Magnetismm-4: An Open Label, Phase 1B/2 Umbrella Study of Elranatamab in Combination with Other Anti-Cancer Treatments for Patients with Multiple Myeloma
Bibliographic record
Abstract
Background Elranatamab (PF-06863135) is a humanized bispecific molecule that targets multiple myeloma (MM) cells via B-cell maturation antigen (BCMA) and T cells via CD3 to induce T cell-mediated cytotoxicity. In MagnetisMM-1 (NCT03269136), an ongoing, phase 1 study in patients with relapsed or refractory MM (RRMM), subcutaneous (SC) elranatamab yielded an overall response rate (ORR) of 64% and had a manageable safety profile (Jakubowiak et al, J Clin Oncol, 2022). In the phase 2 MagnetisMM-3 (NCT04649359) study in patients with heavily pretreated RRMM, SC elranatamab was well tolerated and yielded an ORR of 61% at the recommended phase 2 dose (Lesokhin et al, J Clin Oncol, 2022). Study Design and Methods MagnetisMM-4 (NCT05090566) is a phase 1B/2, open label, non-randomized, multicenter, umbrella study of elranatamab in combination with other anti-cancer treatments for patients with MM. The estimated enrollment is 105 patients. The study is split into 2 sub-studies (Figure 1). In each sub study, a 2 step-up priming dose of elranatamab will be employed to mitigate the risk of cytokine release syndrome and a Bayesian logistic regression model will be utilized for dose escalation. Sub-study A (SSA) is comprised of 2 phases in which patients will receive elranatamab + the gamma-secretase inhibitor (GSI) nirogacestat. Studies have shown that GSIs block BCMA cleavage and can potentially enhance BCMA-directed therapy (Eastman et al, Blood, 2019; Pont et al, Blood, 2019; Cowan et al, Blood, 2019). Phase 1 of SSA is designed to evaluate the safety, tolerability and select a recommended dose and regimen for the combination of elranatamab and nirogacestat. The primary endpoint for SSA Phase 1 is dose limiting toxicity (DLT) up to 35 days. Phase 2 of SSA will further evaluate the efficacy and safety of the combination of elranatamab and nirogacestat. The primary endpoint for SSA phase 2 is objective response rate (ORR) assessed every 4 weeks for ~2 years. A key secondary endpoint in both phases of SSA is the incidence of treatment-emergent adverse events (TEAEs). In sub-study B (SSB), patients will receive elranatamab + lenalidomide + dexamethasone. The dose escalation part of SSB is designed to assess the safety and tolerability of elranatamab in combination with lenalidomide and dexamethasone. The primary outcome of the dose escalation part is DLT up to 42 days. The dose expansion part of SSB is designed to evaluate the overall safety profile of elranatamab in combination with lenalidomide and dexamethasone. The primary endpoints of the dose expansion part of SSB are incidence of TEAEs and laboratory abnormalities across the duration of the study. A key secondary endpoint in SSB is ORR. Additional secondary endpoints in both SSA and SSB are time to response, duration of response, complete response (CR) rate, duration of CR, progression-free survival, overall survival, minimal residual disease negativity rate, immunogenicity to elranatamab, and elranatamab pharmacokinetics. Inclusion criteria in SSA and SSB include age ≥18 years, RRMM with ≥3 prior lines of therapy, refractory to at least one immunomodulatory drug, one proteasome inhibitor, and one anti-CD38 antibody, measurable disease by serum M-protein ≥0.5g/dL, urinary M-protein excretion ≥200mg/24h, or serum immunoglobulin free light chain (FLC) ≥10mg/dL and abnormal serum immunoglobulin kappa to lambda FLC ratio, and Eastern Cooperative Oncology Group performance status ≤1 (Table 1). Exclusion criteria include active plasma cell leukemia, amyloidosis, stem cell transplant within 12 weeks prior to enrolment or active graft-versus-host disease, POEMS syndrome, any active uncontrolled infection, impaired cardiovascular function or clinically significant cardiovascular disease within 6 months prior to enrolment, and previous administration with an investigational drug within 30 days or 5 half-lives preceding the first dose of study treatment. In SSA, patients who received prior treatment with a BCMA-bispecific antibody are excluded, and in SSB, patients who received prior treatment with BCMA-directed therapy are excluded. The study is enrolling the Phase 1 portions and is being opened at multiple sites in the United States and Canada. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.001 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.009 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".