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    Flotetuzumab as salvage immunotherapy for refractory acute myeloid leukemia

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    Author
    Uy, G.L.
    Aldoss, I.
    Foster, M.C.
    Sayre, P.H.
    Wieduwilt, M.J.
    Advani, A.S.
    Godwin, J.E.
    Arellano, M.L.
    Sweet, K.L.
    Emadi, A.
    Ravandi, F.
    Erba, H.P.
    Byrne, M.
    Michaelis, L.
    Topp, M.S.
    Vey, N.
    Ciceri, F.
    Carrabba, M.G.
    Paolini, S.
    Huls, G.A.
    Jongen-Lavrencic, M.
    Wermke, M.
    Chevallier, P.
    Gyan, E.
    Recher, C.
    Stiff, P.J.
    Pettit, K.M.
    Lowenberg, B.
    Church, S.E.
    Anderson, E.
    Vadakekolathu, J.
    Santaguida, M.
    Rettig, M.P.
    Muth, J.
    Curtis, T.
    Fehr, E.
    Guo, K.
    Zhao, J.
    Bakkacha, O.
    Jacobs, K.
    Tran, K.
    Kaminker, P.
    Kostova, M.
    Bonvini, E.
    Walter, R.B.
    Davidson-Moncada, J.K.
    Rutella, S.
    DiPersio, J.F.
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    Date
    2020-09-14
    Journal
    Blood
    Publisher
    Elsevier B.V.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1182/blood.2020007732
    Abstract
    Approximately 50% of acute myeloid leukemia (AML) patients do not respond to induction therapy (primary induction failure [PIF]) or relapse after <6 months (early relapse [ER]). We have recently shown an association between an immune-infiltrated tumor microenvironment (TME) and resistance to cytarabine-based chemotherapy but responsiveness to flotetuzumab, a bispecific DART antibody-based molecule to CD3? and CD123. This paper reports the results of a multicenter, open-label, phase 1/2 study of flotetuzumab in 88 adults with relapsed/refractory AML: 42 in a dose-finding segment and 46 at the recommended phase 2 dose (RP2D) of 500 ng/kg per day. The most frequent adverse events were infusion-related reactions (IRRs)/cytokine release syndrome (CRS), largely grade 1-2. Stepwise dosing during week 1, pretreatment dexamethasone, prompt use of tocilizumab, and temporary dose reductions/interruptions successfully prevented severe IRR/CRS. Clinical benefit accrued to PIF/ER patients showing an immune-infiltrated TME. Among 30 PIF/ER patients treated at the RP2D, the complete remission (CR)/CR with partial hematological recovery (CRh) rate was 26.7%, with an overall response rate (CR/CRh/CR with incomplete hematological recovery) of 30.0%. In PIF/ER patients who achieved CR/CRh, median overall survival was 10.2 months (range, 1.87-27.27), with 6- and 12-month survival rates of 75% (95% confidence interval [CI], 0.450-1.05) and 50% (95% CI, 0.154-0.846). Bone marrow transcriptomic analysis showed that a parsimonious 10-gene signature predicted CRs to flotetuzumab (area under the receiver operating characteristic curve = 0.904 vs 0.672 for the European LeukemiaNet classifier). Flotetuzumab represents an innovative experimental approach associated with acceptable safety and encouraging evidence of activity in PIF/ER patients. This trial was registered at www.clinicaltrials.gov as #NCT02152956. Key Points: - Flotetuzumab is associated with acceptable safety and evidence of activity in AML patients with PIF/ER. - A 10-gene immune signature predicts response to flotetuzumab with greater accuracy than the ELN risk classifier. Copyright 2021 American Society of Hematology
    Sponsors
    M.P.R. was supported by National Institutes of Health/National Cancer Institute grant R50 CA211466. J.F.D. was supported by National Institutes of Health/National Cancer Institute grants R01 CA152329, P50 CA171963, and R35 CA210084. S.R. was supported by Qatar National Research Fund grant NPRP8-2297-3-494.
    Keyword
    flotetuzumab
    Immunotherapy
    Leukemia, Acute, Myeloid--drug therapy
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/15225
    ae974a485f413a2113503eed53cd6c53
    10.1182/blood.2020007732
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