Description:
This study is a multi-cohort, open-label, multicenter Phase 2 study to evaluate the efficacy
and safety of bb2121 in subjects with relapsed and refractory MM (Cohort 1), in subjects with
MM having progressed within one 18 months of initial treatment including autologous stem cell
transplantation (ASCT) (Cohort 2a), and without ASCT (Cohort 2b) or, in subjects with
inadequate response post ASCT during initial treatment (Cohort 2c) Approximately 181 subjects
will be enrolled into one of two cohorts. Cohort 1 will enroll approximately 73 RRMM subjects
with ≥ 3 prior anti-myeloma treatment regimens. Cohort 2a will enroll approximately 39 MM
subjects, with 1 prior anti-myeloma therapy including ASCT and with early relapse. Cohort 2b
will enroll approximately 39 MM subjects with 1 prior anti-myeloma therapy not including ASCT
and with early relapse. Cohort 2c will enroll approximately 30 MM subjects with inadequate
response to ASCT during their initial anti-myeloma therapy. The cohorts will start in
parallel and independently.
Title
- Brief Title: An Efficacy and Safety Study of bb2121 in Subjects With Relapsed and Refractory Multiple Myeloma and in Subjects With High-Risk Multiple Myeloma
- Official Title: A Phase 2, Multicohort, Open-label, Multicenter Study to Evaluate the Efficacy and Safety of bb2121 in Subjects With Relapsed and Refractory Multiple Myeloma and in Subjects With Clinical High-Risk Multiple Myeloma (KarMMa-2)
Clinical Trial IDs
- ORG STUDY ID:
BB2121-MM-002
- SECONDARY ID:
U1111-1216-4209
- SECONDARY ID:
2018-000264-28
- NCT ID:
NCT03601078
Conditions
Interventions
Drug | Synonyms | Arms |
---|
bb2121 | | bb2121 in relapsed and refractory multiple myeloma patients |
Purpose
This study is a multi-cohort, open-label, multicenter Phase 2 study to evaluate the efficacy
and safety of bb2121 in subjects with relapsed and refractory MM (Cohort 1), in subjects with
MM having progressed within one 18 months of initial treatment including autologous stem cell
transplantation (ASCT) (Cohort 2a), and without ASCT (Cohort 2b) or, in subjects with
inadequate response post ASCT during initial treatment (Cohort 2c) Approximately 181 subjects
will be enrolled into one of two cohorts. Cohort 1 will enroll approximately 73 RRMM subjects
with ≥ 3 prior anti-myeloma treatment regimens. Cohort 2a will enroll approximately 39 MM
subjects, with 1 prior anti-myeloma therapy including ASCT and with early relapse. Cohort 2b
will enroll approximately 39 MM subjects with 1 prior anti-myeloma therapy not including ASCT
and with early relapse. Cohort 2c will enroll approximately 30 MM subjects with inadequate
response to ASCT during their initial anti-myeloma therapy. The cohorts will start in
parallel and independently.
Detailed Description
Anti-myeloma bridging treatment is allowed for disease control while bb2121 is being
manufactured for cohorts 1, 2a and 2b only.
Trial Arms
Name | Type | Description | Interventions |
---|
bb2121 in relapsed and refractory multiple myeloma patients | Experimental | bb2121 autologous CAR T cells will be infused at a dose ranging from 150 - 450 x 10^6 CAR+ T cells after receiving lymphodepleting chemotherapy | |
Eligibility Criteria
Inclusion Criteria:
Subjects must satisfy the following criteria to be enrolled in the study:
1. Subject is ≥ 18 years of age at the time of signing the informed consent form (ICF)
2. Subject has measurable disease, defined as:
- M-protein (serum protein electrophoresis [sPEP] or urine protein electrophoresis
[uPEP]): sPEP ≥ 0.5 g/dL or uPEP ≥ 200 mg/24 hours and/or
- Light chain MM without measurable disease in the serum or urine: Serum
immunoglobulin free light chain ≥ 10 mg/dL and abnormal serum immunoglobulin
kappa lambda free light chain ratio
3. Subjects with one of the following cohort specific requirements:
Cohort 1 RRMM subjects with ≥ 3 prior anti-myeloma treatment regimens:
- Subject must have received at least 3 prior anti-myeloma treatment regimens.
Note: induction with or without hematopoietic stem cell transplant and with or
without maintenance therapy is considered a single regimen
- Subject must have undergone at least 2 consecutive cycles of treatment for each
regimen, unless PD was the best response to the regimen
- Subject must have received prior treatment with a proteasome inhibitor, an
immunomodulatory agent and an anti-CD38 antibody
- Subject has evidence of PD on or within 60 days of the most recent prior
treatment regimen
- Subject achieved a response (minimal response [MR] or better) to at least 1 prior
treatment regimen
Cohort 2 subjects with 1 prior anti-myeloma treatment regimen:
- Subject must have received only 1 prior anti-myeloma treatment regimen. Note:
induction with or without hematopoietic stem cell transplant and with or without
maintenance therapy is considered a single regimen
- Subject must have the following HR factors:
- R-ISS stage III AND
- Early relapse defined as:
Cohort 2a: PD < 18 months since date of start of initial therapy. Initial therapy must
contain induction, ASCT (single or tandem) and lenalidomide containing maintenance.
Cohort 2b: PD < 18 months since date of start or initial therapy which must contain at
minimum, a proteasome inhibitor, an immunomodulatory agent and dexamethasone Cohort
2c: Subject must have received minimum 3 cycles of induction therapy which must
contain at minimum, a proteasome inhibitor, an immunomodulatory agent and
dexamethasone. Subjects must have had ASCT (single or tandem AND < VGPR (excluding PD)
at first assessment between 70 to 110 days after last ASCT, with initial therapy
without consolidation and maintenance.
4. Subject must have Eastern Cooperative Oncology Group (ECOG) performance status ≤ 1
5. Subject must have recovery to Grade 1 or baseline of any non-hematologic toxicities
due to prior treatments, excluding alopecia and Grade 2 neuropathy
Exclusion Criteria:
The presence of any of the following will exclude a subject from enrollment:
1. Subject used any investigational agents within 14 days of leukapheresis
2. Subject received any of the following within the last 14 days of leukapheresis:
1. Plasmapheresis
2. Major surgery (as defined by the investigator)
3. Radiation therapy other than local therapy for myeloma associated bone lesions
4. Use of any systemic anti-myeloma drug therapy
3. Subject with known central nervous system involvement with myeloma
4. Subject has clinical evidence of pulmonary leukostasis and disseminated intravascular
coagulation
5. History or presence of clinically relevant central nervous system (CNS) pathology
6. Subject with active or history of plasma cell leukemia, Waldenstrom's
macroglobulinemia, POEMS syndrome, or clinically significant amyloidosis
7. Inadequate organ function Subject with a history of Class III or IV congestive heart
failure (CHF) or severe nonischemic cardiomyopathy, unstable or poorly controlled
angina, myocardial infarction, or ventricular arrhythmia within the previous 6 months
prior to starting study treatment
8. Ongoing treatment with chronic immunosuppressants
9. Previous history of an allogeneic hematopoietic stem cell transplantation or treatment
with any gene therapy-based therapeutic for cancer or investigational cellular therapy
for cancer or BCMA targeted therapy
10. Subject has received ASCT within 12 weeks prior to leukapheresis
11. Subject has history of primary immunodeficiency
12. Subject is positive for human immunodeficiency virus (HIV-1), chronic or active
hepatitis B or active hepatitis A or C
13. Subject has uncontrolled systemic fungal, bacterial, viral or other infection
(including tuberculosis) despite appropriate antibiotics or other treatment
14. Subject with prior history of malignancies, other than MM, unless the subject has been
free of the disease for ≥ 5 years
15. Pregnant or lactating women
16. Subject with known hypersensitivity to any component of bb2121 product,
cyclophosphamide, fludarabine, and/or tocilizumab
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Overall response rate (ORR)- Cohort 1 |
Time Frame: | Minimum of 2 years after bb2121 infusion |
Safety Issue: | |
Description: | Percentage of subjects who achieved partial response (PR) or better according to IMWG Uniform Response Criteria for Multiple Myeloma as assessed by an independent response committee (IRC) |
Secondary Outcome Measures
Measure: | Complete response (CR) rate - Cohort 1 |
Time Frame: | Minimum of 2 years after bb2121 infusion |
Safety Issue: | |
Description: | Percentage of subjects who achieved CR or better according to IMWG Uniform Response Criteria for Multiple Myeloma as assessed by an IRC |
Measure: | Overall response rate (ORR) - Cohort 2a, b and c |
Time Frame: | Minimum of 2 years after bb2121 infusion |
Safety Issue: | |
Description: | Percentage of subjects who achieved partial response (PR) or better according to IMWG Uniform Response Criteria for Multiple Myeloma as assessed by an IRC |
Measure: | Time to response (TTR) |
Time Frame: | Minimum of 2 years after bb2121 infusion |
Safety Issue: | |
Description: | Time from first bb2121 infusion to first documentation of response (PR or greater) |
Measure: | Duration of response (DoR) |
Time Frame: | Minimum of 2 years after bb2121 infusion |
Safety Issue: | |
Description: | Time from first documentation of response (PR or greater) to first documentation of progressive disease (PD) or death from any cause, whichever occurs first |
Measure: | Progression-free survival (PFS) |
Time Frame: | Minimum of 2 years after bb2121 infusion |
Safety Issue: | |
Description: | Time from first bb2121 infusion to first documentation of PD, or death due to any cause, whichever occurs first |
Measure: | Time to progression (TTP) |
Time Frame: | Minimum of 2 years after bb2121 infusion |
Safety Issue: | |
Description: | Time from first bb2121 infusion to first documentation of PD |
Measure: | Overall survival (OS) |
Time Frame: | Minimum of 2 years after bb2121 infusion |
Safety Issue: | |
Description: | Time from first bb2121 infusion to time of death due to any cause |
Measure: | Adverse Events (AEs) |
Time Frame: | Minimum 5 years after bb2121 infusion |
Safety Issue: | |
Description: | Type, frequency, seriousness and severity of adverse events (AEs), adverse events of special interest (AESIs) (including cytokine release syndrome, neurotoxicity and infection), and relationship of AE to study drug. |
Measure: | Pharmacokinetics - Cmax |
Time Frame: | Minimum 5 years after bb2121 infusion |
Safety Issue: | |
Description: | Maximum expansion of bb2121 chimeric antigen receptor (CAR) T cells |
Measure: | Pharmacokinetics - tmax |
Time Frame: | Minimum 5 years after bb2121 infusion |
Safety Issue: | |
Description: | Time to peak of bb2121 CAR T cells |
Measure: | Pharmacokinetics - AUC |
Time Frame: | Minimum 5 years after bb2121 infusion |
Safety Issue: | |
Description: | Area under the curve of CAR T cells |
Measure: | Pharmacokinetics - tlast |
Time Frame: | Minimum 5 years after bb2121 infusion |
Safety Issue: | |
Description: | Time to last measurable CAR T cells |
Measure: | Pharmacokinetics - AUC0-28days |
Time Frame: | Minimum 5 years after bb2121 infusion |
Safety Issue: | |
Description: | Area under the curve of CAR T cells from time zero to Day 28 |
Measure: | Immunogenicity |
Time Frame: | Minimum of 2 years after bb2121 infusion |
Safety Issue: | |
Description: | Development of an anti-CAR antibody response |
Measure: | Minimal Residual Disease (MRD) negative rate |
Time Frame: | Minimum of 2 years after bb2121 infusion |
Safety Issue: | |
Description: | Proportion of subjects that are MRD negative |
Measure: | Subject-reported outcomes as measured by European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire (EORTC-QLQ-C30) |
Time Frame: | Minimum 5 years after bb2121 infusion |
Safety Issue: | |
Description: | Questionnaire will be used as a measure of health-related quality of life |
Measure: | Subject-reported outcomes as measured by EuroQoL Group EQ-5D-5L Health Questionnaire |
Time Frame: | Minimum 5 years after bb2121 infusion |
Safety Issue: | |
Description: | Is a standardized measure of health status developed by the EuroQol Group in order to provide a simple, generic measure of health for clinical and economic appraisal |
Measure: | Subject-reported outcomes as measured by EORTC-QLQ-MY20 |
Time Frame: | Minimum 5 years after bb2121 infusion |
Safety Issue: | |
Description: | Is a 20-item myeloma module intended for use among patients varying in disease stage and treatment modality |
Measure: | Very good partial response (VGPR) rate - Cohort 2c |
Time Frame: | Minimum of 2 years after bb2121 infusion |
Safety Issue: | |
Description: | Percentage of subjects who achieved VGPR or better according to IMWG Uniform Response Criteria for Multiple Myeloma as assessed by an IRC |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Celgene |
Trial Keywords
- Multiple Myeloma
- bb2121
- Relapsed and Refractory Multiple Myeloma
- High Risk Multiple Myeloma
Last Updated
September 1, 2021