alternative numbering conventions for CDR sequences, for example those set out in Chothia et al. (1989) Nature 342: 877-883. The structure and protein folding of the antigen binding protein may mean that other residues are considered part of the CDR sequence and would be understood to be so by a skilled person.
[00107] Other numbering conventions for CDR sequences available to a skilled person include “AbM” (University of Bath) and “contact” (University College London) methods.
[00108] Table 1 below represents one definition using each numbering convention for each CDR or binding unit. It should be noted that some of the CDR definitions may vary depending on the individual publication used.
Table 1
[00109] An immunoconjugate (interchangeably referred to as an “antibody-drug conjugate,” “ADC” or “antigen binding protein-drug conjugate”) comprises an antigen binding protein (e.g., an antibody or antigen binding fragment thereof) conjugated to one or more drugs, such as a cytotoxic agent, such as a chemotherapeutic agent, an immunotherapeutic agent, a growth inhibitory agent, a toxin (e.g., a protein toxin, such as an enzymatically active toxin of bacterial, fungal, plant, or animal origin, or fragments thereof), an antiviral agent, a radioactive isotope (i.e., a radioconjugate), an antibiotic, or a small interfering RNA (siRNA).
[00110] Immunoconjugates have been used for the local delivery of cytotoxic agents, i.e., drugs that kill or inhibit the growth or proliferation of cells, in the treatment of cancer (Lambert, J. (2005) Curr. Opinion in Pharmacology 5:543-549; Wu et al. (2005) Nature Biotechnology 23(9): 1137- 1146; Payne, G. (2003) Cancer Cell 3:207-212; Syrigos andEpenetos (1999) Anticancer Research 19:605-614; Niculescu-Duvaz and Springer (1997) Adv. Drug Deliv. Rev. 26:151-172; U.S. Pat. No. 4,975,278). Immunoconjugates allow for, inter alia, the targeted delivery of a drug moiety to a tumor, and intracellular accumulation therein, where systemic administration of unconjugated drugs may result in unacceptable levels of toxicity to normal cells (Tsuchikama and An, Protein and Cell, (2018) 9: 33-46). Immunoconjugates can enable selective delivery of a potent cytotoxic payload to target cancer cells, resulting in improved efficacy, reduced systemic toxicity, and preferable pharmacokinetics (PK)/pharmacodynamics (PD) and biodistribution compared to traditional chemotherapy (Tsuchikama and An 2018); Beck A. et al (2017) Nature Rev. Drug Disc. 16: 315-337).
[00111] Both polyclonal antibodies and monoclonal antibodies have been reported as useful in these strategies (Rowland et al., (1986) Cancer Immunol. Immunother. 21 :183-87). Drugs used in these methods include daunomycin, doxorubicin, methotrexate, and vindesine (Rowland et al.,
(1986) supra). Toxins used in antibody-toxin conjugates include bacterial toxins such as diphtheria toxin, plant toxins such as ricin, small molecule toxins such as geldanamycin (Mandi er et al (2000) J. Nat. Cancer Inst. 92(19): 1573-1581 ; Mandler et al (2000) Bioorganic & Med. Chem. Letters 10: 1025-1028; Mandler et al (2002) Bioconjugate Chem. 13:786-791), maytansinoids (EP 1391213; Liu et al., (1996) Proc. Natl. Acad. Sci. USA 93:8618-8623), and calicheamicin (Lode et al (1998) Cancer Res. 58:2928; Hinman et al (1993) Cancer Res. 53:3336-3342).
[00112] In certain embodiments, an immunoconjugate comprises an antigen binding protein, such as an antibody, and a drug, such as toxin, such as a chemotherapeutic agent. The drug can be modified (e.g., via standard synthetic chemistry) to allow its chemical attachment (e.g., to contain a reaction handle to allow its chemical attachment) to a reactive end of a linker that joins the drug to the antigen binding protein.
[00113] Drugs, such as chemotherapeutic agents, useful in the generation of immunoconjugates are described herein. Enzymatically active toxins and fragments thereof that can be used include diphtheria A chain, nonbinding active fragments of diphtheria toxin, exotoxin A chain (from Pseudomonas aeruginosa), ricin A chain, abrin A chain, modeccin A chain, alpha-sarcin, Aleurites fordii proteins, dianthin proteins, Phytolaca americana proteins (PAPI, PAPII, and PAP-S), momordica charantia inhibitor, curcin, crotin, sapaonaria officinalis inhibitor, gelonin, mitogellin, restrictocin, phenomycin, enomycin, and the tricothecenes. See, e.g., WO 93/21232 published Oct. 28, 1993.
[00114] In addition to toxins, a radioactive material, such as a radionucleotide, may be used as the drug in an ADC. A variety of radionucleotides are available for the production of radioconjugated antibodies. Examples include 212Bi, 1311, 131In, 90Y, and 186Re.
[00115] Antigen binding proteins (such as antibodies) may also be conjugated to one or more toxins, including, but not limited to, a calicheamicin, a maytansinoid, a dolastatin, an aurostatin, a trichothecene, and CC1065, and a derivative of these toxins that have toxin activity. Suitable cytotoxic agents include, but are not limited to, an auristatin including dovaline-valine- dolaisoleunine-dolaproine-phenylalanine (MMAF) and monomethyl auristatin E (MMAE) as well as an ester form of MMAE, a DNA minor groove binding agent, a DNA minor groove alkylating agent, an enediyne, a lexitropsin, a duocarmycin, a taxane (such as paclitaxel and docetaxel), a puromycin, a dolastatin, a maytansinoid, and a vinca alkaloid. Specific cytotoxic agents include topotecan, morpholino-doxorubicin, rhizoxin, cyanomorpholino-doxorubicin, dolastatin- 10, 1
echinomycin, combretatstatin, chalicheamicin, maytansine, DM-1, DM-4, and netropsin. Other suitable cytotoxic agents include anti-tubulin agents, such as an auristatin, a vinca alkaloid, a podophyllotoxin, a taxane, a baccatin derivative, a cryptophysin, a maytansinoid, a combretastatin, or a dolastatin. Antitubulin agents include dimethylvaline-valine-dolaisoleuine-dolaproine- phenylalanine-p-phenylenediamine (AFP), MMAF, MMAE, auristatin E, vincristine, vinblastine, vindesine, vinorelbine, VP- 16, camptothecin, paclitaxel, docetaxel, epothilone A, epothilone B, nocodazole, colchicines, colcimid, estramustine, cemadotin, discodermolide, maytansine, DM-1, DM-4, and eleutherobin.
[00116] Antibody drug conjugates can be produced by conjugating the anti-tubulin agent monomethylauristatin E (MMAE) or monomethylauristatin F (MMAF) to an antigen binding protein (such as an antibody). In the case of MMAE, the linker can consist of a thiol-reactive maleimide, a caproyl spacer, the dipeptide valine-citrulline, or p-aminobenzyloxy carbonyl, a self- immolative fragmenting group. In the case of MMAF, a protease-resistant maleimidocaproyl linker can be used. The conjugation process leads to heterogeneity in drug-antibody attachment, varying in both the number of drugs bound to each antibody molecule (drug-antibody ratio [DAR]) and the site of attachment. The most prevalent species is the material with an DAR = 4; less prevalent are materials with DAR of 0, 2, 6, and 8. The overall average drug-to-antibody ratio (DAR) is approximately 4.
[00117] The term “progression” of tumor growth or a “progressive disease” (“PD”) as used herein in reference to cancer status indicates an increase in the sum of the diameters of the target lesions (tumors). In some embodiments, progressive disease is measured and defined as per International Myeloma Working Group (IMWG) criteria (see, e.g., Kumar S, Paiva B, Anderson KC., et al. International myeloma working group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 2016;17(8):e328-46.). In some embodiments, progression of tumor growth refers to at least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In some embodiments, in addition to a relative increase of 20%, the sum of diameters of target lesions must also demonstrate an absolute increase of at least 5 mm. An appearance of one or more new lesions may also be factored into the determination of progression of tumor growth.
[00118] As used herein “about” means ±10% of the stated value.
[00119] “Treating” as used herein refers to alleviating one or more symptoms or effects associated with a disorder and/or slowing the progression of the disorder. For example, in some embodiments, the disclosed therapies reduce ocular toxicity. “Ocular toxicity” refers to any unintended exposure of a therapeutic agent to ocular tissue, and includes changes in corneal epithelium, dry eyes, irritation, redness, blurred vision, dry eyes, photophobia, and/or changes in visual acuity. Detection of ocular toxicity may be determined by ophthalmic examination by an ophthalmologist or optometrist, before, during, and/or after treatment.
[00120] An ophthalmic examination may include one or more of the following:
[00121] 1. Best corrected visual acuity,
[00122] 2. Documentation of manifest refraction and the method used to obtain best corrected visual acuity,
[00123] 3. Current glasses prescription (if applicable),
[00124] 4. Intraocular pressure measurement,
[00125] 5. Anterior segment (slit lamp) examination including fluorescein staining of the cornea and lens examination,
[00126] 6. Dilated funduscopic examination, and/or
[00127] 7. An ocular surface disease index (OSDI) which is visual function questionnaire that assess the impact of potential ocular change in vision on function and health-related quality of life.
Methods of Treatment Using Belantamab
[00128] Described herein are methods of treating a disease or disorder in a patient that benefits from inhibition or blocking of B-cell maturation antigen (BCMA). Also described are uses of BCMA-inhibiting or blocking therapies in the treatment of a disease or disorder in a patient. In one aspect, the disclosure provides methods of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering belantamab to the patient. Belantamab is the unconjugated monoclonal antibody component of belantamab mafodotin targeting BCMA and thus lacks the cytotoxic payload of belantamab mafodotin.
[00129] In an embodiment, belantamab is administered at a dose of about 300 mg to about 2000 mg. In an embodiment, belantamab is administered at a dose of about 300 mg to about 900 mg. In an embodiment, belantamab is administered at a dose of about 900 mg to about 2000 mg. In an
embodiment, belantamab is administered at a dose of about 300 mg. In an embodiment, belantamab is administered at a dose of about 900 mg. In an embodiment, belantamab is administered at a dose of about 2000 mg.
[00130] In an embodiment, the dose of belantamab is administered at a regular interval for a period of time. In an embodiment, the dose of belantamab is administered on day 1 of the regular interval. In an embodiment, the regular interval is at least once every 8 weeks ± 3 days, at least once every 6 weeks ± 3 days, at least once every 4 weeks ± 3 days, at least once every 3 weeks ± 3 days, at least once every 2 weeks ± 3 days, at least once every week ± 3 days, once every week ± 3 days to once every 8 weeks ± 3 days, once every week ± 3 days to once every 6 weeks ± 3 days, once every week ± 3 days to once every 4 weeks ± 3 days, once every week ± 3 days to once every 3 weeks ± 3 days, once every week ± 3 days to once every 2 weeks ± 3 days, once every 2 weeks ± 3 days to once every 3 weeks ± 3 days, once every 3 weeks ± 3 days to once every 4 weeks ± 3 days, once every 4 weeks ± 3 days to once every 5 weeks ± 3 days, once every 5 weeks ± 3 days to once every 6 weeks ± 3 days, once every 6 weeks ± 3 days to once every 7 weeks ± 3 days, and/or once every 7 weeks ± 3 days to once every 8 weeks ± 3 days. In an embodiment, the period of time is until progressive disease occurs.
[00131] In an embodiment, the dose of belantamab is administered at least once every 8 weeks ± 3 days, at least once every 6 weeks ± 3 days, at least once every 4 weeks ± 3 days, at least once every 3 weeks ± 3 days, at least once every 2 weeks ± 3 days, at least once every week ± 3 days, once every week ± 3 days to once every 8 weeks ± 3 days, once every week ± 3 days to once every 6 weeks ± 3 days, once every week ± 3 days to once every 4 weeks ± 3 days, once every week ± 3 days to once every 3 weeks ± 3 days, once every week ± 3 days to once every 2 weeks ± 3 days, once every 2 weeks ± 3 days to once every 3 weeks ± 3 days, once every 3 weeks ± 3 days to once every 4 weeks ± 3 days, once every 4 weeks ± 3 days to once every 5 weeks ± 3 days, once every 5 weeks ± 3 days to once every 6 weeks ± 3 days, once every 6 weeks ± 3 days to once every 7 weeks ± 3 days, and/or once every 7 weeks ± 3 days to once every 8 weeks ± 3 days. In an embodiment, the dose of belantamab is administered once every week ± 3 days to once every 4 weeks ± 3 days. In an embodiment, the dose of belantamab is administered once every 2 weeks ± 3 days to once every 4 weeks ± 3 days. In an embodiment, the dose of belantamab is administered once every 2 weeks ± 3 days. In an embodiment, the dose of belantamab is administered once
every 3 weeks ± 3 days. In an embodiment, the dose of belantamab is administered once every 4 weeks ± 3 days.
[00132] In an embodiment, the dose of belantamab is administered by parenteral administration, i.e., subcutaneously (s.c. or SC), intrathecally, intraperitoneally, intramuscularly (i.m. or IM) or intravenously (i.v. or IV), including by intravenous infusion. In an embodiment, the dose of belantamab is administered intravenously. In an embodiment, the dose of belantamab is administered through an intravenous infusion. In an embodiment, the dose of belantamab is administered subcutaneously.
[00133] In an embodiment, belantamab is administered as a first line of treatment for the disease or disorder. In an embodiment, belantamab is administered after one or more prior lines of treatment for the disease or disorder. In an embodiment, belantamab is administered after at least 1 prior line of treatment, after at least 2 prior lines of treatment, after at least 3 prior lines of treatment, after at least 4 prior lines of treatment, after 1 to 4 prior lines of treatment, after 2 to 4 prior lines of treatment, after 1 to 2 prior lines of treatment, after 2 to 3 prior lines of treatment, after 3 to 4 prior lines of treatment, after 1 prior line of treatment, after 2 prior lines of treatment, after 3 prior lines of treatment, or after 4 prior lines of treatment for the disease or disorder. In an embodiment, belantamab is administered as a first line of cancer treatment. In an embodiment, belantamab is administered after one or more prior lines of cancer treatment. In an embodiment, belantamab is administered after at least 1 prior line of cancer treatment, after at least 2 prior lines of cancer treatment, after at least 3 prior lines of cancer treatment, after at least 4 prior lines of cancer treatment, after 1 to 4 prior lines of cancer treatment, after 2 to 4 prior lines of cancer treatment, after 1 to 2 prior lines of cancer treatment, after 2 to 3 prior lines of cancer treatment, after 3 to 4 prior lines of cancer treatment, after 1 prior line of cancer treatment, after 2 prior lines of cancer treatment, after 3 prior lines of cancer treatment, or after 4 prior lines of cancer treatment. In an embodiment, the patient has not been treated with a prior treatment for the disease or disorder. In an embodiment, the patient has been treated with at least one prior treatment for the disease or disorder. In an embodiment, the patient has been treated with at least 1 prior line of treatment, at least 2 prior lines of treatment, at least 3 prior lines of treatment, at least 4 prior lines of treatment, 1 to 4 prior lines of treatment, 2 to 4 prior lines of treatment, 1 to 2 prior lines of treatment, 2 to 3 prior lines of treatment, 3 to 4 prior lines of treatment, 1 prior line of treatment, 2 prior lines of treatment, 3 prior lines of treatment, or 4 prior lines of treatment for the disease or disorder.
[00134] In an embodiment, the patient has relapsed or refractory multiple myeloma and had previously received at least four prior therapies to treat the multiple myeloma.
[00135] In an embodiment, the prior lines of cancer treatments are selected from an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or a combination thereof. For example, a patient that has had 0, 1, 2, 3, or 4 or more prior lines of treatment before being treated as described herein, can have previously been treated with an immunomodulatory agent (e.g., an immunomodulatory imide drug (ImiD)), a proteasome inhibitor (PI), an anti-CD38 treatment or combinations thereof. In an embodiment, the prior lines of cancer treatments include an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent.
[00136] Examples of anti-CD38 antibodies useful in the methods described herein include, but are not limited to, isatuximab or isatuximab-irfc (e.g., SARCLISA®) and daratumumab (e.g, DARZALEX®, DARZALEX FASPRO®). In an embodiment, the anti-CD38 monoclonal antibody is selected from daratumumab or isatuximab.
[00137] Examples of proteasome inhibitors useful in the methods described herein include, but are not limited to, bortezomib (e.g., VELCADE®), ixazomib (e.g., NINLARO®), carfilzomib (e.g., KYPROLIS®), oprozomib, and delanzomib. In an embodiment, the proteasome inhibitor is selected from bortezomib, carfilzomib, or ixazomib. In an embodiment, the proteasome inhibitor is bortezomib.
[00138] Examples of immunomodulatory imide drugs (ImiDs) useful in the methods described herein include, but are not limited to, thalidomide (e.g., THALOMID®), lenalidomide (e.g., REVLIMID®), and pomalidomide (e.g., POMALYST®). In an embodiment, the immunomodulatory agent is selected from thalidomide, lenalidomide, or pomalidomide. In an embodiment, the immunomodulatory agent is lenalidomide or pomalidomide. In an embodiment, the immunomodulatory agent is lenalidomide.
[00139] In an embodiment, belantamab is administered as a monotherapy. In an embodiment, belantamab is administered in combination with at least one additional treatment. In an embodiment, belantamab is administered in combination with at least one additional cancer treatment. In an embodiment, belantamab is administered on day 1 of a treatment cycle. In an embodiment, belantamab is administered on day 1 of a 28-day treatment cycle. In an embodiment, belantamab is administered on day 1 and day 15 of a 28-day treatment cycle. In an embodiment, belantamab is administered on day 1 of a 21 -day treatment cycle.
[00140] In an embodiment, the additional cancer treatment is selected from an anti-CD38 monoclonal antibody, a gamma-secretase inhibitor, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
[00141] Examples of anti-CD38 antibodies useful in the methods described herein include, but are not limited to, isatuximab or isatuximab-irfc (e.g., SARCLISA®) and daratumumab (e.g, DARZALEX®, DARZALEX FASPRO®). In an embodiment, the anti-CD38 monoclonal antibody is selected from daratumumab or isatuximab.
[00142] Examples of gamma-secretase inhibitors useful in the methods described herein include, but are not limited to, nirogacestat (PF-0308014), crenigacestat (LY3039478), CB-103, tarenflurbil, semagacestat (LY450139), RG-4733, EVP-0962, avagacestat, MK-0752, and BMS- 906024, as well as derivatives and polymorphs thereof.
[00143] Examples of proteasome inhibitors useful in the methods described herein include, but are not limited to, bortezomib (e.g., VELCADE®), ixazomib (e.g., NINLARO®), carfilzomib (e.g., KYPROLIS®), oprozomib, and delanzomib. In an embodiment, the proteasome inhibitor is selected from bortezomib, carfilzomib, or ixazomib. In an embodiment, the proteasome inhibitor is bortezomib.
[00144] Examples of immunomodulatory imide drugs (ImiDs) useful in the methods described herein include, but are not limited to, thalidomide (e.g., THALOMID®), lenalidomide (e.g., REVLIMID®), and pomalidomide (e.g., POMALYST®). In an embodiment, the immunomodulatory agent is selected from thalidomide, lenalidomide, or pomalidomide. In an embodiment, the immunomodulatory agent is lenalidomide or pomalidomide. In an embodiment, the immunomodulatory agent is lenalidomide. In an embodiment, the immunomodulatory agent is pomalidomide.
[00145] Examples of anti-PD-1 monoclonal antibodies useful in the methods described herein include, but are not limited to, pembroluzimab and dostarlimab. In an embodiment, the anti-PD-1 monoclonal antibody is selected from pembroluzimab or dostarlimab.
[00146] Other additional cancer treatments include corticosteroids. Examples of corticosteroids include, but are not limited to, dexamethasone (e.g., DECADRON®, DEXASONE®, DIODEX®, HEXADROL®, MAXIDEX®), prednisone (e.g., DELTASONE®), and methylprednisolone (e.g., MEDROL®).
[00147] In an embodiment, the additional cancer treatment is selected from lenalidomide, pomalidomide, dexamethasone, or a combination thereof. In an embodiment, the additional cancer treatments are lenalidomide and dexamethasone. In an embodiment, the additional cancer treatments are pomalidomide and dexamethasone. In an embodiment, the additional cancer treatments are bortezomib and dexamethasone. In an embodiment, the additional cancer treatments are pomalidomide, bortezomib, and dexamethasone. In an embodiment, the additional cancer treatments are lenalidomide, bortezomib, and dexamethasone.
[00148] In an embodiment, the additional cancer treatment is standard of care treatment.
[00149] In an embodiment, the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time. In an embodiment, the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily administered on days 1-21 of a 28 day cycle. [00150] In an embodiment, the additional cancer treatment is dexamethasone. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 40 mg once weekly if the patient is less than 75 years old. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg once weekly if the patient is at least 75 years old. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 40 mg once weekly if the patient has a BMI of at least 18.5. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg once weekly if the patient has a BMI less than 18.5. In an embodiment, the dexamethasone is administered on days 1, 8, 15, and 22 of a 28 day cycle.
[00151] In an embodiment, the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 20 mg to 40 mg administered on days 1, 8, 15, and 22 of a 28 day cycle. In an embodiment, the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 40 mg administered on days 1, 8, 15, and 22 of a 28 day cycle if the patient is less than 75 years old or has a BMI of at least 18.5. In an embodiment, the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 20 mg administered on days 1, 8, 15, and 22 of a 28 day cycle if the patient is at least 75 years old or has a BMI of less than 18.5.
Lead-In Dose Period
[00152] In some cases, a patient is receiving an initial therapy or combination of initial therapies, referred to as a lead-in doses, prior to administration of a subsequent therapy or combination of therapies. The “lead-in period” refers to a period of time in which a specified initial therapy or combination of initial therapies is administered prior to administration of a subsequent therapy or combination of therapies.
[00153] In an embodiment, the method further comprises administering a lead-in dose of belantamab mafodotin prior to beginning administration of belantamab. In an embodiment, the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 3.4 mg/kg once during a lead- in period. In an embodiment, the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 1.9 mg/kg once during a lead-in period. In an embodiment, the lead-in dose of belantamab mafodotin is about 1.4 mg/kg, about 1.5 mg/kg, about 1.6 mg/kg, about 1.7 mg/kg, about 1.8 mg/kg, about 1.9 mg/kg, about 2.0 mg/kg, about 2.5 mg/kg, about 3.0 mg/kg, or about 3.4 mg/kg once during a lead-in period. In an embodiment, the lead-in dose of belantamab mafodotin is about 1.4 mg/kg once during a lead-in period. In an embodiment, the lead-in dose of belantamab mafodotin is about 1.9 mg/kg once during a lead-in period.
[00154] In an embodiment, the lead-in period is four weeks ± 3 days and belantamab mafodotin is administered on day 1 of the lead-in period.
[00155] In an embodiment, the dose of belantamab mafodotin is administered by parenteral administration, i.e., subcutaneously (s.c. or SC), intrathecally, intraperitoneally, intramuscularly (i.m. or IM) or intravenously (i.v. or IV), including by intravenous infusion. In an embodiment, the dose of belantamab mafodotin is administered intravenously. In an embodiment, the dose of belantamab mafodotin is administered through an intravenous infusion.
[00156] In an embodiment, belantamab mafodotin is administered as a monotherapy during the lead-in period. In an embodiment, belantamab mafodotin is administered in combination with at least one additional treatment during the lead-in period. In an embodiment, belantamab mafodotin is administered in combination with at least one additional cancer treatment during the lead-in period.
[00157] In an embodiment, the additional cancer treatment for administration during the lead- in period is selected from an anti-CD38 monoclonal antibody, a gamma-secretase inhibitor, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
[00158] Examples of anti-CD38 antibodies useful in the methods described herein include, but are not limited to, isatuximab or isatuximab-irfc (e.g., SARCLISA®) and daratumumab (e.g, DARZALEX®, DARZALEX FASPRO®). In an embodiment, the anti-CD38 monoclonal antibody for administration during the lead-in period is selected from daratumumab or isatuximab. [00159] Examples of gamma-secretase inhibitors useful in the methods described herein include, but are not limited to, nirogacestat (PF-0308014), crenigacestat (LY3039478), CB-103, tarenflurbil, semagacestat (LY450139), RG-4733, EVP-0962, avagacestat, MK-0752, and BMS- 906024, as well as derivatives and polymorphs thereof.
[00160] Examples of proteasome inhibitors useful in the methods described herein include, but are not limited to, bortezomib (e.g., VELCADE®), ixazomib (e.g., NINLARO®), carfilzomib (e.g., KYPROLIS®), oprozomib, and delanzomib. In an embodiment, the proteasome inhibitor for administration during the lead-in period is selected from bortezomib, carfilzomib, or ixazomib. In an embodiment, the proteasome inhibitor for administration during the lead-in period is bortezomib.
[00161] Examples of immunomodulatory imide drugs (ImiDs) useful in the methods described herein include, but are not limited to, thalidomide (e.g., THALOMID®), lenalidomide (e.g., REVLIMID®), and pomalidomide (e.g., POMALYST®). In an embodiment, the immunomodulatory agent for administration during the lead-in period is selected from thalidomide, lenalidomide, or pomalidomide. In an embodiment, the immunomodulatory agent for administration during the lead-in period is lenalidomide or pomalidomide. In an embodiment, the immunomodulatory agent for administration during the lead-in period is lenalidomide. In an embodiment, the immunomodulatory agent for administration during the lead-in period is pomalidomide.
[00162] Examples of anti-PD-1 monoclonal antibodies useful in the methods described herein include, but are not limited to, pembroluzimab and dostarlimab. In an embodiment, the anti-PD-1 monoclonal antibody is selected from pembroluzimab or dostarlimab.
[00163] Other additional cancer treatments include corticosteroids. Examples of corticosteroids include, but are not limited to, dexamethasone (e.g., DECADRON®, DEXASONE®, DIODEX®, HEXADROL®, MAXIDEX®), prednisone (e.g., DELTASONE®), and methylprednisolone (e.g., MEDROL®).
[00164] In an embodiment, the additional cancer treatment for administration during the lead- in period is selected from lenalidomide, pomalidomide, dexamethasone, or a combination thereof. In an embodiment, the additional cancer treatments for administration during the lead-in period are lenalidomide and dexamethasone. In an embodiment, the additional cancer treatments for administration during the lead-in period are pomalidomide and dexamethasone. In an embodiment, the additional cancer treatments for administration during the lead-in period are lenalidomide and dexamethasone. In an embodiment, the additional cancer treatments for administration during the lead-in period are bortezomib and dexamethasone. In an embodiment, the additional cancer treatments for administration during the lead-in period are pomalidomide, bortezomib, and dexamethasone. In an embodiment, the additional cancer treatments for administration during the lead-in period are lenalidomide, bortezomib, and dexamethasone.
[00165] In an embodiment, the additional cancer treatment for administration during the lead- in period is standard of care treatment.
[00166] In an embodiment, the additional cancer treatment for administration during the lead- in period is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time. In an embodiment, the additional cancer treatment for administration during the lead-in period is lenalidomide at a dose of 10 mg to 25 mg once daily administered on days 1-21 of a 28 day lead- in period.
[00167] In an embodiment, the additional cancer treatment for administration during the lead- in period is dexamethasone. In an embodiment, the additional cancer treatment for administration during the lead-in period is dexamethasone at a dose of 20 mg to 40 mg once weekly. In an embodiment, the additional cancer treatment for administration during the lead-in period is dexamethasone at a dose of 40 mg once weekly if the patient is less than 75 years old. In an embodiment, the additional cancer treatment for administration during the lead-in period is dexamethasone at a dose of 20 mg once weekly if the patient is at least 75 years old. In an embodiment, the additional cancer treatment for administration during the lead-in period is dexamethasone at a dose of 40 mg once weekly if the patient has a BMI of at least 18.5. In an embodiment, the additional cancer treatment for administration during the lead-in period is dexamethasone at a dose of 20 mg once weekly if the patient has a BMI less than 18.5. In an embodiment, the dexamethasone is administered on days 1, 8, 15, and 22 of a 28 day lead-in period.
[00168] In an embodiment, the additional cancer treatments for administration during the lead- in period are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day lead-in period and dexamethasone at a dose of 20 mg to 40 mg administered on days 1, 8, 15, and 22 of a 28 day lead-in period. In an embodiment, the additional cancer treatments for administration during the lead-in period are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day lead-in period and dexamethasone at a dose of 40 mg administered on days 1, 8, 15, and 22 of a 28 day lead-in period if the patient is less than 75 years old or has a BMI of at least 18.5. In an embodiment, the additional cancer treatments for administration during the lead-in period are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day lead-in period and dexamethasone at a dose of 20 mg administered on days 1, 8, 15, and 22 of a 28 day lead-in period if the patient is at least 75 years old or has a BMI of less than 18.5.
[00169] In an embodiment, the method comprises administering a lead-in dose of belantamab mafodotin during a lead-in period, followed by administering belantamab during a subsequent treatment period. In an embodiment, the method comprises administering a lead-in dose of belantamab mafodotin at a dose of about 1.4 mg/kg to about 3.4 mg/kg once during a lead-in period, followed by administering belantamab at a dose of about 300 mg to about 2000 mg during a subsequent treatment period. In an embodiment, the method comprises administering a lead-in dose of belantamab mafodotin at a dose of about 1.4 mg/kg, about 1.9 mg/kg, about 2.5 mg/kg, or about 3.4 mg/kg once during a lead-in period, followed by administering belantamab at a dose of about 300 mg, 900 mg, or about 2000 mg during a subsequent treatment period.
[00170] In some embodiments, the method further comprises application of a bandage contact lens during the lead-in period and/or subsequent treatment period. A bandage contact lens is a therapeutic contact lens made of soft, flexible plastics that allow oxygen to pass through to the cornea which is worn in one or both eyes for a period of time to protect the cornea and/or treat ocular toxicities, e.g., ocular toxicities resulting from treatment with a therapeutic agent such as belantamab mafodotin. In some embodiments, a bandage contact lens is comprised of N-carboxy vinyl ester (NCVE), N-vinyl pyrrolidone (NVE), poly[dimethylsiloxyl] di [silylbutanol] bis[vinyl carbamate] (PBVC) and/or tris-(trimethylsiloxysilyl) propylvinyl carbamate (TPVC). In some embodiments, a bandage contact lens of comprises of NCVE, NVE, PBVC, and TPVC. In some embodiments, a bandage contact lens of comprises of NCVE, NVE, PBVC, and TPVC and has a
water content of 30% to 40%, such as 30%, 32%, 34%, 36%, 38%, or 40%. In some embodiments, a bandage contact lens of comprises of NCVE, NVE, PBVC, and TPVC and has a water content of about 36%. In some embodiments, a bandage contact lens is made of balafilcon A. Balafilcon A is a copolymer of silicone vinyl carbamate, N-vinyl-pyrrolidone, a siloxane crosslinker and a vinyl alanine wetting monomer, and is 36% water by weight when immersed in solution, e.g., saline solution.
Discontinuation of Belantamab
[00171] In an embodiment, the method further comprises discontinuing administration of belantamab and subsequently administering belantamab mafodotin. In an embodiment, belantamab mafodotin is administered at a dose of 2.5 mg/kg once every three weeks ± 3 days. In an embodiment, administration of belantamab is discontinued after the patient demonstrates progressive disease.
[00172] In an embodiment, the method further comprises administering belantamab mafodotin and subsequently discontinuing administration of belantamab. In an embodiment, belantamab mafodotin is administered at a dose of 2.5 mg/kg once every three weeks ± 3 days. In an embodiment, administration of belantamab is discontinued after the patient demonstrates progressive disease.
Methods of Treatment Using Belantamab Mafodotin
[00173] In one aspect, the disclosure provides methods of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering belantamab mafodotin to the patient.
[00174] In an embodiment, belantamab mafodotin is administered at a dose of about 1.4 mg/kg to about 3.4 mg/kg. In an embodiment, belantamab mafodotin is administered at a dose of about 1.4 mg/kg to about 1.9 mg/kg. In an embodiment, belantamab mafodotin is administered at a dose of about 1.4 mg/kg, about 1.5 mg/kg, about 1.6 mg/kg, about 1.7 mg/kg, about 1.8 mg/kg, about 1.9 mg/kg, about 2.0 mg/kg, about 2.5 mg/kg, about 3.0 mg/kg, or about 3.4 mg/kg. In an embodiment, belantamab mafodotin is administered at a dose of about 1.4 mg/kg. In an embodiment, belantamab mafodotin is administered at a dose of about 1.9 mg/kg. In an embodiment, belantamab is administered once every eight weeks ± 3 days.
[00175] In an embodiment, belantamab mafodotin is administered at a dose of about 1.4 mg/kg to about 3.4 mg/kg once every eight weeks ± 3 days. In an embodiment, belantamab mafodotin is administered at a dose of about 1.4 mg/kg to about 1.9 mg/kg once every eight weeks ± 3 days. In an embodiment, belantamab mafodotin is administered at a dose of about 1.4 mg/kg, about 1.5 mg/kg, about 1.6 mg/kg, about 1.7 mg/kg, about 1.8 mg/kg, about 1.9 mg/kg, about 2.0 mg/kg, about 2.5 mg/kg, about 3.0 mg/kg, or about 3.4 mg/kg once every eight weeks ± 3 days. In an embodiment, belantamab mafodotin is administered at a dose of about 1.4 mg/kg once every eight weeks ± 3 days. In an embodiment, belantamab mafodotin is administered at a dose of about 1.9 mg/kg once every eight weeks ± 3 days.
[00176] In some embodiments, the method further comprises application of a bandage contact lens.
Co- Administration of BCMA Antagonists
[00177] Described herein are methods of treating a disease or disorder in a patient that benefits from inhibition or blocking of B-cell maturation antigen (BCMA). Also described are uses of BCMA-inhibiting or blocking therapies in the treatment of a disease or disorder in a patient. Additionally, described herein are kits comprising BCMA-inhibiting or blocking therapies and instructions for use.
[00178] In one aspect, the disclosure provides methods of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering a therapeutically effective amount of a combination comprising a first BCMA antagonist and a second BCMA antagonist to the patient. The term “BCMA antagonist” refers to a molecule that specifically binds B-cell maturation antigen (BCMA) and inhibits the binding of BAFF and/or APRIL to the BCMA receptor. Examples of BCMA antagonists include, but are not limited to, anti-BCMA antibodies or antigen binding fragments thereof, anti-BCMA antibody-drug conjugates, bispecific anti-BCMA antibodies or antigen binding fragments thereof, and BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
[00179] In an embodiment, the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti- BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy. The first BCMA-antagonist differs from the second BCMA-antagonist. In an embodiment, the first and
second BCMA-antagonists are both anti-BCMA antibodies or fragments thereof, both anti-BCMA antibody-drug conjugates, both bispecific anti-BCMA antibodies or fragments thereof, or both BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapies. In an embodiment, the first BCMA-antagonist is an anti-BCMA antibody or antigen binding fragment thereof and the second BCMA-antagonist is a different anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the first BCMA-antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA-antagonist is a different anti-BCMA antibody-drug conjugate. In an embodiment, the first BCMA-antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof and the second BCMA-antagonist is a different bispecific anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the first BCMA-antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy and the second BCMA-antagonist is a different BCMA- targeted chimeric antigen receptor T (CAR T)-cell therapy.
[00180] In an embodiment, the bispecific anti-BCMA antibody or antigen binding fragment thereof comprises an anti-BCMA antibody or antigen binding fragment thereof and an anti-CD38 antibody or antigen binding fragment thereof. In an embodiment, the bispecific anti-BCMA antibody or antigen binding fragment thereof specifically binds both BCMA and CD3.
[00181] In an embodiment, the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
[00182] In an embodiment, the first BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is belantamab.
[00183] In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is an anti-BCMA antibody-drug conjugate. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
[00184] In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is an anti-BCMA antibody-drug conjugate. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
[00185] In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is idecabtagene vicleucel. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is ciltacabtagene autoleucel. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is teclistamab. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is REGN5458. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is SEA-BCMA. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is ABBV-383. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is elrantamab. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is pavurutumab. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is alnuctamab. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is MEDI2228. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is CC99712.
[00186] In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is idecabtagene vicleucel. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is ciltacabtagene autoleucel. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is teclistamab. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is REGN5458. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is SEA- BCMA. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is ABBV-383. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is elrantamab. In an embodiment, the first BCMA antagonist is
belantamab and the second BCMA antagonist is pavurutumab. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is alnuctamab. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is MEDI2228. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is and CC99712.
[00187] In an embodiment, the combination further comprises a third BCMA antagonist. In an embodiment, the third BCMA antagonist is selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy. The third BCMA-antagonist differs from the first and second BCMA-antagonists. In an embodiment, the third BCMA antagonist is selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
[00188] In an embodiment, the combination comprises belantamab mafodotin, belantamab, and an anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and an anti-BCMA antibody-drug conjugate. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and a bispecific anti- BCMA antibody or antigen binding fragment thereof. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
[00189] In an embodiment, the combination comprises belantamab mafodotin, belantamab, and idecabtagene vicleucel. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and ciltacabtagene autoleucel. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and teclistamab. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and REGN5458. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and SEA-BCMA. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and ABBV-383. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and elrantamab. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and pavurutumab. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and
alnuctamab. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and MEDI2228. In an embodiment, the combination comprises belantamab mafodotin, belantamab, and CC99712.
[00190] In an embodiment, the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab. In an embodiment, the first and second BCMA antagonists, and the third BCMA antagonist, if present, are administered simultaneously, such as on the same day of a treatment cycle. In an embodiment, the first and second BCMA antagonists, and the third BCMA antagonist, if present, are administered on the same day of a treatment cycle. In an embodiment, the first and second BCMA antagonists, and the third BCMA antagonist, if present, are administered during the same treatment cycle on different days of the treatment cycle.
[00191] In an embodiment, the first and second BCMA antagonists, and the third BCMA antagonist, if present, are independently administered at least once every 8 weeks ± 3 days, at least once every 6 weeks ± 3 days, at least once every 4 weeks ± 3 days, at least once every 3 weeks ± 3 days, at least once every 2 weeks ± 3 days, at least once every week ± 3 days, once every week ± 3 days to once every 8 weeks ± 3 days, once every week ± 3 days to once every 6 weeks ± 3 days, once every week ± 3 days to once every 4 weeks ± 3 days, once every week ± 3 days to once every 3 weeks ± 3 days, once every week ± 3 days to once every 2 weeks ± 3 days, once every 2 weeks ± 3 days to once every 3 weeks ± 3 days, once every 3 weeks ± 3 days to once every 4 weeks ± 3 days, once every 4 weeks ± 3 days to once every 5 weeks ± 3 days, once every 5 weeks ± 3 days to once every 6 weeks ± 3 days, once every 6 weeks ± 3 days to once every 7 weeks ± 3 days, and/or once every 7 weeks ± 3 days to once every 8 weeks ± 3 days.
[00192] In some embodiments, the first and second BCMA antagonists, and the third BCMA antagonist, if present, are administered in combination with application of a bandage contact lens. [00193] In an embodiment, the first and second BCMA antagonists, and the third BCMA antagonist, if present, are administered in combination with at least one additional treatment. In an embodiment, the additional cancer treatment is selected from an anti-CD38 monoclonal antibody, a gamma-secretase inhibitor, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD- 1 monoclonal antibody.
[00194] Examples of anti-CD38 antibodies useful in the methods described herein include, but are not limited to, isatuximab or isatuximab-irfc (e.g., SARCLISA®) and daratumumab (e.g, DARZALEX®, DARZALEX FASPRO®). In an embodiment, the anti-CD38 monoclonal antibody is selected from daratumumab or isatuximab.
[00195] Examples of gamma-secretase inhibitors useful in the methods described herein include, but are not limited to, nirogacestat (PF-0308014), crenigacestat (LY3039478), CB-103, tarenflurbil, semagacestat (LY450139), RG-4733, EVP-0962, avagacestat, MK-0752, and BMS- 906024, as well as derivatives and polymorphs thereof.
[00196] Examples of proteasome inhibitors useful in the methods described herein include, but are not limited to, bortezomib (e.g., VELCADE®), ixazomib (e.g., NINLARO®), carfilzomib (e.g., KYPROLIS®), oprozomib, and delanzomib. In an embodiment, the proteasome inhibitor is selected from bortezomib, carfilzomib, or ixazomib. In an embodiment, the proteasome inhibitor is bortezomib.
[00197] Examples of immunomodulatory imide drugs (ImiDs) useful in the methods described herein include, but are not limited to, thalidomide (e.g., THALOMID®), lenalidomide (e.g., REVLIMID®), and pomalidomide (e.g., POMALYST®). In an embodiment, the immunomodulatory agent is selected from thalidomide, lenalidomide, or pomalidomide. In an embodiment, the immunomodulatory agent is lenalidomide or pomalidomide. In an embodiment, the immunomodulatory agent is lenalidomide.
[00198] Examples of anti-PD-1 monoclonal antibodies useful in the methods described herein include, but are not limited to, pembroluzimab and dostarlimab. In an embodiment, the anti-PD-1 monoclonal antibody is selected from pembroluzimab or dostarlimab.
[00199] Other additional cancer treatments include corticosteroids. Examples of corticosteroids include, but are not limited to, dexamethasone (e.g., DECADRON®, DEXASONE®, DIODEX®, HEXADROL®, MAXIDEX®), prednisone (e.g., DELTASONE®), and methylprednisolone (e.g., MEDROL®).
[00200] In an embodiment, the additional cancer treatment is selected from lenalidomide, pomalidomide, dexamethasone, or a combination thereof. In an embodiment, the additional cancer treatments are lenalidomide and dexamethasone. In an embodiment, the additional cancer treatments are pomalidomide and dexamethasone. In an embodiment, the additional cancer treatments are bortezomib and dexamethasone. In an embodiment, the additional cancer treatments
are pomalidomide, bortezomib, and dexamethasone. In an embodiment, the additional cancer treatments are lenalidomide, bortezomib, and dexamethasone.
[00201] In an embodiment, the additional cancer treatment is standard of care treatment.
[00202] In an embodiment, the first and second BCMA antagonists, and the third BCMA antagonist, if present, are administered on day 1 of a treatment cycle. In an embodiment, the first and second BCMA antagonists, and the third BCMA antagonist, if present, are administered on day 1 of a 28-day treatment cycle. In an embodiment, the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time. In an embodiment, the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily administered on days 1-21 of a 28 day cycle. In an embodiment, the additional cancer treatment is dexamethasone. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 40 mg once weekly if the patient is less than 75 years old. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg once weekly if the patient is at least 75 years old. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 40 mg once weekly if the patient has a BMI of at least 18.5. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg once weekly if the patient has a BMI less than 18.5. In an embodiment, the dexamethasone is administered on days 1, 8, 15, and 22 of a 28 day cycle. In an embodiment, the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 20 mg to 40 mg administered on days 1, 8, 15, and 22 of a 28 day cycle. In an embodiment, the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 40 mg administered on days 1, 8, 15, and 22 of a 28 day cycle if the patient is less than 75 years old or has a BMI of at least 18.5. In an embodiment, the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 20 mg administered on days 1, 8, 15, and 22 of a 28 day cycle if the patient is at least 75 years old or has a BMI of less than 18.5.
[00203] In one aspect, the disclosure provides a kit comprising: (i) a first B-cell maturation antigen (BCMA) antagonist; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking BCMA when combined with a second BCMA antagonist. In an
embodiment, the kit further comprises a third BCMA antagonist. In an embodiment, the instructions further describe use in treating a disease or disorder responsive to inhibiting or blocking BCMA when combined with second and third BCMA antagonist.
[00204] In an embodiment, the first, second, and third BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy. In an embodiment, the first, second, and third BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
[00205] In one aspect, the disclosure provides a kit comprising: (i) belantamab mafodotin; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking BCMA when combined with belantamab.
[00206] In one aspect, the disclosure provides a kit comprising: (i) belantamab; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking BCMA when combined with belantamab mafodotin.
Sequential Use of BCMA Antagonists
[00207] Described herein are methods of treating a disease or disorder in a patient that benefits from inhibition or blocking of B-cell maturation antigen (BCMA). Also described are uses of BCMA-inhibiting or blocking therapies in the treatment of a disease or disorder in a patient. Additionally, described herein are kits comprising BCMA-inhibiting or blocking therapies and instructions for use.
[00208] In one aspect, the disclosure provides methods of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with a first BCMA antagonist, the method comprising administering a therapeutically effective amount of a second BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist. [00209] In one aspect, the disclosure provides methods of reducing corneal toxicity in a patient previously treated with a first B-cell maturation antigen (BCMA) antagonist, the method
comprising administering a therapeutically effective amount of a second BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist. “Corneal toxicity” or “corneal adverse reaction” refers to changes in the cornea, including keratopathy (e.g., mild superficial keratopathy, moderate superficial keratopathy, severe superficial keratopathy) and corneal epithelial defect, such as corneal ulcers. In some embodiments, corneal toxicity or corneal adverse reaction refers to keratopathy, and the severity or grade of such corneal adverse reaction can be determined using the keratopathy visual acuity (KVA) scale for treatment-related corneal toxicities according to Table 2. In some embodiments, a patient has a Grade 1 corneal adverse reaction. In some embodiments, a patient has a Grade 2 corneal adverse reaction. In some embodiments, a patient has a Grade 3 corneal adverse reaction. In some embodiments, a patient has a Grade 4 corneal adverse reaction. In some embodiments, reducing ocular toxicity refers to reducing the severity of a corneal adverse reaction or the grade of a treatment related corneal toxicity as determined according to the KVA scale.
Table 2
logMAR=logarithm of the minimum angle of resolution; SPK=superficial punctate keratitis.
[00210] In an embodiment, the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti- BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment
thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy. The first BCMA-antagonist differs from the second BCMA-antagonist. In an embodiment, the first and second BCMA-antagonists are both anti-BCMA antibodies or fragments thereof, both anti-BCMA antibody-drug conjugates, both bispecific anti-BCMA antibodies or fragments thereof, or both BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapies. In an embodiment, the first BCMA-antagonist is an anti-BCMA antibody or antigen binding fragment thereof and the second BCMA-antagonist is a different anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the first BCMA-antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA-antagonist is a different anti-BCMA antibody-drug conjugate. In an embodiment, the first BCMA-antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof and the second BCMA-antagonist is a different bispecific anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the first BCMA-antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy and the second BCMA-antagonist is a different BCMA- targeted chimeric antigen receptor T (CAR T)-cell therapy.
[00211] In an embodiment, the bispecific anti-BCMA antibody or antigen binding fragment thereof comprises an anti-BCMA antibody or antigen binding fragment thereof and an anti-CD38 antibody or antigen binding fragment thereof. In an embodiment, the bispecific anti-BCMA antibody or antigen binding fragment thereof comprises an anti-BCMA antibody or antigen binding fragment thereof and an anti-CD3 antibody or antigen binding fragment thereof.
[00212] In an embodiment, the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
[00213] In an embodiment, the first BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is belantamab. In an embodiment, the second BCMA antagonist is belantamab mafodotin. In an embodiment, the second BCMA antagonist is belantamab.
[00214] In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is an anti-BCMA antibody-drug conjugate. In an embodiment, the first BCMA
antagonist is belantamab mafodotin and the second BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy. In an embodiment, the first BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy and the second BCMA antagonist is belantamab mafodotin.
[00215] In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is an anti-BCMA antibody-drug conjugate. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy. In an embodiment, the first BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy and the second BCMA antagonist is belantamab.
[00216] In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is idecabtagene vicleucel. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is ciltacabtagene autoleucel. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is teclistamab. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is REGN5458. In an embodiment, the first BCMA antagonist is
belantamab mafodotin and the second BCMA antagonist is SEA-BCMA. In an embodiment, the first BCMA antagonist is idecabtagene vicleucel and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is ciltacabtagene autoleucel and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is teclistamab and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is REGN5458 and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is SEA-BCMA and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is ABBV-383 and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is elrantamab and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is pavurutumab and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is alnuctamab and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is MEDI2228 and the second BCMA antagonist is belantamab mafodotin. In an embodiment, the first BCMA antagonist is CC99712 and the second BCMA antagonist is belantamab mafodotin.
[00217] In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is idecabtagene vicleucel. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is ciltacabtagene autoleucel. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is teclistamab. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is REGN5458. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is SEA- BCMA. In an embodiment, the first BCMA antagonist is idecabtagene vicleucel and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is ciltacabtagene autoleucel and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is teclistamab and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is REGN5458 and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is SEA-BCMA and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is ABBV-383 and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is elrantamab and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is pavurutumab and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA
antagonist is alnuctamab and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is MEDI2228 and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is CC99712 and the second BCMA antagonist is belantamab.
[00218] In an embodiment, the method further comprises administering a therapeutically effective amount of a third BCMA antagonist to the patient in combination with the second BCMA antagonist, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second and third BCMA antagonists and the third BCMA antagonist is not the same as the first and second BCMA antagonists.
[00219] In an embodiment, the first BCMA antagonist is an anti-BCMA antibody or antigen binding fragment thereof, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is an anti-BCMA antibody-drug conjugate, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is a bispecific anti-BCMA antibody or antigen binding fragment thereof, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. [00220] In an embodiment, the first BCMA antagonist is idecabtagene vicleucel, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is ciltacabtagene autoleucel, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is teclistamab, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is REGN5458, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is SEA-BCMA, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is ABBV-383, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is elrantamab, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is
pavurutumab, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is alnuctamab, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is MEDI2228, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is CC99712, the second BCMA antagonist is belantamab mafodotin, and the third BCMA antagonist is belantamab.
[00221] In an embodiment, the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody. In an embodiment, the second BCMA antagonist is an anti-BCMA antibody-drug conjugate and the first BCMA antagonist is the corresponding unconjugated anti-BCMA antibody. In an embodiment, the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab. In an embodiment, the first BCMA antagonist is belantamab and the second BCMA antagonist is belantamab mafodotin.
[00222] In an embodiment, the second BCMA antagonist, and the third BCMA antagonist, if present, are independently administered at least once every 8 weeks ± 3 days, at least once every 6 weeks ± 3 days, at least once every 4 weeks ± 3 days, at least once every 3 weeks ± 3 days, at least once every 2 weeks ± 3 days, at least once every week ± 3 days, once every week ± 3 days to once every 8 weeks ± 3 days, once every week ± 3 days to once every 6 weeks ± 3 days, once every week ± 3 days to once every 4 weeks ± 3 days, once every week ± 3 days to once every 3 weeks ± 3 days, once every week ± 3 days to once every 2 weeks ± 3 days, once every 2 weeks ± 3 days to once every 3 weeks ± 3 days, once every 3 weeks ± 3 days to once every 4 weeks ± 3 days, once every 4 weeks ± 3 days to once every 5 weeks ± 3 days, once every 5 weeks ± 3 days to once every
6 weeks ± 3 days, once every 6 weeks ± 3 days to once every 7 weeks ± 3 days, and/or once every
7 weeks ± 3 days to once every 8 weeks ± 3 days.
[00223] In an embodiment, the second BCMA antagonist and the third BCMA antagonist, if present, are administered in combination with application of bandage contact lens.
[00224] In an embodiment, the second BCMA antagonist, and the third BCMA antagonist, if present, are administered in combination with at least one additional treatment. In an embodiment, the additional cancer treatment is selected from an anti-CD38 monoclonal antibody, a gamma-
secretase inhibitor, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
[00225] Examples of anti-CD38 antibodies useful in the methods described herein include, but are not limited to, isatuximab or isatuximab-irfc (e.g., SARCLISA®) and daratumumab (e.g, DARZALEX®, DARZALEX FASPRO®). In an embodiment, the anti-CD38 monoclonal antibody is selected from daratumumab or isatuximab.
[00226] Examples of gamma-secretase inhibitors useful in the methods described herein include, but are not limited to, nirogacestat (PF-0308014), crenigacestat (LY3039478), CB-103, tarenflurbil, semagacestat (LY450139), RG-4733, EVP-0962, avagacestat, MK-0752, and BMS- 906024, as well as derivatives and polymorphs thereof.
[00227] Examples of proteasome inhibitors useful in the methods described herein include, but are not limited to, bortezomib (e.g., VELCADE®), ixazomib (e.g., NINLARO®), carfilzomib (e.g., KYPROLIS®), oprozomib, and delanzomib. In an embodiment, the proteasome inhibitor is selected from bortezomib, carfilzomib, or ixazomib. In an embodiment, the proteasome inhibitor is bortezomib.
[00228] Examples of immunomodulatory imide drugs (ImiDs) useful in the methods described herein include, but are not limited to, thalidomide (e.g., THALOMID®), lenalidomide (e.g., REVLIMID®), and pomalidomide (e.g., POMALYST®). In an embodiment, the immunomodulatory agent is selected from thalidomide, lenalidomide, or pomalidomide. In an embodiment, the immunomodulatory agent is lenalidomide or pomalidomide. In an embodiment, the immunomodulatory agent is lenalidomide.
[00229] Examples of anti-PD-1 monoclonal antibodies useful in the methods described herein include, but are not limited to, pembroluzimab and dostarlimab. In an embodiment, the anti-PD-1 monoclonal antibody is selected from pembroluzimab or dostarlimab.
[00230] Other additional cancer treatments include corticosteroids. Examples of corticosteroids include, but are not limited to, dexamethasone (e.g., DECADRON®, DEXASONE®, DIODEX®, HEXADROL®, MAXIDEX®), prednisone (e.g., DELTASONE®), and methylprednisolone (e.g., MEDROL®).
[00231] In an embodiment, the additional cancer treatment is selected from lenalidomide, pomalidomide, dexamethasone, or a combination thereof. In an embodiment, the additional cancer treatments are lenalidomide and dexamethasone. In an embodiment, the additional cancer
treatments are pomalidomide and dexamethasone. In an embodiment, the additional cancer treatments are bortezomib and dexamethasone. In an embodiment, the additional cancer treatments are pomalidomide, bortezomib, and dexamethasone. In an embodiment, the additional cancer treatments are lenalidomide, bortezomib, and dexamethasone.
[00232] In an embodiment, the additional cancer treatment is standard of care treatment.
[00233] In an embodiment, the second BCMA antagonist, and the third BCMA antagonist, if present, are administered on day 1 of a treatment cycle. In an embodiment, the second BCMA antagonist, and the third BCMA antagonist, if present, are administered on day 1 of a 28-day treatment cycle. In an embodiment, the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time. In an embodiment, the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily administered on days 1-21 of a 28 day cycle. In an embodiment, the additional cancer treatment is dexamethasone. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 40 mg once weekly if the patient is less than 75 years old. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg once weekly if the patient is at least 75 years old. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 40 mg once weekly if the patient has a BMI of at least 18.5. In an embodiment, the additional cancer treatment is dexamethasone at a dose of 20 mg once weekly if the patient has a BMI less than 18.5. In an embodiment, the dexamethasone is administered on days 1, 8, 15, and 22 of a 28 day cycle. In an embodiment, the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 20 mg to 40 mg administered on days 1, 8, 15, and 22 of a 28 day cycle. In an embodiment, the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 40 mg administered on days 1, 8, 15, and 22 of a 28 day cycle if the patient is less than 75 years old or has a BMI of at least 18.5. In an embodiment, the additional cancer treatments are lenalidomide at a dose of 10 mg to 25 mg administered once daily on days 1-21 of a 28 day cycle and dexamethasone at a dose of 20 mg administered on days 1, 8, 15, and 22 of a 28 day cycle if the patient is at least 75 years old or has a BMI of less than 18.5.
[00234] In an embodiment, the first BCMA antagonist is discontinued after the patient demonstrates progressive disease.
Combinations of Antibody-Drug Conjugates and Corresponding Unconjugated Antibodies
[00235] In some cases, an immunoconjugate or antibody-drug conjugate is used in combination with its corresponding unconjugated antibody. When used with reference to an immunoconjugate or antibody-drug conjugate (ADC), a corresponding unconjugated antibody refers to the antibody portion of the immunoconjugate or ADC that lacks the cytotoxic payload and optionally any linker portion of the immunoconjugate or ADC. In one aspect, the disclosure provides methods of treating a disease or disorder in a patient, the method comprising administering a therapeutically effective amount of a combination comprising an antibody-drug conjugate and the corresponding unconjugated antibody to the patient.
[00236] In one aspect, the disclosure provides methods of reducing toxicity of an antibody-drug conjugate, the method comprising administering to a patient in need thereof a therapeutically effective amount of a combination comprising the antibody-drug conjugate and the corresponding unconjugated antibody to the patient.
[00237] In one aspect, the disclosure provides methods of treating a disease or disorder in a patient previously treated with an antibody-drug conjugate, the method comprising administering a therapeutically effective amount of the corresponding unconjugated antibody to the patient, wherein the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody.
[00238] In one aspect, the disclosure provides methods of reducing toxicity in a patient previously treated with an antibody-drug conjugate, the method comprising administering a therapeutically effective amount of the corresponding unconjugated antibody to the patient, wherein the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody.
[00239] In an embodiment, the antibody-drug conjugate is selected from gemtuzumab ozogamicin, brentuximab vedotin, ado-trastuzumab emtansine, inotuzumab ozogamicin, polatuzumab vedotin, enfortumab vedotin, fam-trastuzumab deruxtecan, sacituzumab govitecan, belantamab mafodotin, loncastuximab tesirine, tisotumab vedotin, moxetumomab pasudotox, MEDI2228, or CC99712.
Diseases and Disorders
[00240] Described herein are methods of treating a disease or disorder in a patient that benefits from inhibition or blocking of B-cell maturation antigen (BCMA). Also described are uses of BCMA-inhibiting or blocking therapies in the treatment of a disease or disorder in a patient.
[00241] In an embodiment, the disease or disorder is a plasma cell disorder or a B-cell disorder. B-cell disorders can be divided into defects of B-cell development/immunoglobulin production (immunodeficiencies) and excessive/uncontrolled proliferation (lymphomas, leukemias). As used herein, B-cell disorder refers to both types of diseases, and methods are provided for treating B- cell disorders. In some embodiments, the cancer can be a B cell cancer (e.g., leukemias and lymphomas).
[00242] Examples diseases or disorders that can be treated according to the methods described herein include Multiple Myeloma (MM), chronic lymphocytic leukemia (CLL), Follicular Lymphoma (FL), Diffuse Large B-Cell Lymphoma (DLBCL), Non-secretory multiple myeloma, Smoldering multiple myeloma, Monoclonal gammopathy of undetermined significance (MGUS), Solitary plasmacytoma (Bone, Extramedullary), Lymphoplasmacytic lymphoma (LPL), Waldenstrom’s Macroglobulinemia, Plasma cell leukemia, Primary Amyloidosis (AL), Heavy chain disease, Systemic lupus erythematosus (SLE), POEMS syndrome / osteosclerotic myeloma, Type I and II cryoglobulinemia, Light chain deposition disease, Goodpasture’s syndrome, Idiopathic thrombocytopenic purpura (ITP), Acute glomerulonephritis, Pemphigus and Pemphigoid disorders, and Epidermolysis bullosa acquisita; or any Non-Hodgkin’s Lymphoma B-cell leukemia (NHL) and Hodgkin’s lymphoma (HL). In some cases, the disease or disorder can be selected from the group consisting of Multiple Myeloma (MM), Non-Hodgkin’s Lymphoma B- cell leukemia (NHL), Follicular Lymphoma (FL), and Diffuse Large B-Cell Lymphoma (DLBCL). In an embodiment, the disease can be Multiple Myeloma or Non-Hodgkin’s Lymphoma B-cell leukemia (NHL). In an embodiment, the disease can be Multiple Myeloma.
[00243] In an embodiment, the disease or disorder is a BCMA-expressing cancer. In an embodiment, the disease or disorder is multiple myeloma (MM). In an embodiment, the MM is relapsed and/or refractory MM, newly-diagnosed MM, transplant-ineligible MM, or transplant- ineligible newly-diagnosed MM. In an embodiment, the disease or disorder is multiple myeloma previously treated with at least one, at least two, at least three, or at least four therapeutics to treat the multiple myeloma. In an embodiment, the disease or disorder is relapsed and/or refractory
multiple myeloma previously treated with at least one, at least two, at least three or at least four therapeutics to treat the multiple myeloma. In another embodiment, the disease or disorder is relapsed and/or refractory multiple myeloma previously treated with at least 3 prior lines of therapy that may include the following: an immunomodulatory drug (ImiD), a proteasome inhibitor (PI) and anti-CD38 treatment (e.g., daratumumab) or combinations thereof. Lines of therapy may be defined by consensus panel of the International Myeloma Workshop (IMWG). In some embodiments, a patient that had prior lines of treatment may have a cancer that is recurrent, relapsed and/or refractory. In some cases, a cancer can be a primary cancer. In some cases, a cancer can be metastatic cancer. In some cases, a cancer can be chemo-resistant cancer.
[00244] In an embodiment, the disease or disorder is an autoimmune disease or disorder. In an embodiment, the disease or disorder is systemic lupus erythematosus (SLE), idiopathic thrombocytopenic purpura (ITP), rheumatoid arthritis, Type 1 diabetes mellitus, multiple sclerosis, or psoriasis.
Antibody Sequences
[00245] The term “belantamab” refers to a B-cell maturation antigen (BCMA)-blocking antibody (“anti-BCMA antibody”) or a functional fragment or functional variant thereof which specifically binds to BCMA and which inhibits the binding of BAFF and/or APRIL to the BCMA receptor, comprising an immunoglobulin heavy chain variable domain (VH) comprising a complementary determining region (CDR) Hl comprising the amino acid sequence of SEQ ID NO 5; a CDRH2 comprising the amino acid sequence of SEQ ID NO: 6; a CDRH3 comprising the amino acid sequence of SEQ ID NO: 7; and an immunoglobulin light chain variable domain (VL) comprising a CDRL1 comprising the amino acid sequence of SEQ ID NO: 8; a CDRL2 comprising the amino acid sequence of SEQ ID NO: 9; and a CDRL3 comprising the amino acid sequence of SEQ ID NO: 10. Exemplary antibody heavy chain variable region and light chain variable region sequences are provided in Table 3 below. In certain embodiments, the VH comprises an amino acid sequence of SEQ ID NO: 3. In certain embodiments, the VL comprises an amino acid sequence of SEQ ID NO 4. In certain embodiments, the heavy chain comprises the amino acid sequence of SEQ ID NO 1. In certain embodiments, the light chain comprises the amino acid sequence of SEQ ID NO 2. In certain other embodiments, belantamab comprises a VH comprising an amino acid sequence of SEQ ID NO: 3 and a VL comprising an amino acid
sequence of SEQ ID NO: 4. In other embodiments, belantamab comprises the heavy and light chain sequences of SEQ ID NO: 1 and SEQ ID NO: 2, respectively.
[00246] The terms “belantamab mafodotin” and “belamaf ’ are used interchangeably and refer to an immunoconjugate comprising belantamab conjugated to monomethyl auristatin F (MMAF) via a 6- maleimidocaproyl (MC) linker.
[00247] The term “biosimilar” refers to a biopharmaceutical or a biologic product that is highly similar to a reference biologic product (e.g., belantamab or belantamab mafodotin) notwithstanding minor differences in clinically inactive components, and for which there are no clinically meaningful differences between the biologic product and the reference product in terms of the safety, purity, and potency of the product (Section 351 (i) of the Public Health Service Act (42 U.S.C. 262(i)).
[00248] Therefore, the term “biosimilar” refers to a biologic product that is highly similar to the reference product (e.g., belantamab or belantamab mafodotin) approved by a regulatory agency (e.g., the Federal Drug Administration (FDA) or the European Medicines Agency (EMA)) based on data from (a) analytical studies demonstrating that the biologic product is highly similar to the reference product notwithstanding minor differences in clinically inactive components; (b) animal studies (including the assessment of toxicity); and/or (c) a clinical study or studies (including the assessment of immunogenicity and pharmacokinetics or pharmacodynamics) that are sufficient to demonstrate safety, purity, and potency in one or more appropriate conditions of use for which the reference product is approved and intended to be used and for which approval is sought (e.g., that there are no clinically meaningful differences between the biologic product and the reference product in terms of the safety, purity and potency of the product). In certain embodiments, the biosimilar product is an interchangeable product as determined by a regulatory agency (e.g., the FDA).
[00249] It will be generally understood that a biosimilar of belantamab mafodotin will comprise the post-translational modifications that are essential for the function and efficacy of belantamab mafodotin (as disclosed in International Patent Application Publication No. WO 2021/024133). However, in certain embodiments, the biosimilar (e.g., a biosimilar of belantamab or belantamab mafodotin) may comprise one or more molecular differences, such as post-translational modifications, for example, although not limited to, glycosylation, oxidation, deamidation, and/or truncation which is/are different to the post-translational modifications of
the reference medicinal product (e.g., belantamab or belantamab mafodotin) provided that the differences do not result in a significant change in safety and/or efficacy of the medicinal product. In certain embodiments, the biosimilar (e.g., a biosimilar of belantamab or belantamab mafodotin) may have an identical or different glycosylation pattern to the reference medicinal product (e.g., belantamab or belantamab mafodotin). Particularly, although not exclusively, the biosimilar (e.g., a biosimilar of belantamab or belantamab mafodotin) may have a different glycosylation pattern, such as, if the differences address or are intended to address safety concerns associated with the reference medicinal product (e.g., belantamab or belantamab mafodotin). Additionally, the biosimilar (e.g., a biosimilar of belantamab or belantamab mafodotin) may deviate from the reference medicinal product (e.g., belantamab or belantamab mafodotin) in, for example, its strength, pharmaceutical form, formulation, excipients and/or presentation, providing safety and efficacy of the medicinal product is not compromised. In other embodiments, the biosimilar (e.g., a biosimilar of belantamab or belantamab mafodotin) may comprise differences in, for example, pharmacokinetic (PK) and/or pharmacodynamic (PD) profiles as compared to the reference medicinal product (e.g., belantamab or belantamab mafodotin) but is still deemed sufficiently similar to the reference medicinal product as to be authorized or considered suitable for authorization. In certain embodiments, the biosimilar (e.g., a biosimilar of belantamab or belantamab mafodotin) may exhibit different binding characteristics as compared to the reference medicinal product (e.g., belantamab or belantamab mafodotin), wherein the different binding characteristics are considered by a Regulatory Authority such as the FDA and/or EMA not to be a barrier for authorization as a similar biologic product. The term “biosimilar” is also used synonymously by other national and regional regulatory agencies.
[00250] It will be understood that a drug’s international nonproprietary name (INN), (e.g., belantamab or belantamab mafodotin), is to be interpreted as including generic, bioequivalent, and/or biosimilar versions of that drug, including but not limited to any drug that has received abbreviated regulatory approval by reference to an earlier regulatory approval of that drug. Additionally, a drug’s INN optionally includes, but is not limited to, glycosylation variants of belantamab or belantamab mafodotin, and biosimilars thereof.
Table 3
EMBODIMENTS
[00251] Embodiment 1 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering to the patient belantamab at a dose of about 300 mg to about 2000 mg.
[00252] Embodiment 2 is the method of embodiment 1, wherein the dose is about 300 mg, about 900 mg, or about 2000 mg.
[00253] Embodiment 3 is the method of embodiment 1 or 2, wherein the dose is administered at a regular interval for a period of time.
[00254] Embodiment 4 is the method of embodiment 1 or 2, wherein the dose is administered once every week ± 3 days to once every four weeks ± 3 days.
[00255] Embodiment 5 is the method of embodiment 1 or 2, wherein the dose is administered once every two weeks ± 3 days.
[00256] Embodiment 6 is the method of embodiment 1 or 2, wherein the dose is administered once every three weeks ± 3 days.
[00257] Embodiment 7 is the method of embodiment 1 or 2, wherein the dose is administered once every four weeks ± 3 days.
[00258] Embodiment 8 is the method of embodiment 1 or 2, wherein the dose is administered on days 1 and 15 of a 28 day cycle.
[00259] Embodiment 9 is the method of embodiment 1 or 2, wherein the dose is administered on day 1 of a 21 day cycle.
[00260] Embodiment 10 is the method of any one of the preceding embodiments, wherein the patient has been treated with at least one prior line of cancer treatment.
[00261] Embodiment 11 is the method of any one of the preceding embodiments, wherein the patient has been treated with one, two, three, or four prior lines of cancer treatments.
[00262] Embodiment 12 is the method of embodiment 11, wherein the prior lines of cancer treatments include an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent.
[00263] Embodiment 13 is the method of any one of the preceding embodiments, wherein belantamab is administered through an intravenous infusion or a subcutaneous injection.
[00264] Embodiment 14 is the method of any one of the preceding embodiments, wherein the patient is further receiving at least one additional cancer treatment, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
[00265] Embodiment 15 is the method of embodiment 14, wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone. [00266] Embodiment 16 is the method of embodiment 15, wherein the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time.
[00267] Embodiment 17 is the method of embodiment 16, wherein the patient is receiving lenalidomide on days 1-21 of a 28 day cycle.
[00268] Embodiment 18 is the method of any one of embodiments 14 to 17, wherein the additional cancer treatment is dexamethasone.
[00269] Embodiment 19 is the method of embodiment 18, wherein the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly.
[00270] Embodiment 20 is the method of embodiment 19, wherein the patient is receiving dexamethasone on days 1, 8, 15, and 22 of a 28 day cycle.
[00271] Embodiment 21 is the method of embodiment 19, wherein (i) the patient is less than 75 years old and is receiving dexamethasone at a dose of 40 mg once weekly; or (ii) the patient is at least 75 years old and is receiving dexamethasone at a dose of 20 mg once weekly.
[00272] Embodiment 22 is the method of embodiment 19, wherein (i) the patient has a BMI of at least 18.5 and is receiving dexamethasone at a dose of 40 mg once weekly; or (ii) the patient has a BMI less than 18.5 and is receiving dexamethasone at a dose of 20 mg once weekly.
[00273] Embodiment 23 is the method of any one of the preceding embodiments, further comprising discontinuing administration of belantamab and subsequently administering belantamab mafodotin.
[00274] Embodiment 24 is the method of any one of embodiments 1 to 22, further comprising administering belantamab mafodotin and subsequently discontinuing administration of belantamab.
[00275] Embodiment 25 is the method of embodiment 23 or 24, wherein belantamab mafodotin is administered at a dose of 2.5 mg/kg once every three weeks ± 3 days.
[00276] Embodiment 26 is the method of any one of the preceding embodiments, further comprising administering a lead-in dose of belantamab mafodotin prior to beginning administration of belantamab, wherein the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 3.4 mg/kg once during a lead-in period.
[00277] Embodiment 27 is the method of embodiment 26, wherein the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 1.9 mg/kg once during a lead-in period. [00278] Embodiment 28 is the method of embodiment 26, wherein the lead-in dose of belantamab mafodotin is about 1.4 mg/kg, about 1.9 mg/kg, about 2.5 mg/kg, or about 3.4 mg/kg once during a lead-in period.
[00279] Embodiment 29 is the method of embodiment 26, wherein the lead-in dose of belantamab mafodotin is about 1.4 mg/kg once during a lead-in period.
[00280] Embodiment 30 is the method of any one of embodiments 26 to 29, wherein the lead- in period is four weeks ± 3 days and belantamab mafodotin is administered on day 1 of the lead- in period.
[00281] Embodiment 31 is the method of any one of embodiments 26 to 30, further comprising administering at least one additional cancer treatment to the patient during the lead-in period, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
[00282] Embodiment 32 is the method of embodiment 31, wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone. [00283] Embodiment 33 is the method of embodiment 32, wherein the additional cancer treatment is lenalidomide at a dose of 10 mg to 25 mg once daily for a period of time.
[00284] Embodiment 34 is the method of embodiment 33, wherein lenalidomide is administered to the patient on days 1-21 of the lead-in period.
[00285] Embodiment 35 is the method of any one of embodiments 32 to 34, wherein the additional cancer treatment is dexamethasone.
[00286] Embodiment 36 is the method of embodiment 35, wherein the additional cancer treatment is dexamethasone at a dose of 20 mg to 40 mg once weekly.
[00287] Embodiment 37 is the method of embodiment 36, wherein dexamethasone is administered to the patient on days 1, 8, 15, and 22 of the lead-in period.
[00288] Embodiment 38 is the method of embodiment 36, wherein (i) the patient is less than 75 years old and dexamethasone is administered to the patient at a dose of 40 mg once weekly; or (ii) the patient is at least 75 years old and dexamethasone is administered to the patient at a dose of 20 mg once weekly.
[00289] Embodiment 39 is the method of embodiment 36, wherein (i) the patient has a BMI of at least 18.5 and dexamethasone is administered to the patient at a dose of 40 mg once weekly; or (ii) the patient has a BMI less than 18.5 and dexamethasone is administered to the patient at a dose of 20 mg once weekly.
[00290] Embodiment 40 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering to a patient belantamab mafodotin at a dose of about 1.4 mg/kg to about 3.4 mg/kg once every eight weeks ± 3 days, such as about 1.4 mg/kg to about 1.9 mg/kg once every eight weeks ± 3 days.
[00291] Embodiment 41 is the method of embodiment 40, wherein the dose is about 1.4 mg/kg, about 1.9 mg/kg, about 2.5 mg/kg, or about 3.4 mg/kg once every eight weeks ± 3 days. [00292] Embodiment 42 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering a therapeutically effective amount of a combination comprising a first BCMA antagonist and a second BCMA antagonist to the patient.
[00293] Embodiment 43 is the method of embodiment 42, wherein the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
[00294] Embodiment 44 is the method of embodiment 42 or 43, wherein the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
[00295] Embodiment 45 is the method of any one of embodiments 42 to 44, wherein the first BCMA antagonist is belantamab mafodotin.
[00296] Embodiment 46 is the method of any one of embodiments 42 to 44, wherein the first BCMA antagonist is belantamab.
[00297] Embodiment 47 is the method of embodiment 42, wherein the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
[00298] Embodiment 48 is the method of embodiment 47, wherein the anti-BCMA antibodydrug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
[00299] Embodiment 49 is the method of embodiment 48, wherein the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab.
[00300] Embodiment 50 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering a therapeutically effective amount of a combination comprising belantamab mafodotin and belantamab to the patient.
[00301] Embodiment 51 is the method of any one of embodiments 42 to 50, further comprising administering at least one additional cancer treatment to the patient, such as an anti- CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD- 1 monoclonal antibody.
[00302] Embodiment 52 is the method of embodiment 51 , wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone. [00303] Embodiment 53 is a kit comprising: (i) a first B-cell maturation antigen (BCMA) antagonist; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking BCMA when combined with a second BCMA antagonist.
[00304] Embodiment 54 is a kit comprising: (i) belantamab mafodotin; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) when combined with belantamab.
[00305] Embodiment 55 is a kit comprising: (i) belantamab; and (ii) instructions for use in treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) when combined with belantamab mafodotin.
[00306] Embodiment 56 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with a first BCMA antagonist, the method comprising administering a therapeutically effective amount of a second
BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
[00307] Embodiment 57 is the method of embodiment 56, wherein the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
[00308] Embodiment 58 is the method of embodiment 56 or 57, wherein the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
[00309] Embodiment 59 is the method of any one of embodiments 56 to 58, wherein the first BCMA antagonist is belantamab mafodotin.
[00310] Embodiment 60 is the method of any one of embodiments 56 to 58, wherein the first BCMA antagonist is belantamab.
[00311] Embodiment 61 is the method of any one of embodiments 56 to 58, wherein the second BCMA antagonist is belantamab mafodotin.
[00312] Embodiment 62 is the method of any one of embodiments 56 to 58, wherein the second BCMA antagonist is belantamab.
[00313] Embodiment 63 is the method of embodiment 56, wherein the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
[00314] Embodiment 64 is the method of embodiment 63, wherein the anti-BCMA antibodydrug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
[00315] Embodiment 65 is the method of embodiment 63, wherein the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab.
[00316] Embodiment 66 is the method of embodiment 56, wherein the second BCMA antagonist is an anti-BCMA antibody-drug conjugate and the first BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
[00317] Embodiment 67 is the method of embodiment 66, wherein the anti-BCMA antibodydrug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
[00318] Embodiment 68 is the method of embodiment 66, wherein the second BCMA antagonist is belantamab mafodotin and the first BCMA antagonist is belantamab.
[00319] Embodiment 69 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab mafodotin, the method comprising administering a therapeutically effective amount of belantamab to the patient, wherein the patient discontinued administration of belantamab mafodotin prior to beginning administration of belantamab.
[00320] Embodiment 70 is a method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with belantamab, the method comprising administering a therapeutically effective amount of belantamab mafodotin to the patient, wherein the patient discontinued administration of belantamab prior to beginning administration of belantamab mafodotin.
[00321] Embodiment 71 is the method of any one of embodiments 56 to 70, further comprising administering at least one additional cancer treatment to the patient, such as an anti- CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD- 1 monoclonal antibody.
[00322] Embodiment 72 is the method of embodiment 71, wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone. [00323] Embodiment 73 is a method of reducing corneal toxicity in a patient previously treated with a first B-cell maturation antigen (BCMA) antagonist, the method comprising administering a therapeutically effective amount of a second BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist.
[00324] Embodiment 74 is the method of embodiment 73, wherein the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy.
[00325] Embodiment 75 is the method of embodiment 73 or 74, wherein the first and second BCMA antagonists are independently selected from the group consisting of idecabtagene vicleucel, ciltacabtagene autoleucel, teclistamab, REGN5458, belantamab mafodotin, belantamab, SEA-BCMA, ABBV-383, elrantamab, pavurutumab, alnuctamab, MEDI2228, and CC99712.
[00326] Embodiment 76 is the method of any one of embodiments 73 to 75, wherein the first BCMA antagonist is belantamab mafodotin.
[00327] Embodiment 77 is the method of any one of embodiments 73 to 75, wherein the first BCMA antagonist is belantamab.
[00328] Embodiment 78 is the method of any one of embodiments 73 to 75, wherein the second BCMA antagonist is belantamab mafodotin.
[00329] Embodiment 79 is the method of any one of embodiments 73 to 75, wherein the second BCMA antagonist is belantamab.
[00330] Embodiment 80 is the method of embodiment 73, wherein the first BCMA antagonist is an anti-BCMA antibody-drug conjugate and the second BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
[00331] Embodiment 81 is the method of embodiment 80, wherein the anti-BCMA antibodydrug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
[00332] Embodiment 82 is the method of embodiment 80, wherein the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab.
[00333] Embodiment 83 is the method of embodiment 73, wherein the second BCMA antagonist is an anti-BCMA antibody-drug conjugate and the first BCMA antagonist is the corresponding unconjugated anti-BCMA antibody.
[00334] Embodiment 84 is the method of embodiment 83, wherein the anti-BCMA antibodydrug conjugate is selected from the group consisting of belantamab mafodotin, MEDI2228, and CC99712.
[00335] Embodiment 85 is the method of embodiment 83, wherein the second BCMA antagonist is belantamab mafodotin and the first BCMA antagonist is belantamab.
[00336] Embodiment 86 is a method of reducing corneal toxicity in a patient previously treated with belantamab mafodotin, the method comprising administering a therapeutically effective amount of belantamab to the patient, wherein the patient discontinued administration of belantamab mafodotin prior to beginning administration of belantamab.
[00337] Embodiment 87 is a method of reducing corneal toxicity in a patient previously treated with belantamab, the method comprising administering a therapeutically effective amount of belantamab mafodotin to the patient, wherein the patient discontinued administration of belantamab prior to beginning administration of belantamab mafodotin.
[00338] Embodiment 88 is the method of any one of embodiments 73 to 87, further comprising administering at least one additional cancer treatment to the patient, such as an anti- CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD- 1 monoclonal antibody.
[00339] Embodiment 89 is the method of embodiment 88, wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone. [00340] Embodiment 90 is a method of treating a disease or disorder in a patient, the method comprising administering a therapeutically effective amount of a combination comprising an antibody-drug conjugate and the corresponding unconjugated antibody.
[00341] Embodiment 91 is a method of treating a disease or disorder in a patient previously treated with an antibody-drug conjugate, the method comprising administering a therapeutically effective amount of the corresponding unconjugated antibody to the patient, wherein the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody.
[00342] Embodiment 92 is the method of embodiment 90 or 91, wherein the antibody-drug conjugate is selected from gemtuzumab ozogamicin, brentuximab vedotin, ado-trastuzumab emtansine, inotuzumab ozogamicin, polatuzumab vedotin, enfortumab vedotin, fam-trastuzumab
deruxtecan, 66andomized66 govitecan, belantamab mafodotin, loncastuximab tesirine, tisotumab vedotin, moxetumomab pasudotox, MEDI2228, or CC99712.
[00343] Embodiment 93 is the method of any one of embodiments 1 to 52 or 56 to 92, or the kit of any one of embodiments 53 to 55, wherein the disease or disorder is a plasma cell disorder or a B-cell disorder.
[00344] Embodiment 94 is the method any one of embodiments 1 to 52 or 56 to 92, or the kit of any one of embodiments 53 to 55, wherein the disease or disorder is a BCMA-expressing cancer.
[00345] Embodiment 95 is the method any one of embodiments 1 to 52 or 56 to 92, or the kit of any one of embodiments 53 to 55, wherein the disease or disorder is multiple myeloma (MM). [00346] Embodiment 96 is the method of embodiment 95, wherein the MM is relapsed and/or refractory MM, newly-diagnosed MM, transplant-ineligible MM, or transplant-ineligible newly- diagnosed MM.
[00347] Embodiment 97 is the kit of embodiment 95, wherein the MM is relapsed and/or refractory MM, newly-diagnosed MM, transplant-ineligible MM, or transplant-ineligible newly- diagnosed MM.
[00348] Embodiment 98 is a method of treating cancer in a patient, wherein the patient has a Grade 1 corneal adverse reaction resulting from belantamab mafadotin administration, the method comprising temporarily discontinuing administration of belantamab mafadotin; administering to the patient a therapeutically effective amount of belantamab for a lead-in period; and resuming administration of belantamab mafadotin after the lead-in period.
[00349] Embodiment 99 is a method of treating cancer in a patient, wherein the patient has a Grade 2 or above corneal adverse reaction resulting from belantamab mafodotin administration, the method comprising temporarily discontinuing administration of belantamab mafadotin; administering to the patient a therapeutically effective amount of belantamab I Ifor a lead-in period; and resuming administration of belantamab mafadotin after the lead-in period.
EXAMPLES
[00350] The following examples are provided to illustrate, but not limit the claimed disclosure.
Example 1: In Vivo Efficacy of Belantamab in the Treatment of Subcutaneous NCI-H929 Human Multiple Myeloma Model in NOD/SCID Mice.
[00351] A study was conducted to evaluate the in vivo therapeutic efficacy of belantamab (GSK2857914) and belantamab mafodotin (GSK2857916) in the treatment of a subcutaneous NCI-H929 human multiple myeloma model in NOD/SCID mice. Groups of 10 mice were dosed by intraperitoneal administration in the amount and at the frequency and duration shown in Table
Table 4
[00352] Methods: The NCI-H929 tumor cells were maintained in vitro with RPMI1640 medium supplemented with 10% fetal bovine serum and 0.05mM 0-ME at 37°C in an atmosphere of 5%
C02 in air. Cells in an exponential growth phase were harvested and counted for tumor inoculation. Each mouse was inoculated subcutaneously in the right front flank region with NCI-H929 tumor cells (5x 106) in 0.1 ml of PBS mixed with matrigel (1: 1) for tumor development. The randomization started when the mean tumor size reached 121 mm3. 80 mice were enrolled in the study. All animals were randomly allocated to 8 study groups. Randomization was performed based on “Matched distribution” method (Study Director™ software, version 3.1.399.19) randomized block design. The date of randomization was denoted as day 0. The treatment was initiated on the same day of randomization (day 0) per study design.
[00353] After tumor cells inoculation, the animals were checked daily for morbidity and mortality. During routine monitoring, the animals were checked for any effects of tumor growth and treatments on behavior such as mobility, food and water consumption, body weight gain/loss (body weights were measured twice weekly after randomization), eye/hair matting and any other abnormalities. Mortality and observed clinical signs were recorded for individual animals in detail. Tumor volumes were measured twice weekly after randomization in two dimensions using a caliper, and the volume was expressed in mm3 using the formula: “V = (L x W x W) x 0.52, where V was tumor volume, L was tumor length (the longest tumor dimension) and W was tumor width (the longest tumor dimension perpendicular to L). Dosing as well as tumor and body weight measurements were conducted in a Laminar Flow Cabinet. The body weights and tumor volumes were measured by using StudyDirectorTM software (version 3.1.399.19).
[00354] Statistical Analysis: To compare tumor volumes of different groups at a pre-specified day, Bartlett’s test was first used to check the assumption of homogeneity of variance across all groups. When the p-value of Bartlett’s test was >= 0.05, one-way ANOVA was run to test overall equality of means across all groups. If the p-value of the one-way ANOVA was < 0.05, post hoc testing was further performed by running Tukey’s HSD (honest significant difference) tests for all pairwise comparisons, and Dunnett’s tests for comparing each treatment group with the vehicle group. When the p-value of Bartlett’s test was <0.05, Kruskal- Wallis test was run to test overall equality of medians among all groups. If the p-value the Kruskal-Wallis test was <0.05, post hoc testing was further performed by running Conover’s non-parametric test for all pairwise comparisons or for comparing each treatment group with the vehicle group, both with single-step p-value adjustment.
[00355] In addition, pairwise comparisons without multiple comparison correction were performed and nominal/uncorrected p-values were reported directly from Welch’s t-test or Mann- Whitney U test. Specifically, Bartlett’s test was first used to check the assumption of homogeneity of variance for a pair of groups. When the p-value of Bartlett’s test was ''0.05, Welch’s t-test was run, otherwise Mann- Whitney U test was run, to obtain nominal p-values.
[00356] All statistical analyses were done in R-a language and environment for statistical computing and graphics (version 3.3.1). All tests have two-sided unless otherwise specified, and p-values of <0.05 were regarded as statistically significant.
[00357] The survival time was analyzed by Kaplan-Meier method. The event of interest was the animal death. The survival time was defined as the time from the day of randomization to the day when the tumor volume reached to 2500 mm3. For each group, the median survival time (MST), corresponding 95% confidence interval and the increased in life-span (ILS) were calculated. The Kaplan-Meier curves was constructed for each group and the log-rank test was used to compare survival curves between groups. All data were analyzed using SPSS 18.0. P < 0.05 was considered to be statistically significant.
[00358] Results: The tumor volume analysis showed that GSK2857916 at 4 mg/kg and GSK2857914 at 8 mg/kg as the single agent or in combination with different dosing schedules (G2-G8) demonstrated significant anti-tumor efficacy in NCLH929 Xenograft model compared with vehicle (Gl). In addition, GSK2857916 in combination with GSK2857914 (G4 and G6) showed significant improved anti-tumor efficacy compared with the single agent of GSK2857916 (G2). The tumor volume growth curves between randomization grouping and study termination are shown in FIG. 1. Tumor growth inhibition (TGI) from data collected on day 24 is provided in Table 5.
Table 5
[00359] The survival analysis showed that GSK2857916 at 4 mg/kg and GSK2857914 at 8 mg/kg as the single agent or in combination with different dosing schedules (G2-G8) significantly
increased the life-span of mice in NCI-H929 Xenograft model compared with vehicle (Gl). In addition, GSK2857916 in combination with GSK2857914 (G4 and G6) could further increase the life-span of mice compared with the single agent of GSK2857916 (G2). Kaplan-Meier survival curves for all treatment groups as a function of study day are shown in FIG. 2. Median survival day for mice in each group is provided in Table 6.
Table 6
Note: 1. A. vs. Gl;
Note 2. G2 vs. G4, p<0.001; G2 vs. G6, p=0.003; G2 vs. G7, p=0.122.
Example 2: Phase 1/2 Study to Evaluate the Safety and Efficacy of Belantamab in Multiple Myeloma .
[00360] A study is conducted to evaluate the safety and efficacy of belantamab in participants with relapsed or refractory multiple myeloma (RRMM).
Study Design
Part 1 : Does Escalation Phase in RRMM,
[00361] Part 1 is a Phase 1 open-label study evaluating the safety, tolerability, and clinical activity of escalating doses of single agent belantamab in participants with RRMM who have received at least 3 prior lines of treatment to determine the recommended part 2 dose. Belantamab is dosed twice a cycle on Days 1 and 15 of a 28-day cycle, starting at a dose of 300 mg IV. Dose escalation is guided by modified toxicity probability interval to 900 mg and then to the maximum dose of 2000 mg according to a dose escalation plan and as directed by a dose escalation committee. The exploration of an additional intermediate dose is allowed if suggested by the dose
escalation committee and agreed upon by the Medical Monitor and treating investigators. The progression from one dose level to another and the recommended Part 2 doses are based on the totality of available data from Part 1 of belantamab treatment; the dose escalation committee takes into consideration, in particular, the safety and tolerability of each dose level, available PK and PD data and preliminary efficacy to recommend two dose levels to further characterize in Part 2. [00362] Participants are dosed until progressive disease (PD) after which they have the option to receive treatment with single agent belantamab mafodotin (Part IB) at 2.5 mg/kg Q3W. Participants who opt to be treated with belantamab mafodotin following the first PD proceed with an end of treatment (EOT) visit before starting belantamab mafodotin treatment, and then continue to be monitored for safety, tolerability and disease response during belantamab mafodotin treatment until the next PD. After the second PD, participants undergo a second EOT belantamab mafodotin visit (if feasible) and are monitored for safety up to at least 70 days after the last belantamab mafodotin dose. Participants who opt out of belantamab mafodotin treatment after the first PD terminate the treatment and proceed with the EOT visit and follow-up safety monitoring. [00363] The belantamab treatment duration is until first PD (followed by optional belantamab mafodotin treatment until second PD), unacceptable toxicity, or any other treatment termination criteria. For example, the treatment duration could be up to approximately 8 months.
[00364] The visit frequency is every 2 weeks from Cycle 3 forward. More visits are scheduled in Cycles 1 and 2.
Part 2: Combination Evaluation in RRMM,
[00365] Part 2 is a 2-arm safety run-in randomized, open-label study evaluating the safety, tolerability, and clinical activity of 1 cycle of belantamab mafodotin-xRd (belantamab mafodotin, treatment x, lenalidomide, and dexamethasone) followed by continuous treatment with belantamab-xRd (belantamab, treatment x, lenalidomide, and dexamethasone) in participants with recurrent MM who have received at least 1 prior line of treatment (2L+). In some cases, treatment x includes, but is not limited to, a combination of an anti-CD38 antibody such as daratumumab or isatuximab) and a gamma secretase inhibitor such as nirogacestat. In some cases, treatment x includes, but is not limited to, a proteasome inhibitor such as bortezomib.
[00366] The combination treatment xRd includes lenalidomide (R) and dexamethasone (d). The selection of treatment x is based on data from on-going belantamab mafodotin clinical studies and is either a standard of care or an emerging treatment for MM.
[00367] The belantamab doses are based on the totality of available Part 1 data. Two different dose levels of belantamab (Arms A and B) are dosed every 4 weeks. More frequent dosing is used if justified by Part 1 data based on safety, tolerability, PK/PD modelling or other data. Up to approximately 20 participants, evaluable for safety and tolerability, are randomized equally into Arms A and B, after receiving one cycle (28 days) of belantamab mafodotin-xRd. A single dose of belantamab mafodotin at 1.4 mg/kg is administered in combination with treatment x, lenalidomide at 25 or 10 mg once daily (on days 1-21 of the cycle), and dexamethasone at 40 mg once daily (on days 1, 8, 15, and 22 of the cycle) (or 20 mg if age ^75 years or BMI <18.5).
[00368] Dosing with belantamab-xRd is continued until progressive disease (PD).
[00369] Part 2 of the study assesses overall safety events and tolerability and corneal adverse events for 10 parti cipants/ Arm after 3 cycles of treatment. Participants are considered evaluable for safety and tolerability if they have completed at least 3 cycles of treatment including one cycle of belantamab mafodotin-xRd followed by 2 cycles of belantamab-xRd. Participants not meeting the definition of evaluable may be replaced if they withdraw for reason other than treatment related adverse event, death or PD. The totality of data from Part 1 and Part 2 are used to determine the belantamab recommended Phase 2 dose(s) to be used in Part 3.
[00370] Participants who terminate treatment in Part 2 of the study for other reasons than PD continue to be followed for progression-free survival and overall survival.
[00371] The treatment duration is until PD, unacceptable toxicity, or any other treatment termination criteria. For example, the treatment duration could be up to approximately 15 months. [00372] The visit frequency is every 4 weeks from Cycle 3 unless data from Part 1 and from on-going belantamab mafodotin clinical trials suggest more frequent dosing with administration of belantamab-xRd. More visits are planned during Cycles 1 and 2.
Part 3: Combination Evaluation in Transplant-Ineligible Newly Diagnosed Multiple Myeloma (TI- NDMM),
[00373] Part 3 is a 4-arm Phase 2 randomized, open-label study evaluating the safety and efficacy of continuous belantamab-xRd following treatment with 1 cycle of belantamab mafodotin-xRd in participants with TI-NDMM. Cycle length is 4 weeks. Two different doses of belantamab (Arms A and B) are dosed every 4 weeks. The belantamab dose levels are selected based on the totality of available data from Parts 1 and 2 and may be different to the ones administered in Part 2; the selection process by the dose escalation committee takes into
consideration the overall safety and tolerability of the combination, available PK/PD data and evidence of efficacy of the different dose levels. Dosing with belantamab-xRd continues until PD. The belantamab mafodotin and xRd doses are the same in Arms A and B: a single dose of belantamab mafodotin at 1.4 mg/kg administered in combination with treatment x, lenalidomide at 25 or 10 mg once daily (on days 1-21 of the cycle), and dexamethasone at 40 mg once daily (on days 1, 8, 15, and 22 of the cycle) (or 20 mg if age ^75 years or BMI <18.5).
[00374] Part 3 also tests the outcome of: 1) treatment with continuous dosing of belantamab mafodotin-xRd (Arm C), and 2) treatment with a continuous dosing of belantamab-xRd in absence of the belantamab mafodotin-xRd initial dose (Arm D).
[00375] In Arm C, belantamab mafodotin is dosed once every two 28-days cycles (Q8W) at a dose of 1.4 mg/kg in combination with treatment x, lenalidomide at 25 or 10 mg once daily (on days 1-21 of the cycle), and dexamethasone at 40 mg once daily (on days 1, 8, 15, and 22 of the cycle) (or 20 mg if age ^75 years or BMI <18.5).
[00376] In Arm D, belantamab is administered once per 28-day cycle in combination with treatment x, lenalidomide at 25 or 10 mg once daily (on days 1-21 of the cycle), and dexamethasone at 40 mg once daily (on days 1, 8, 15, and 22 of the cycle) (or 20 mg if age ^75 years or BMI <18.5).
[00377] Approximately 80 participants are randomised 1 : 1 : 1 : 1 to either Arm A or B or C or D with the aim to obtain data on 20 evaluable participants per arm. Participants are considered evaluable if they have completed at least 4 cycles of treatment, including one cycle of belantamab mafodotin-xRd followed by 3 cycles of belantamab-xRd. Participants not meeting the definition of evaluable may be replaced if they withdraw for reason other than treatment related adverse event, death or disease progression.
[00378] The xRd doses are the same in all four arms of the study, while the belantamab mafodotin and belantamab doses and dosing frequencies may differ in Arm C and Arm D, respectively, compared to the ones in Arms A and B.
[00379] The study terminates 18 months after last subject first dose. At that time, data collection for all recruited participants who no longer receive study treatment stops and the clinical trial database is closed. If the disease has not progressed at time of study termination, participants who continue benefitting by the treatment as suggested by the investigator are transferred in a post- analysis-continual-treatment study to continue receiving treatment. Under these circumstances, the
1
treatment duration for Part 3 participants until the data cut-off date of this study is up to approximately 24 months.
[00380] The visit frequency is every 4 weeks starting from Cycle 3, unless data from Parts 1 and 2 and from on-going belantamab mafodotin clinical trials suggest more frequent dosing with belantamab-xRd. More visits are planned during Cycles 1 and 2.
[00381] An overview of the study treatments is provided in Table 7.
Table 7
'Dose limiting toxicity (DLT)
2Belantamab (bela)
3Belantamab mafodotin (belamaf)
4Belantamab recommended part 2 dose level 1 (bela RPart2 DL1)
5Belantamab recommended part 2 dose level 2 (bela RPart2 DL2)
6Belantamab recommended phase 2 dose level 1 (bela RP2 DL1)
7Belantamab recommended phase 2 dose level 2 (bela RP2 DL2)
[00382] A summary of the treatment doses and administration frequency is provided in Table
8. A standard of care (SoC) treatment or emerging MM treatment is also administered as provided in Table 8.
Table 8
1 Based on the safety data observed in this study, the infusion duration may be adjusted to 30-60 mins.
2 Based on PK/PD modelling a more frequent bela dosing schedule may be used in Parts 2 and 3.
3 Premedication (e.g., systemic corticosteroids) is not required unless deemed medically necessary by the investigator, in which case it should be administered according to institutional recommendations.
4 Infusions may be prolonged in the event of an infusion reaction. If multiple participants experience clinically significant infusion reactions, the infusion rate may be slowed for all future administrations of study treatment for all participants. Should this global change in infusion rate be required, it will be communicated to the sites in writing.
Dosing Adjustments: Belantamab Mafodotin
[00383] In Part 3 Arm C, continuous belantamab mafodotin is administered 1.4 mg/kg Q8W, and based on emerging data from ongoing belantamab mafodotin trials, the dose level may be increased to 1.9 mg/kg Q8W unless data supports more frequent administration. The initial dose(s) match Parts A and B with the ongoing dose selected based on considerations of data from other studies and clinical experience with belantamab mafodotin.
Dosing Adjustments: Lenalidomide and Dexamethasone
[00384] Lenalidomide is administered as 25 mg PO daily on days 1-21 of each 28-day cycle, in participants with CLcr of >60 mL/min (by Cockcroft-Gault). The dose of lenalidomide will be reduced to 10 mg daily on Days 1 to 21 in participants with CLcr of 30-60 mL/min. Lenalidomide is administered at a fixed dose level, with no adjustments needed for body weight or BSA. On lenalidomide and belantamab/belantamab mafodotin co-administration days, lenalidomide should be administered as close as possible to the end of the 1-2 hours rest period after administration of
belantamab/belantamab mafodotin, and on PK days no later than 6 hours after the end of the rest period after administration of belantamab/belantamab mafodotin. Dexamethasone will be given at 40 mg (or 20 mg if age ^75 years or BMI <18.5 kg/m2) weekly PO on Days 1, 8, 15 and 22 of each cycle.
Eligibility Criteria
Inclusion Criteria:
[00385] Participants are eligible to be included in the study only if all the following criteria are met:
[00386] 1. Participants are at least 18 years old or are of the legal age of consent in the jurisdiction in which the study is taking place.
[00387] 2. Participants have histologically or cytologically confirmed diagnosis of MM, as defined by the international myeloma working group (IMWG).
[00388] Part 1 : Participants who have received at least 3 prior lines of anti-myeloma treatments, and have already received an immunomodulating agent, a proteasome inhibitor, and an anti-CD38 mAb (unless contraindicated or unavailable). Lines of therapy are defined by consensus panel of the International Myeloma Workshop.
[00389] Part 2: Participants who meet all of the following: (1) have undergone autologous stem cell transplant (ASCT) or are considered transplant ineligible; (2) have been previously treated with at least one prior line of MM therapy; (3) have documented disease progression during or after their most recent therapy.
[00390] Part 3: Participants who meet both of the following: (1) NDMM with a requirement for treatment as documented per IMWG criteria; and (2) not considered a candidate for high dose chemotherapy with ASCT due to: (a) Age
65 years; or (b) age 18-65 years with presence of comorbid condition(s) likely to have a negative impact on tolerability of high-dose chemotherapy with ASCT or who refuse high-dose chemotherapy with ASCT as an initial treatment.
[00391] 3. Participants with a history of ASCT are eligible for study participation provided the following eligibility criteria are met: (a) transplant was >100 days prior to screening; and (b) no active infection(s).
[00392] 4. Eastern cooperative oncology group-performance status (ECOG-PS) of 0-2.
[00393] 5. Measurable disease defined as at least ONE of the following: (a) serum M-protein concentration 0.5 g/dL (^5 g/L); (b) urine M-protein excretion -'200 mg/24 hours ( '0.2 g/24 hours); or (c) serum free light chain (FLC) assay: involved FLC level ^10 mg/dL ( ' 100 mg/L) and an abnormal serum FLC ratio (<0.26 or >1.65).
[00394] 6. Have adequate organ system functions as provided in Table 9:
Table 9
Note: Laboratory results obtained during screening should be used to determine eligibility criteria. In situations where laboratory results are outside the permitted range, the investigator may re-test the participant and the subsequent within range screening result may be used to confirm eligibility.
1. Without growth support, transfusion, or platelet stimulating agents within 14 days of the assessment.
2. As calculated by MDRD formula.
[00395] 7. All prior treatment-related toxicities (defined by NCI-CTCAE, v5.0, 2017) must be
Grade <1 at the time of screening except for alopecia (any grade), neuropathy (Grade <2), or endocrinopathy managed with replacement therapy (any grade).
[00396] 8. Participants who are currently receiving physiological doses oral steroids (<10 mg/day), inhaled steroids or ophthalmological steroids are allowed on study.
Exclusion Criteria:
[00397] Participants are excluded from the study if any of the following criteria apply:
[00398] Medical Conditions:
[00399] 1. Diagnosis of primary AL Amyloidosis, active POEMS syndrome, primary plasma cell leukemia.
[00400] 2. Any serious and/or unstable pre-existing medical, psychiatric disorder, or other conditions (including lab abnormalities) that could interfere with participant’s safety, obtaining informed consent, or compliance with study procedures.
[00401] 3. Participant is exhibiting signs of meningeal or central nervous system involvement with MM.
[00402] 4. Current corneal epithelial disease except nonconfluent SPK.
[00403] 5. Current unstable liver or biliary disease per investigator assessment defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminemia, esophageal or gastric varices, persistent jaundice, or cirrhosis. NOTE: Stable chronic liver disease (including Gilbert’s syndrome or asymptomatic gallstones) is acceptable if participant otherwise meets entry criteria.
[00404] 6. Presence of malignancies other than disease under study are excluded, except for any other malignancy from which the participant has been disease- free for more than 2 years and, in the opinion of the PI and GSK Medical Director, will not affect the evaluation of the effects of this clinical trial treatment on the currently targeted malignancy (MM). Note: Participants with curatively treated non-melanoma skin cancer are not excluded.
[00405] 7. Evidence of cardiovascular risk including any of the following: (a) Evidence of current clinically significant untreated arrhythmias, including, but not limited to, clinically significant ECG abnormalities such as 2nd degree (Mobiz Type II) or 3rd degree AV block; (b) QTcF interval >450 msec (QT interval corrected for heart rate according to Fridericia’s formula), and/or hypokalemia, and/or family history of long QT syndrome (for Part 1); (c) History of MI, acute coronary syndromes (including unstable angina), coronary angioplasty, stenting or bypass grafting, all within three months of screening; (d) Class III or IV heart failure as defined by the NYHA functional classification system; (e) Uncontrolled hypertension.
[00406] 8. Known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to belantamab/belantamab mafodotin or any of the components of the study treatment. History of severe hypersensitivity to other mAbs.
[00407] 9. Active infection requiring antibiotic, antiviral, or antifungal treatment.
[00408] 10. Known HIV infection, unless the participant can meet all the following criteria: (a)
Established ART for at least 4 weeks and HIV viral load <400 copies/mL; (b) CD4+ T-cell (CD4+) counts A 350 cells/uL; (c) No history of AIDS-defining opportunistic infections within the last 12 months.
[00409] 11. Recent history (within the past 6 months) of acute diverticulitis, inflammatory bowel disease, intra-abdominal abscess, or gastrointestinal obstruction.
[00410] 12. Presence of HBsAg, or HBcAb, at screening. Note: presence of HBsAb indicating previous vaccination will not exclude a participant.
[00411] 13. Positive Hepatitis C antibody test result or positive Hepatitis C RNA test result at screening or within 3 months prior to first dose of study treatment unless the participant can meet the following criteria: (a) RNA test negative; (b) Successful anti-viral treatment (usually 8 weeks duration) is required, followed by a negative HCV RNA test after a washout period of at least 4 weeks upon completion of anti-viral treatment.
[00412] 14. Presence of active renal condition (infection, requirement for dialysis or any other condition that could affect participant’s safety). Participants with isolated proteinuria resulting from MM are eligible, provided they fulfil criteria given in the Table for Adequate Organ System Function (Table 9).
[00413] Prior/Concomitant Therapy:
[00414] 15. Part 1 and 2: Refractory to belantamab mafodotin (confirmed PD as per IMWG criteria while on belantamab mafodotin therapy or within 60 days of completing that treatment). Prior belantamab mafodotin is allowed if it was discontinued due to toxicity which subsequently resolved. Note: Prior treatment with other Anti-BCMA directed agents is allowed.
[00415] 16. Parts 2 and 3: Discontinuation of prior treatment with lenalidomide due to intolerable AEs.
[00416] 17. Part 1 and 2: Refractoriness to prior standard anti-myeloma therapies including lenalidomide is allowed for other mAbs within 30 days or systemic anti-myeloma therapy within 14 days of first dose of study drug.
[00417] 18. Prior radiotherapy within 2 weeks of start of study therapy. Participants must have recovered from all radiation-related toxicities, not require corticosteroids, and not have had
radiation pneumonitis. A 1-week washout is permitted for palliative radiation ( A2 weeks of radiotherapy) to non-CNS disease.
[00418] 19. Part 3 only: Prior systemic therapy for MM.
[00419] Note: An emergency course of steroids (defined as no greater than 40 mg of dexamethasone, or equivalent per day for a maximum of 4 days (that is, a total of 160 mg) is permitted.
[00420] Note: Focal palliative radiation is permitted prior to enrolment, provided it occurred at least 2 weeks prior to the first dose of study intervention, that the participant has recovered from radiation-related toxicities, and that the participant did not require corticosteroids for radiation- induced AEs.
[00421] 20. Plasmapheresis within 7 days prior to the first dose of study drug.
[00422] 21. Prior allogeneic transplant is prohibited.
[00423] 22. Participant who have received prior CAR-T therapy with lymphodepletion with chemotherapy within 3 months of screening.
[00424] 23. Any major surgery (other than bone-stabilizing surgery) within 2 weeks of first dose or has not recovered fully from surgery.
[00425] 24. Prior treatment with a mAb within 30 days of receiving the first dose of study drugs, or treatment with an investigational agent or approved systemic anti-myeloma therapy (including systemic steroids) within 14 days or 5 half-lives of receiving the first dose of study drugs, whichever is longer.
[00426] Other Exclusions:
[00427] 25. Has received transfusion of blood products (including platelets or red blood cells) or administration of colony stimulating factors (including G-CSF, GMCSF, recombinant erythropoietin) or any thrombopoietin receptor agonists within 2 weeks before the first dose of study drug.
[00428] 26. Participants must not receive live/live attenuated vaccines within 30 days prior to first dose of study treatment or whilst receiving belantamab for at least 70 days following last study treatment. Examples of live vaccines include, but are not limited to the following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, BCG, and typhoid vaccine. Seasonal influenza and COVID-19 vaccines for injection are not live or attenuated virus vaccines and are
allowed; however, intranasal influenza vaccines (for example, FluMist) are live attenuated vaccines and are not allowed.
[00429] 27. Known, current drug or alcohol abuse.
Meals and Dietary Restrictions (For Parts 2 and 3 only)
[00430] Refrain from consumption of red wine, Seville oranges, grapefruit or grapefruit juice, pomelos, exotic citrus fruits, grapefruit hybrids, or fruit juices starting from one day before each bela/belamaf dosing and 1 day prior to study visits independently of belantamab/belantamab mafodotin dosing, until the end of belantamab/belantamab mafodotin dosing day or study visit day.
[00431] No water is allowed until 2 hours after oral medication dosing, water is allowed ad libitum at all other times.
[00432] Lenalidomide capsules should be swallowed whole with water; the capsules should not be opened, broken, or chewed.
[00433] Lenalidomide should be taken orally at approximately the same time each day.
[00434] Lenalidomide capsules contain lactose. The risk-benefit of should be evaluated in participants with lactose intolerance.
Caffeine, Alcohol, and Tobacco (For Parts 1, 2, and 3)
[00435] Participants will abstain from ingesting caffeine- or xanthine- containing products (e.g., coffee, tea, cola drinks, and chocolate) for 24 hours before clinic visits on days scheduled for periodic PK and pharmacodynamic sample collection throughout the study.
[00436] Participants will abstain from alcohol for 24 hours before clinic visits on days scheduled for periodic PK and pharmacodynamic sample collection throughout the study.
[00437] Participants who use tobacco products will be instructed that use of nicotine-containing products (including nicotine patches and other delivery devices such as vaporizers) will not be permitted while they are in the clinical unit.
Dose Modifications (Dose Reductions and Dose Delays)
[00438] Dose modifications may be made for individual participants, based on safety findings for that participant. After Cycle 1, participants may have their belantamab or belantamab mafodotin dose reduced or delayed due to toxicities, including corneal events/toxicity.
[00439] If a dose is delayed, the participant should wait for the next scheduled dose to resume treatment. In individual cases, where in the judgment of the investigator waiting a full cycle to resume treatment after delay (skipping dose) related to toxicity which has resolved would be detrimental to the participant’s health, the investigator should contact the Medical Monitor to discuss an earlier re-start. An earlier re-start may be considered only for participants who have recovered from toxicity to at most Grade 1. The dosing with belantamab mafodotin in Parts 2 and 3 cannot occur more frequently than every 28 days (+3-day window). In such cases, efficacy and safety assessments must remain every 4 weeks in line with initial efficacy and safety assessments on study, which may result in 2 separate visits (1 for dosing, 1 for disease assessments). Only Part IB participants who opt to receive belantamab mafodotin after PD during treatment with belantamab therapy in Part 1, will receive belantamab mafodotin every 3 weeks (+3 -day window) and efficacy and safety assessments every 3 weeks as per EMA and FDA approval. Evaluations associated with a dose would be entered into the electronic case report form (eCRF) under the next scheduled cycle.
[00440] Dosing delays are permitted in the case of medical/surgical events or for logistical reasons not related to study therapy (e.g., elective surgery, unrelated medical events, participant vacation, and/or holidays, but not for participants’ decision to delay treatment). The reason for any dose delay must be documented in the participant’s eCRF and clinic record and discussed with the Medical Monitor.
[00441] The maximum dose delay without evidence of PD or significant toxicity related to investigational products allowed for belantamab or belantamab mafodotin is 16 weeks, unless agreed in writing by the Medical Monitor.
[00442] In Part 1 , the decision to proceed to the next dose level of belantamab (either an increase or a decrease) will be made by the DEC based on safety, tolerability, and preliminary PK data obtained in participants at the prior dose level.
Example 3: Analysis of the Effect of GSK2857916 Drug to Antibody Ratio (PAR) Variance on Anti-Tumor Activity In Vivo.
[00443] The impact of drug to antibody ratio (DAR) on in vitro and in vivo activity of GSK2857916 was evaluated. The results demonstrate that there is no significant effect of DAR variance on in vivo anti-tumor activity and that activity depends on dose rather than DAR.
Experimental Procedures
[00444] Female severe combined immunodeficient (SCID) mice were nine weeks old with a body weight range of 15.6 to 23.8 grams on Day 1 of the study. H929 human plasmacytoma cell line was obtained from the American Type Culture Collection (ATCC). The cells were maintained as exponentially growing suspension cultures in RPMI 1640 medium supplemented with 20% fetal bovine serum, 2 mM glutamine, 50 pM mercaptoethanol, 100 units/mL sodium penicillin G, 100 pg/mL streptomycin sulfate, and 25 pg/mL gentamicin. The tumor cells were cultured in tissue culture flasks in a humidified incubator at 37 °C, in an atmosphere of 5% CO2 and 95% air.
[00445] The H929 cells used for implantation were harvested during log phase growth and resuspended in 50% Matrigel (BD Biosciences) in cold PBS. Each mouse was injected subcutaneously in the right flank with 1 x 107 tumor cells (0.1 m cell suspension). Twenty days after tumor implantation, which was designated as Day 1 of the study, the mice bearing established H929 tumors were sorted into four groups (n = 10/group). The individual tumor volumes ranged from 126 to 288 mm3 for all groups and the group mean tumor volume ranged from 195 - 198 mm3. Dosing was initiated according to the treatment plan summarized in Table 10 and dosing volumes were scaled to the body weights of the individual animals.
Results and Discussion
[00446] The results of the study are shown in FIG. 3. The results demonstrate that GSK2857916 DAR4.1 at 2 mg/kg led to significant tumor growth delay, but no initial tumor regression. GSK2857916 DAR2.1 at 4 mg/kg was significantly more potent than GSK2857916 DAR4.1 at 2 mg/kg even though the same dose of the toxin is expected to be delivered under each condition. Further, GSK2857916 DAR2.1 at 4 mg/kg was more potent than GSK2857916DAR5.7 at 2 mg/kg even though more toxin is expected to be delivered under the latter condition. These results suggest that the dose of the antibody is a more significant determinant of anti-tumor activity than the DAR of the molecule.
[00447] In summary, varying DAR from 2.1 to 5.7 had no effect on anti -tumor activity of GSK2857916 at 2 mg/kg. Rather, the administered ADC dose was the primary determinant of antitumor activity as GSK2857916 DAR2.1 at 4 mg/kg was significantly more active than GSK2857916 DAR4.1 at 2 mg/kg, even though the same amount of toxin was administered in both cases. This analysis thus shows that at a given drug concentration, there is no significant effect of DAR variance on in vivo anti-tumor activity.
Table 10. Study Treatment Groups
Example 4: Evaluation of soluble BCMA (sBCMA) levels in relapsed/refractory multiple myeloma (RRMM) patients treated with belantamab mafodotin
[00448] Soluble BCMA (sBCMA) levels were analyzed as an exploratory endpoint in patients enrolled in a phase III open-label randomized clinical trial evaluating the safety and efficacy of single agent belantamab mafodotin compared to a combination of pomalidomide dexamethasone in participants with RRMM (DREAMM-3 study; NCT04162210). Overall, the results suggest that unconjugated belantamab administered in combination with belantamab mafodotin could impact sBCMA levels and thus improve the efficacy of belantamab mafodotin treatment.
Experimental Procedures
[00449] Study participants having RRMM were randomized in a 2: 1 ratio to receive either single agent belantamab mafodotin or a combination of pomalidomide and dexamethasone (pom/dex). Belantamab mafodotin was administered by intravenous (IV) infusion at a dose of 2.5 mg/kg on day 1 of a 21 day cycle, i.e., once every three weeks (Q3W). Pomalidomide was administered daily on each of days 1 to 21 of a 28 day cycle with dexamethasone administered once weekly (i.e., on days 1, 8, 15, and 22 of each 28 day cycle). Participants in both study arms were treated until disease progression, death, unacceptable toxicity, withdrawal of consent, and lost to follow-up or end of study, whichever comes first.
[00450] Serum samples were obtained from patients in both study arms at the following timepoints relative to belantamab mafodotin infusion: pre-dose, at end of infusion, 2 hours postinfusion, 24 hours post-infusion, 4 days post- infusion, and 8-15 days post- infusion. sBCMA levels in cell supernatants were measured using a validated electrochemiluminescent immunoassay.
Results and Discussion
[00451] sBCMA levels are impacted by treatment with belantamab mafodotin. Analysis of sBCMA levels in patients treated with belantamab mafodotin versus pom/dex demonstrated a difference in sBCMA levels between the two treatment arms with sBCMA levels being impacted specifically by belantamab mafodotin treatment compared to pom/dex treatment. As shown in FIG. 4, progression free survival (PFS) of patients in the highest quartile (Q4) of baseline sBCMA levels (i.e., prior to administration of belantamab mafodotin) was the lowest in both treatment arms, indicating a worse response to treatment. Response of patients in the highest quartiles of baseline sBCMA levels (Q3 and Q4) in the pom/dex arm was substantially similar between the two quartiles (PFS of approximately 4-5 months). However, response of patients in the highest quartiles of baseline sBCMA levels (Q3 and Q4) in the belantamab mafodotin arm was differentiated between the two quartiles with an observed PFS of approximately 7 months and 15 months for Q4 and Q3 patients, respectively. These data indicate that response to belantamab mafodotin treatment is directly impacted by sBCMA levels at baseline, whereas such effect is not observed with pom/dex treatment.
[00452] Belantamab mafodotin binds sBCMA in patient samples. sBCMA levels were measured at the end of infusion (EOI) of belantamab mafodotin in participants in the belantamab mafodotin treatment arm. Patient samples were obtained within 30 minutes following the end of infusion of belantamab mafodotin and sBCMA levels in the samples were measured. Based on sBCMA levels detected at EOI, it was determined that belantamab mafodotin substantially bound all sBCMA in the periphery at a dose level of 2.5 mg/kg. See FIG. 5 which shows the level of reduction of sBCMA from pre-dosing with belantamab mafodotin to EOI for cycle 1, day 1 of belantamab mafodotin treatment with the x-axis showing the pre-dose sBCMA level and y-axis showing the difference in sBCMA levels from pre-infusion to EOI. The level of reduction of sBCMA at EOI was consistent at each cycle (data not shown). In the data shown, ELISA detected approximately 89% of sBCMA bound, which is likely the limit of detection of the assay, as there is no evidence that the amount of sBCMA exceeds the amount of study drug.
[00453] sBCMA is immediately bound following belantamab mafodotin infusion, but sBCMA levels rebound 24 hours later. sBCMA levels were detected to be increasing in participants treated with belantamab mafodotin at 24 hours post-end of infusion (EOI) of belantamab mafodotin. While a linear decrease in sBCMA levels was observed, an exponential increase in sBCMA levels
was observed 24 hours later suggesting that sBCMA rebound is non-linear with baseline level of sBCMA and follows a different pattern than the decrease of sBCMA levels (FIG. 6). However, sBCMA levels observed at 24 hours post-EOI is not due solely to dissociation of sBCMA from belantamab mafodotin because the half-life of sBCMA is approximately 24 hours suggesting that the majority of the increase in sBCMA levels is due to fresh shedding from tumor cells. Further, when evaluating sBCMA levels in patients grouped by response to treatment with belantamab mafodotin, patients with progressive disease (PD) had the highest baseline sBCMA levels, but there was a large overlap observed in baseline sBCMA levels between responders and nonresponders (FIG. 7A). While the rebound of sBCMA levels after infusion of belantamab mafodotin was also greatest for the progressive disease group, there was an observed difference between responders (including patient groups having complete response (CR), very good partial response (VGPR) and partial response (PR)) and non-responders (including patient groups having stable disease (SD) or progressive disease (PD)) (FIG. 7B) that was increased compared to baseline levels. This suggests that the presence of sBCMA in the periphery and the rate/level of sBCMA rebound after belantamab mafodotin infusion may have a direct impact on the efficacy of belantamab mafodotin treatment.
[00454] Taken together, these data suggest that eliminating or binding free sBCMA may be an advantageous strategy to increase the efficacy of belantamab mafodotin.
Example 5: In Vivo Efficacy of Belantamab and Belantamab Mafodotin in the Treatment of Human Multiple Myeloma Xenograft Model in NOG Mice
[00455] A study was conducted to evaluate the in vivo therapeutic efficacy of belantamab (GSK2857914), belantamab mafodotin (GSK2857916), and nirogacestat as single agents and in combination in the treatment of a MM.1 S-Luc human multiple myeloma xenograft model in NOG mice.
Experimental Procedures
[00456] Cell Culture. MM.1 S-Luc cancer cells were maintained in vitro with RMPI1640 medium supplemented with 10% fetal bovine serum and 1% sodium pyruvate + 1% L-glutamine + 1% penicillin-streptomycin at 37°C in an atmosphere of 5% CO2. The cells in exponential growth phase were harvested and quantitated by cell counter before tumor inoculation.
[00457] Tumor inoculation. Each mouse was inoculated intravenously via tail vein with MM.1S-Luc tumor cells (1 x 107) in 0.1 mL PBS for tumor development. Mice were imaged 7 days after tumor cell inoculation and randomly allocated to seven study groups.
[00458] Treatment administration. Groups of ten (10) mice were dosed by intraperitoneal (ip) administration in the amount and at the frequency and duration shown in Table 11.
Table 11
[00459] Tumor monitoring. Tumor growth was imaged twice per week by bioluminescent imaging. At 15 minutes prior to imaging, mice were injected subcutaneously with D-Luciferin
(PerkinElmer, Catalog Number 122799) at 150 mg/kg. Mice were imaged on a PerkinElmer IVIS Lumina Series III in vivo imaging system.
Results
[00460] The mean tumor volume curves of vehicle and treatment groups between randomization and study termination are shown in FIG. 8 and the tumor growth inhibition (TGI) from data collected on Day 11 is shown in Table 12. Kaplan-Meier survival curves for all treatment groups as a function of study are shown in FIG. 9 and the median survival day and the Kaplan-Meier statistical analysis is presented in Table 13. The results demonstrate that GSK2857916 as single agent (Group 2), GSK2857916 in combination with GSK2857914 (Groups 3 and 4), and GSK2857916 in combination with nirogacestat (Group 5) resulted in a significant anti-tumor efficacy against MM1S -LUC model with TGI values of 98.87%, 99.19%, 97.88%, and 99.19%, respectively, at day 11 with a statistically significant difference (p<0.01) compared with vehicle control group. GSK2857916 in combination with GSK2857914 (Groups 3 and 4) showed the greatest anti-tumor efficacy over the course of the study across all treatment groups. Further, GSK2857916 in combination with GSK2857914 (Groups 3 and 4) and GSK2857916 in combination with nirogacestat (Group 5) significantly prolonged animals’ survival (Median Survival Day 54.5, 58.00, and 53.50, respectively), compared with vehicle control group (Median Survival Day 25.00).
Table 12
Table 13
[00461] Unless otherwise indicated, all numbers expressing quantities of ingredients, properties such as molecular weight, reaction conditions, and so forth used in the specification and claims are to be understood as being modified in all instances by the term “about.” Accordingly, unless indicated to the contrary, the numerical parameters set forth in the specification and attached claims are approximations that may vary depending upon the desired properties sought to be obtained by the present disclosure. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical parameter should at least be construed in light of the number of reported significant digits and by applying ordinary rounding techniques.
[00462] Notwithstanding that the numerical ranges and parameters setting forth the broad scope of the disclosure are approximations, the numerical values set forth in the specific examples are reported as precisely as possible. Any numerical value, however, inherently contains certain errors necessarily resulting from the standard deviation found in their respective testing measurements.
[00463] The terms “a,” “an,” “the” and similar referents used in the context of describing the disclosure (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. Recitation of ranges of values herein is merely intended to serve as a shorthand method of referring individually to each separate value falling within the range. Unless otherwise indicated herein, each individual value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., “such as”) provided herein is intended merely to better illuminate the disclosure and does not pose a limitation on the scope of the disclosure otherwise claimed. No language in the specification should be construed as indicating any non-claimed element essential to the practice of the disclosure.
[00464] Groupings of alternative elements or embodiments of the disclosure disclosed herein are not to be construed as limitations. Each group member can be referred to and claimed
individually or in any combination with other members of the group or other elements found herein. It is anticipated that one or more members of a group can be included in, or deleted from, the group for reasons of convenience and/or patentability. When any such inclusion or deletion occurs, the specification is deemed to contain the group as modified, thus fulfilling the written description of all Markush groups used in the appended claims.
[00465] Certain embodiments of this disclosure are described herein, including the best mode known to the inventors for carrying out the disclosure. Of course, variations on these described embodiments will become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventor expects skilled artisans to employ such variations as appropriate, and the inventors intend for the disclosure to be practiced otherwise than specifically described herein. Accordingly, this disclosure includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the disclosure unless otherwise indicated herein or otherwise clearly contradicted by context.
[00466] Specific embodiments disclosed herein can be further limited in the claims using “consisting of’ or “consisting essentially of’ language. When used in the claims, whether as filed or added per amendment, the transition term “consisting of’ excludes any element, step, or ingredient not specified in the claims. The transition term “consisting essentially of’ limits the scope of a claim to the specified materials or steps and those that do not materially affect the basic and novel characteristic(s). Embodiments of the disclosure so claimed are inherently or expressly described and enabled herein.
[00467] It is to be understood that the embodiments of the disclosure disclosed herein are illustrative of the principles of the present disclosure. Other modifications that can be employed are within the scope of the disclosure. Thus, by way of example, but not of limitation, alternative configurations of the present disclosure can be utilized in accordance with the teachings herein. Accordingly, the present disclosure is not limited to that precisely as shown and described.
[00468] While the present disclosure has been described and illustrated herein by references to various specific materials, procedures and examples, it is understood that the disclosure is not restricted to the particular combinations of materials and procedures selected for that purpose. Numerous variations of such details can be implied as will be appreciated by those skilled in the art. It is intended that the specification and examples be considered as exemplary only, with the
true scope and spirit of the disclosure being indicated by the following claims. All references, patents, and patent applications referred to in this application are herein incorporated by reference in their entirety.
Claims
1. A method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering to the patient belantamab at a dose of about 300 mg to about 2000 mg.
2. The method of claim 1, wherein the dose is about 300 mg, about 900 mg, or about 2000 mg.
3. The method of any one of the preceding claims, wherein the patient has been treated with one, two, three, or four prior lines of cancer treatments, wherein the prior lines of cancer treatments include an anti-CD38 monoclonal antibody, a proteasome inhibitor, and an immunomodulatory agent.
4. The method of any one of the preceding claims, wherein the patient is further receiving at least one additional cancer treatment, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
5. The method of claim 4, wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone.
6. The method of any one of the preceding claims, further comprising administering a lead- in dose of belantamab mafodotin prior to beginning administration of belantamab, wherein the lead-in dose of belantamab mafodotin is about 1.4 mg/kg to about 3.4 mg/kg once during a lead-in period.
7. The method of claim 6, wherein the lead-in dose of belantamab mafodotin is about 1.4 mg/kg, about 1.9 mg/kg, about 2.5 mg/kg, or about 3.4 mg/kg once during a lead-in period.
8. The method of claim 6 or claim 7, wherein the lead-in period is four weeks ± 3 days and belantamab mafodotin is administered on day 1 of the lead-in period.
The method of any one of claims 6 to 8, further comprising administering at least one additional cancer treatment to the patient during the lead-in period, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD- 1 monoclonal antibody. The method of claim 9, wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone. A method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering a therapeutically effective amount of a combination comprising a first BCMA antagonist and a second BCMA antagonist to the patient. The method of claim 11, wherein the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy. The method of claim 11, wherein the first BCMA antagonist is an anti-BCMA antibodydrug conjugate and the second BCMA antagonist is the corresponding unconjugated anti- BCMA antibody. A method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient, the method comprising administering a therapeutically effective amount of a combination comprising belantamab mafodotin and belantamab to the patient. The method of any one of claims 11 to 14, further comprising administering at least one additional cancer treatment to the patient, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody.
The method of claim 15, wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone. A method of treating a disease or disorder responsive to inhibiting or blocking B-cell maturation antigen (BCMA) in a patient previously treated with a first BCMA antagonist, the method comprising administering a therapeutically effective amount of a second BCMA antagonist to the patient, wherein the patient discontinued administration of the first BCMA antagonist prior to beginning administration of the second BCMA antagonist and the second BCMA antagonist is not the same as the first BCMA antagonist. The method of claim 17, wherein the first and second BCMA antagonists are independently selected from the group consisting of an anti-BCMA antibody or antigen binding fragment thereof, an anti-BCMA antibody-drug conjugate, a bispecific anti-BCMA antibody or antigen binding fragment thereof, and a BCMA-targeted chimeric antigen receptor T (CAR T)-cell therapy. The method of claim 17, wherein the first BCMA antagonist is an anti-BCMA antibodydrug conjugate and the second BCMA antagonist is the corresponding unconjugated anti- BCMA antibody; or wherein the second BCMA antagonist is an anti-BCMA antibodydrug conjugate and the first BCMA antagonist is the corresponding unconjugated anti- BCMA antibody. The method of claim 19, wherein the first BCMA antagonist is belantamab mafodotin and the second BCMA antagonist is belantamab; or wherein the second BCMA antagonist is belantamab mafodotin and the first BCMA antagonist is belantamab . A method of reducing corneal toxicity in a patient previously treated with belantamab mafodotin, the method comprising administering a therapeutically effective amount of belantamab to the patient, wherein the patient discontinued administration of belantamab mafodotin prior to beginning administration of belantamab.
The method of any one of claims 17 to 21, further comprising administering at least one additional cancer treatment to the patient, such as an anti-CD38 monoclonal antibody, a proteasome inhibitor, an immunomodulatory agent, or an anti-PD-1 monoclonal antibody. The method of claim 22, wherein the additional cancer treatment is selected from lenalidomide, dexamethasone, daratumumab, isatuximab, pomalidomide, bortezomib, or a combination thereof, such as lenalidomide and dexamethasone. A method of treating a disease or disorder in a patient, the method comprising administering a therapeutically effective amount of a combination comprising an antibodydrug conjugate and the corresponding unconjugated antibody. A method of treating a disease or disorder in a patient previously treated with an antibodydrug conjugate, the method comprising administering a therapeutically effective amount of the corresponding unconjugated antibody to the patient, wherein the patient discontinued administration of the antibody-drug conjugate prior to beginning administration of the corresponding unconjugated antibody. The method of any one of claims 1 to 25, wherein the disease or disorder is a plasma cell disorder or a B-cell disorder. The method any one of claims 1 to 25, wherein the disease or disorder is a BCMA- expressing cancer. The method any one of claims 1 to 25, wherein the disease or disorder is multiple myeloma (MM). The method of claim 28, wherein the MM is relapsed and/or refractory MM, newly- diagnosed MM, transplant-ineligible MM, or transplant-ineligible newly-diagnosed MM. A method of treating cancer in a patient, wherein the patient has a Grade 2 or above corneal adverse reaction resulting from belantamab mafodotin administration, the method comprising temporarily discontinuing administration of belantamab mafadotin; administering to the patient a therapeutically effective amount of belantamab thereof for a
lead-in period; and resuming administration of belantamab mafadotin after the lead-in period.
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Family Cites Families (28)
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| TWI679212B (en) | 2011-11-15 | 2019-12-11 | 美商安進股份有限公司 | Binding molecules for e3 of bcma and cd3 |
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| EP3023437A1 (en) | 2014-11-20 | 2016-05-25 | EngMab AG | Bispecific antibodies against CD3epsilon and BCMA |
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| SI3226897T1 (en) | 2014-12-05 | 2021-08-31 | Memorial Sloan Kettering Cancer Center | Antibodies targeting B-cell maturation antigen and methods of administration |
| SI3331910T1 (en) | 2015-08-03 | 2020-07-31 | Engmab Sarl | Monoclonal antibodies against human b cell maturation antigen (bcma) |
| EP3147954A1 (en) | 2015-09-22 | 2017-03-29 | Nokia Technologies Oy | Photodetector with conductive channel made from two dimensional material and its manufacturing method |
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