Announcement • 7h
Regeneron Pharmaceuticals, Inc. Demonstrates Lynozyfic Monotherapy Deep and Rapid Responses in All Treated Patients with Second-Line-Plus Systemic Amyloid Light Chain Amyloidosis
Regeneron Pharmaceuticals, Inc. announced positive results from the Phase 1/2 LINKER-AL2 trial evaluating Lynozyfic (linvoseltamab) in adults with second-line-plus systemic amyloid light chain (AL) amyloidosis. Normalization of free light chains occurred by day 15 across all doses. 100% of patients achieved a hematologic complete response (CR) at the highest tested dose. Majority of patients with renal or cardiac involvement demonstrated improvement in organ function, despite short follow-up. The Phase 2 portion of the trial with registrational intent is ongoing. Lynozyfic is a BCMAxCD3 bispecific antibody that is already approved to treat certain adults with relapsed or refractory (R/R) multiple myeloma (MM). Systemic AL amyloidosis is a rare and potentially fatal hematologic disorder for which there are currently no approved therapies after initial treatment fails. The disorder is characterized by plasma cells that produce abnormal light chain proteins, which clump together to form amyloid deposits in tissues and vital organs (e.g., heart, kidneys, etc.), resulting in life-threatening organ dysfunction. The current standard-of-care for initial treatment is a four-drug combination that includes daratumumab, bortezomib, cyclophosphamide and dexamethasone. In first-line treatment, this daratumumab-and-chemotherapy-containing quadruple combination showed a 53% hematologic complete response (CR), with a median time to response of 59 days per historical clinical data. In LINKER-AL2, the safety and efficacy of Lynozyfic as a monotherapy was evaluated in patients who received at least one prior therapy, and were either relapsed, refractory or had a suboptimal response (“second-line-plus”). LINKER-AL2 is an ongoing, open-label, Phase 1/2 trial investigating the safety and efficacy of fixed-duration Lynozyfic monotherapy in adults with second-line-plus systemic AL amyloidosis. The primary endpoint in Phase 1 was the incidence of dose-limiting toxicities through 28 days. In the ongoing Phase 2 portion of the trial, the primary endpoint is the achievement of hematologic CR. In the preliminary analysis, 20 patients received Lynozyfic 80 mg (n=7) or 240 mg (n=13) subcutaneously, including 60% who previously received a daratumumab-containing regimen. With a median follow-up of 9.5 months (range: 1.6-13.3 months), Lynozyfic had no observed dose-limiting toxicities, with additional results across both doses showing: Hematologic responses in all patients: In the lower-dose group (80 mg), 100% (7 of 7) achieved a very good partial response (VGPR) or better, and 71% (5 of 7) achieved a CR; in the higher-dose group (240 mg), 100% achieved a CR (13 of 13). Responses were durable, with no hematologic progression occurring in all 17 patients still in the trial. Rapid and deep reductions in involved free light chain (iFLC) that normalized by day 15, showing that Lynozyfic treatment rapidly destroyed the plasma cells that produce the abnormal light chains in systemic AL amyloidosis. Further, median time to hematologic CR was 47 days (range: 7-240 days). Notable responses associated with improved renal (73%; 8 of 11) and cardiac (50%; 4 of 8 by biochemical response) organ function, with no patients experiencing major organ deterioration. Across both dose levels, all patients (n=20) treated with Lynozyfic monotherapy experienced =1 treatment-emergent adverse event (TEAE) (Grade =3: 65%), with the most common being cytokine release syndrome (50%; no Grade =3), neutropenia (40%; Grade 3/4: 35%) and infusion-related reactions (35%; no Grade =3). A total of 17 patients (85%) experienced infections (Grade =3: 25%), all of which were resolved. Additionally, there was one Grade 1 incidence of immune effector cell-associated neurotoxicity syndrome that was resolved. One patient in the 240 mg cohort discontinued treatment due to AEs (pneumonia) after achieving CR following three cycles of treatment. Additionally, one patient in the 240 mg cohort with a hematologic CR experienced sudden death in the context of cardiac amyloidosis; and one patient in the 80 mg cohort with pre-existing coronary artery disease had fatal ventricular fibrillation within 24 hours of coronary artery stent placement, which was assessed as unrelated to Lynozyfic by the investigator. The use of Lynozyfic described above is investigational, and its safety and efficacy has not been evaluated by any regulatory authority for this indication. Lynozyfic was invented using Regeneron’s VelocImmune technology and is a fully human BCMAxCD3 bispecific antibody designed to bridge BCMA on MM cells with CD3-expressing T cells to facilitate T-cell activation and cancer-cell killing. Lynozyfic is approved to treat certain adults with R/R MM: in the U.S. after four lines of therapy and in the European Union after at least three prior therapies. Lynozyfic is being investigated in a broad clinical development program exploring its use as a monotherapy and in combination regimens across different lines of therapy in MM, including earlier lines of treatment, as well as plasma cell precursor disorders. These potential uses are investigational, and their safety and efficacy have not been evaluated by any regulatory authority. In addition to LINKER-AL2, ongoing trials include: LINKER-MM 1: Phase 1/2 dose-escalation and dose-expansion trial evaluating the safety, tolerability, dose-limiting toxicities and anti-tumor activity of Lynozyfic monotherapy in R/R MM; LINKER-MM2: Phase 1b open-label trial evaluating Lynozyfic in combination with other cancer treatments in patients with R/R MM; LINKER-MM3: Phase 3 confirmatory trial evaluating Lynozyfic monotherapy compared to the combination of elotuzumab, pomalidomide and dexamethasone in R/R MM; LINKER-MM4: Phase 1/2 trial evaluating Lynozyfic monotherapy in newly diagnosed multiple myeloma (NDMM); LINKER-MM5: Phase 3 trial evaluating Lynozyfic monotherapy or in combination with carfilzomib compared to standard of care combination regimens in patients with R/R MM; LINKER-MM6 (EMN39): Phase 3 trial, in collaboration with the European Myeloma Network, evaluating daratumumab, lenalidomide and dexamethasone induction followed by Lynozyfic monotherapy compared to continued daratumumab, lenalidomide, and dexamethasone in NDMM who are transplant-ineligible.