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2019 Post-ASH Conference Report American Society of Hematology Annual Meeting Orlando, Florida | December 7–10, 2019 REPORT EXTRACT

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Page 1: 2019 Post-ASH Conference Report/media/in... · Summary The 2019 American Society of Hematology (ASH) Annual Meeting was held in Orlando, Florida from December 7-10, 2019. The meeting

2019 Post-ASH Conference ReportAmerican Society of Hematology Annual Meeting

Orlando, Florida | December 7–10, 2019

REPORT EXTRACT

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January 2020 / 6 Information Classification: General

ASH 2019 Overview CAR-T therapy and Bispecific Antibodies Immunotherapies, particularly chimeric antigen receptor T-cell (CAR-T) therapies and bispecific antibodies, were again a hot topic at this year’s meeting. Although the uptake for CAR-T therapies has not been strong thus far, companies are hoping that updated results will persuade providers and patients to try these new therapies. At this year’s conference, it became clear that bispecific antibodies could become significant competition for the CAR-T therapies. In addition to response rates, the focus this year was on safety, namely the rates of cytokine release syndrome and neurotoxicity. With multiple therapies demonstrating dramatic efficacy, the long-term success of these immunotherapies will likely come down to the safety profiles. CAR-T Therapies CD19-directed CAR-T therapy Bristol-Myers Squibb presented updated results for its CD19-targeting CAR-T therapy lisocabtagene maraleucel (JCAR017, liso-cel) in relapsed and refractory B-cell lymphoma (Abstract 241). Liso-cel demonstrated an overall response rate (ORR) of 73% and a complete response (CR) rate of 53% in the efficacy-evaluable population, results that compare favorably with historical results for Yescarta and Kymriah, the two CAR-T therapies already approved in this setting. Liso-cel will also likely distinguish itself based on the relatively promising safety profile, which included a 2% rate of Grade 3/4 cytokine release syndrome and 10% rate of Grade 3/4 neurotoxicity. A regulatory filing has been submitted to the FDA for the treatment of adult patients with relapsed or refractory large B-cell lymphoma (LBCL) after at least two prior therapies. A decision is expected by August 2020. Results were also presented from a Phase I/II trial of liso-cel for the treatment patients with relapsed/refractory chronic lymphocytic leukemia (Abstract 503). The study enrolled 23 patients with CLL/SLL who had received at least three (standard-risk disease) or two (high-risk disease) prior treatments with 22 patients evaluable for efficacy. At a median follow-up of 11 months, the ORR for patients receiving liso-cel was 81% with 45% of patients achieving a CR. In the nine patients that had failed a BTK inhibitor and Venclexta, the ORR was 89% with 67% achieving a CR. Cytokine release syndrome of any grade was seen in 79% of patients with 9% of patients experiencing grade 3 cytokine release syndrome. Thirty-nine percent of patients had neurological events (NE) of any grade, while 22% of patients had grade 3 or higher NE. There were no grade 5 events. The Phase II portion of this study continues to enroll patients.

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In the pivotal Phase II ZUMA-2 study of KTE-X19, a CD19 CAR-T therapy, in relapsed or refractory mantle cell lymphoma, KTE-X19 demonstrated an impressive ORR of 93%, with a CR rate of 67% (Abstract 754). At the time of data cut-off, 57% of the ITT population remained in remission while 78% of the CR population remained in remission. Additionally, 47% of all patients were alive at the two-year follow-up. In terms of safety, grade 3 or higher cytokine release syndrome was seen in 15% of patients and grade 3 or higher neurotoxic adverse events were seen in 31% of patients. A regulatory filing has been submitted to the FDA for the treatment of adult patients with relapsed or refractory mantle cell lymphoma. A decision is expected by August 2020. BCMA-directed CAR-T therapy Janssen presented results from two Phase Ib/II studies evaluating BCMA-directed CAR-T therapy JNJ-4528 (also known as LCAR-B38M) in the treatment of relapsed or refractory multiple myeloma: LEGEND-2, a Chinese study initiated in October 2015 and CARTITUDE-1 a US study initiated in June 2018. With a median follow-up of 25 months for the LEGEND-2 trial (Abstract 579), treatment with JNJ-4528 resulted in an ORR and CR rate of 88% and 74%, respectively and 93% of patients with a CR response were negative for minimal residual disease (MRD). Impressively, 46% of all-treated patients and 64% percent of MRD-negative patients with CR remained progression-free. The median progression-free survival (PFS) for all-treated patients was 20 months (range, 10–28); median PFS for MRD-negative patients with CR was 28 months (range, 20–31). For the CARTITUDE-1 study (Abstract 577), patients had a median of five prior lines of therapy (range, 3–18) and 86% of patients were triple-refractory to a protease inhibitor, immunomodulator, and anti-CD38 antibody; 72% were penta-exposed, and 31% were penta-refractory. In 29 patients with a median follow-up of six months, the ORR and CR or better rate was 100% and 86%, respectively. In addition, 100% of evaluable patients (15 of 29 patients) were MRD negative at the latest sample available. With a median follow-up of six months, 27 of 29 patients were progression-free. These initial results show that despite enrolling a more heavily pretreated population, CARTITUDE-1 showed responses comparable to the LEGEND-2 study. While Bristol Myers Squibb idecabtagene vicluecel (ide-cel) is expected to reach the market first, these results suggest that JNJ-4528, structurally differentiated by its two BCMA targeting single domain antibodies, may beat ide-cel on efficacy. We now await results for the Phase II portion of this trial as well as from two recently initiated trials: a Phase II trial (CARTITUDE-2) and a Phase III trial (CARTITUDE-4) that will compare JNJ-4528 to standard of care therapies for multiple myeloma.

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Summary The 2019 American Society of Hematology (ASH) Annual Meeting was held in Orlando, Florida from December 7-10, 2019. The meeting included findings from early clinical results to updated results from key trials. Selected conference highlights include:

• Johnson & Johnson presented new data for the BCMA-targeting CAR-T therapy LCAR-B38M for the treatment of relapsed/refractory multiple myeloma. Encouraging efficacy results from the Phase Ib/II CARTITUDE-1 study showed patients achieving a 100% overall response rate (ORR) and 66% complete response (CR) rate.

• Top-line results from the Phase II ZUMA-2 study of Gilead’s anti-CD19 CAR-T, KTE-X19, support a Biologics License Application (BLA) for relapsed/refractory mantle cell lymphoma with an impressive 93% ORR and 67% CR rate.

• Bristol-Myers presented long-term follow-up results for the CD19 directed CAR-T therapy lisocabtagene maraleucel for the treatment of relapsed/refractory large B-cell lymphoma. The Phase I TRANSCEND NHL 001 study met both its primary and secondary endpoints.

• Roche’s mosunetuzumab is a CD20-CD3 T-cell engaging bispecific antibody being evaluated in people with relapsed or refractory B-cell NHL. Results from a Phase I/Ib showed efficacy with an ORR of 63% in slow-growing NHL and 37% in aggressive NHL, CR rates were 43% and 19% respectively. Mosunetuzumab continues to be evaluated in several Phase I/II trials including in combination with Polivy and as first-line therapy.

• The first numerical results for the Phase III AALL1331 study of Blincyto in relapsed ALL patients were presented in a late breaking abstract. The Blincyto arm demonstrated significantly improved two-year overall survival compared to the chemotherapy arm. These data support the use of Blincyto as a superior alternative to chemotherapy consolidation following re-induction therapy in pediatric patients at first-relapse.

• Amgen and Janssen presented results for CANDOR, a Phase III study of Kyprolis combined with dexamethasone and Darzalex (KdD) vs Kyprolis and dexamethasone (Kd) in second-line or later multiple myeloma. This combination of two powerful targeted agents did not disappoint and the study met its primary endpoint of improving progression free survival with a 37% reduction in the risk of progression or death. The results from CANDOR suggest that the KdD regimen may be an alternative to the Darzalex/Velcade/dexamethasone (DVd) regimen for patients that relapsed, were refractory to or intolerant of a regimen containing an immunomodulatory agent such as Revlimid. We now await regulatory submissions for this new treatment option for relapsed/refractory multiple myeloma.

• Notable findings from the Phase I/II study of the triple combination of TG-1303 (ublituximab, umbralisib; TGTX) and Venclexta for relapsed/refractory chronic lymphocytic leukemia (CLL) demonstrated a well-tolerated option for patients. Efficacy results of 100% ORR and 44% CR rate were promising and showed potential as the triple combination is being further studied in the Phase II ULTRA-V trial.

• AstraZeneca presented data from the ELEVATE-TN trial which supported approval for CLL of the second generation BTK inhibitor Calquence. Calquence combined with Gazyva showed a median progression-free survival of 22.6 months in previously untreated patients.

• Cerdulatinib (PTLA) is being studied in a Phase I/IIa study for patients with specific subtypes of T-cell Non-Hodgkin Lymphoma. The SYK/JAK inhibitor showed encouraging results for patients

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January 2020 / 3 Information Classification: General

with angioimmunoblastic T-cell lymphoma (AITL) and cutaneous T-cell lymphoma (CTCL) with a 52% ORR and 37% CR rate in the AITL cohort and a favorable 25.8% ORR and 10.8% CR rate was seen in the PTCL cohort.

• In the Phase III ASCERTAIN study, Otsuka’s ASTX727, an oral formulation of decitabine, was evaluated for the treatment of intermediate and high-risk (MDS). The study revealed a 5-day decitabine AUC equivalence of 98.9%, leading the company to move forward on a new drug application (NDA) filing to the U.S. Food and Drug Administration (FDA) with this data.

About the Author Biomedtracker is an independent research service that offers proprietary clinical assessments and patient-based revenue forecasts of developmental drugs within a comprehensive and intuitive drug information database. Clients from the pharmaceutical, biotech, and investment industries rely on Biomedtracker for its insight on the likelihood of approval, commercial potential, and future data and regulatory catalysts for drugs within the competitive landscape of every important disease and indication. Over the last several years, Biomedtracker has become the leader in providing objective information alongside evidence based clinical assessments and investment research on pipeline drugs worldwide. For more information on getting direct access to Biomedtracker, please email [email protected]. Datamonitor Healthcare provides a total business information solution to the pharmaceutical and healthcare industries. We provide expertise in therapeutic, strategic, and company market analysis and competitive intelligence to the global pharmaceutical and healthcare markets, enabling them to ultimately make valuable and profitable decisions. For more information about our products or to arrange a demo of our online service, please contact: [email protected].

Disclaimer Copyright © 2020 Sagient Research This report is published by Sagient Research (the Publisher). This report contains information from reputable sources and although reasonable efforts have been made to publish accurate information, you assume sole responsibility for the selection, suitability and use of this report and acknowledge that the Publisher makes no warranties (either express or implied) as to, nor accepts liability for, the accuracy or fitness for a particular purpose of the information or advice contained herein. The Publisher wishes to make it clear that any views or opinions expressed in this report by individual authors or contributors are their personal views and opinions and do not necessarily reflect the views/opinions of the Publisher.

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Contents Summary ....................................................................................................................................................... 2

About the Author .......................................................................................................................................... 3

Disclaimer...................................................................................................................................................... 3

ASH 2019 Overview ....................................................................................................................................... 6

Drug Abstracts ............................................................................................................................................. 15

Acute Lymphoblastic Leukemia (ALL) ...................................................................................................... 15

Blincyto for Acute Lymphoblastic Leukemia (ALL) (AMGN, Approved) .............................................. 15 GC022 for Acute Lymphoblastic Leukemia (ALL) (Gracell; Development Outside U.S.) ..................... 17

Acute Myelogenous Leukemia (AML) ...................................................................................................... 20 APR-246 for Acute Myelogenous Leukemia (AML) (APRE; Phase II) .................................................. 20

APR-246 for Acute Myelogenous Leukemia (AML) (APRE; Phase II) .................................................. 23 BST-236 for Acute Myelogenous Leukemia (AML) (BioSight, Phase II) .............................................. 25

Cusatuzumab for Acute Myelogenous Leukemia (AML) (JNJ; Phase I/II) ........................................... 27

Flotetuzumab for Acute Myelogenous Leukemia (AML) (MGNX; Phase I) ......................................... 29 Keytruda for Acute Myelogenous Leukemia (AML) (MRK; Phase II) .................................................. 31

Magrolimab for Acute Myelogenous Leukemia (AML) (FTSV; Phase I) .............................................. 33 MBG453 for Acute Myelogenous Leukemia (AML) (NVS; Phase I) ..................................................... 36

Oral Azacitidine for Acute Myelogenous Leukemia (AML) (BMY, Phase III) ....................................... 38 Anemia Due to Oncology Treatment ....................................................................................................... 42

Roxadustat for Anemia Due to Oncology Treatment (AZN; Phase III) ................................................ 42 Autoimmune Hemolytic Anemia (AIHA) .................................................................................................. 45

BIVV009 for Autoimmune Hemolytic Anemia (AIHA) (SNY, Phase III) ................................................ 45

Chronic Lymphocytic Leukemia (CLL)/Small Cell Lymphocytic Lymphoma (SLL) - NHL) .......................... 49 Calquence for Chronic Lymphocytic Leukemia (CLL)/Small Cell Lymphocytic Lymphoma (SLL) – NHL (AZN; Approved) ................................................................................................................................. 49

LOXO-305 for Chronic Lymphocytic Leukemia (CLL)/Small Cell Lymphocytic Lymphoma (SLL) – NHL (LLY; Phase I/II) .................................................................................................................................... 52 TG-1303 for Chronic Lymphocytic Leukemia (CLL)/Small Cell Lymphocytic Lymphoma (SLL) – NHL (TGTX; Phase III) .................................................................................................................................. 55

Diffuse Large B-Cell Lymphoma (DLBCL) - NHL ........................................................................................ 58 AUTO3 for Diffuse Large B-Cell Lymphoma (DLBCL) – NHL (AUTL; Phase I/II) ................................... 58

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Lisocabtagene Maraleucel for Diffuse Large B-Cell Lymphoma (DLBCL) – NHL (BMY; BLA) .............. 61

Indolent Non-Hodgkin's Lymphoma (Including Follicular Lymphoma) - NHL .......................................... 64 Mosunetuzumab for Indolent Non-Hodgkin's Lymphoma (Including Follicular Lymphoma) – NHL (RHHBY; Phase I) ................................................................................................................................. 64 Polivy for Indolent Non-Hodgkin's Lymphoma (Including Follicular Lymphoma) – NHL (RHHBY, Phase II) ......................................................................................................................................................... 67

REGN1979 for Indolent Non-Hodgkin's Lymphoma (Including Follicular Lymphoma) – NHL (REGN; Phase II) ............................................................................................................................................... 69 Tazemetostat for Indolent Non-Hodgkin's Lymphoma (Including Follicular Lymphoma) – NHL (Royalty Pharma; NDA) ....................................................................................................................... 72

Mantle Cell Lymphoma - NHL .................................................................................................................. 75

KTE-X19 for Mantle Cell Lymphoma – NHL (GILD, BLA) ...................................................................... 75 Multiple Myeloma (MM) ......................................................................................................................... 78

CC-93269 for Multiple Myeloma (MM) (BMY; Phase I) ...................................................................... 78 C-CAR088 for Multiple Myeloma (MM) (CBMG; Phase I) ................................................................... 80

Darzalex for Multiple Myeloma (MM) (JNJ, Approved) ...................................................................... 83 ide-cel for Multiple Myeloma (MM) (BMY; Phase III) ......................................................................... 87

LCAR-B38M for Multiple Myeloma (MM) (JNJ, Phase II) .................................................................... 90 Myelodysplastic Syndrome (MDS) ........................................................................................................... 92

APR-246 for Myelodysplastic Syndrome (MDS) (APRE, Phase III) ...................................................... 92

ASTX727 for Myelodysplastic Syndrome (MDS) (Otsuka, Phase III) ................................................... 94 Venclexta for Myelodysplastic Syndrome (MDS) (ABBV, Phase II) ..................................................... 97

Vidaza for Myelodysplastic Syndrome (MDS) (BMY, Approved) ........................................................ 99 Myelofibrosis (MF) ................................................................................................................................ 102

Reblozyl for Myelofibrosis (MF) (XLRN; Phase II) ............................................................................. 102 Peripheral T-Cell Lymphoma (PTCL) - NHL ............................................................................................. 105

Cerdulatinib for Peripheral T-Cell Lymphoma (PTCL) – NHL (PTLA; Phase I/II) ................................ 105

List of Biomedtracker ASH Events …………………………………………………………………………………..………….… 109

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effects of the bridging chemotherapy regimens received prior to administration of KTE-X19. The median vein-to-vein time was 27 days. Improving this process, as with most CAR-T therapies, will improve the response rates even further by eliminating on-study progression from patients waiting for therapy. Source: Press Release 12/09/2019 (GILD) Press Release 12/09/2019 (MD Anderson) American Society of Hematology (ASH) 12/09/2019 (Abstract 754) Sagient Analysis

Multiple Myeloma (MM) CC-93269 for Multiple Myeloma (MM) (BMY; Phase I) Phase I – RRMS Trial Data – Top-Line Results Change to LOA: 2% Abstract 143: First Clinical Study of the B-Cell Maturation Antigen (BCMA) 2+1 T-Cell Engager (TCE) CC-93269 in Patients (Pts) with Relapsed/Refractory Multiple Myeloma (RRMM): Interim Results of a Phase 1 Multicenter Trial Design Eligible pts had RRMM and had received ≥ 3 prior regimens without prior BCMA-directed therapy. In dose escalation, CC-93269 was administered intravenously over 2 hours on Days 1, 8, 15, and 22 for Cycles 1–3; Days 1 and 15 for Cycles 4–6; and on Day 1 for Cycle 7 and beyond, all in 28-day cycles. Dose escalation involved 2 stages: in stage 1, CC-93269 was given in fixed doses; in stage 2, pts received a fixed first dose on Cycle 1 Day 1, followed by intrapatient dose escalation on Cycle 1 Day 8. Minimal residual disease (MRD) was assessed after clinical response in pt bone marrow aspirate samples by Next Generation Flow using the EuroFlow panel. MRD negativity was reported only if a minimum sensitivity of < 1 tumor cell in 105 nucleated cells was achieved. Endpoints Primary objectives were to assess the safety and tolerability of CC-93269 and define the maximum tolerated dose (MTD), non-tolerated dose (NTD), and/or recommended Phase II dose (RP2D).

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Results As of May 24, 2019, 19 pts had received CC-93269. Median age was 64 years (range 51–78), with a median of 6.2 years (range 1.4–13.9) since initial diagnosis. The median number of prior regimens was 6 (range 3–12) and included treatment with autologous stem cell transplantation (73.7%), allogenic stem cell transplantation (10.5%), lenalidomide (100%), pomalidomide (84.2%), bortezomib (100%), carfilzomib (84.2%), and daratumumab (DARA; 94.7%). All pts had MM refractory to their last line of therapy, with 16 (88.9%) refractory to DARA, 17 (89.5%) to their last proteasome inhibitor, and 16 (84.2%) to their last immunomodulatory agent. CC-93269 doses ranged from 0.15 to 10 mg; median duration of treatment was 14.6 weeks (range 1.6–32.0) with pts receiving a median of 4 cycles (range 1–8). Dose-related pharmacodynamic activity, including peripheral blood immune cell redistribution and transient release of pro- and anti-inflammatory cytokines, was observed in pts. Of the 12 pts treated with ≥ 6 mg CC-93269 in Cycle 1, 10 pts achieved a partial response (PR) or better (overall response rate; 83.3%), including 7 (58.3%) with a very good partial response (VGPR) or better and 4 (33.3%) with a stringent complete response (sCR); 9 (75.0%) pts achieved MRD negativity. The median time to response was 4.2 weeks (range 4.0–13.1), and 10 of 10 responses were ongoing with follow-up ranging from 2.1 to 4.7 months. The NTD, MTD, and RP2D have not yet been reached. Most Common Adverse Events Grade 3–4 treatment-emergent adverse events were reported in 15 (78.9%) pts and included 10 (52.6%) pts with neutropenia, 8 (42.1%) with anemia, 5 (26.3%) with infections, and 4 (21.1%) with thrombocytopenia. No pt required dose modifications. Cytokine release syndrome (CRS) was reported in 17 (89.5%) pts, the majority of whom reported a maximum grade 1 (n = 11 [57.9%]) or grade 2 (n = 5 [26.3%]), and occurred most frequently with the first or second dose (n = 22 of 27 events [81.5%]). CRS prophylaxis was implemented with dexamethasone for first dose and dose increases in pts receiving ≥ 6 mg. Of 27 CRS events, 8 (29.6%) were managed with dexamethasone and 10 (37.0%) with tocilizumab. One pt receiving 6 mg CC-93269 as first dose and 10 mg on Cycle 1 Day 8 died on study in the setting of CRS, with a potential infection as a contributing factor. Conclusion CC-93269, a 2+1 BCMA TCE, shows a manageable safety profile and promising efficacy, including MRD-negative sCRs, in pts with heavily pretreated RRMM. The study continues to enroll in the dose escalation phase. Comment These are encouraging early results for CC-93269, a bi-specific antibody targeting BCMA and CD3. At ASH, the presenter mentioned that for nine patients treated with 10 mg CC-93269 (four patients

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received 10 mg as the intial dose, five patients received step-up dosing of 6 mg followed by 10 mg), the overall response rate (ORR) was 89% with a very good partial response (VGPR) rate of 33% and a stringent complete response/complete response (sCR/CR) rate of 44%. Impressively, all patients achieving a sCR/CR response were MRD negative in the bone marrow. These results compare well to Amgen’s bispecific antibody AMG 420 which reported an ORR of 70% in ten patients treated at 400 mcg/day with a VGPR rate of 10% and an MRD-negative complete response rate of 50%. These results also compare well to BCMA directed CAR-Ts with ORRs of 81.5% and 100% for ide-cel (Bristol-Myers Squibb) and LCAR-B38M (Johnson & Johnson), respectively, and CR rates of 35.2% and 66%, respectively. Unlike AMG 420 which must be administered daily, CC-93269 was administered once a week for the first three months, every other week for another three months and then once a month. The presenter mentioned that CC-93269 could potentially be given as outpatient therapy but that for now patients are closely observed for 72 hours following dosing. With regards to safety, data presented at ASH showed cytokine release syndrome (CRS) in 76.7% of all patients (n=30) with one case of Grade 3 or higher CRS. This patient received step-up dosing and experienced Grade 3 CRS at the initial dose of 6 mg and then Grade 5 CRS at the 10 mg dose. Contributing factors to this death included myeloma progression with a high tumor burden (extensive extramedullary disease) and pre-existing infection. There were three other deaths within 35 days of dosing, but they were not treatment related (sepsis in the setting of advanced prostate cancer, sudden cardiac death and progressive disease). Infections and infestations occurred in 56.7% of all patients (30% Grade 3 or higher). Safety will be closely monitored as additional patients get treated with the 10 mg dose. As we await further dose optimization and expansion, we are raising the LOA by 2%. Source: American Society of Hematology (ASH) 12/07/2019 (Abstract 143) American Society of Hematology (ASH) 12/08/2019 (BMY, Slide 13) Sagient Analysis C-CAR088 for Multiple Myeloma (MM) (CBMG; Phase I) Phase I - C-CAR088 Trial Data – Top-Line Results

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