Initial Results of a Phase 1 First-in-Human Study of Cemsidomide (CFT7455), a Novel MonoDACTM Degrader, with Dexamethasone in Patients with Relapsed/Refractory Multiple Myeloma
Authors: Dhakal Binod , Yee Andrew J. , Richardson Paul G. , Ailawadhi Sikander , Chhabra Saurabh , Muchtar Eli , Berdeja Jesús G. , Richard Shambavi , Matous Jeffrey V , Shah Urvi A. , Schroeder Mark A. , Ali Amro , Leahy Leah , Lobbardi Riadh , Chu Rong , Hurh Eunju , Fiorino Anthony S. , Lonial Sagar 
Published: December 2024

Background: Cemsidomide (formerly CFT7455) is a novel, rationally designed, highly potent Ikaros Family Zinc Finger Protein 1/3 (IKZF1/3) MonoDACTM cereblon-based degrader. Cemsidomide has demonstrated best-in-class activity in multiple myeloma (MM) preclinical models and has also been shown to stimulate immune activation, providing combination rationale for various novel and standard of care therapies in MM.

Methods: CFT7455-1101(NCT04756726) is an open-label, phase 1/2, multi-center, first-in-human study evaluating safety, efficacy, pharmacokinetics (PK), and pharmacodynamics (PD) of cemsidomide in patients (pts) with MM and non-Hodgkin's lymphoma who have relapsed from and/or are refractory to standard of care options. Eligible MM pts must have received lenalidomide, pomalidomide, a proteasome inhibitor, and an anti-CD38 antibody. The primary objective of the MM phase 1 portion of the study is to characterize the safety and tolerability of cemsidomide alone and in combination with dexamethasone (DEX) and to determine the maximum tolerated dose (MTD) and/or recommended doses for phase 2. Secondary objectives include assessments of antitumor activity according to the International Myeloma Working Group (IMWG) response criteria, PK, and PD. Dose escalation is guided by a Bayesian logistic regression model with an initial cohort size of 3-6 pts and a provision for additional pts to be enrolled in expansion cohorts at doses deemed safe. We report initial results from our ongoing cemsidomide plus DEX dose escalation arm.

Results: As of July 3rd, 2024, 32 pts have been treated with cemsidomide at various doses plus DEX (20 or 40 mg weekly) in the ongoing dose escalation portion of the study. The median age was 64 (range 40-82) and pts had received a median of 6 prior lines of therapy (range 3-17). 21/32 (66%) of pts received prior treatment with a CAR-T or a bispecific antibody. 9/32 (28%) of pts had high-risk disease at screening and 6/32 (19%) of pts had extramedullary disease. Cemsidomide doses explored in dose-escalation and expansion cohorts included 50 µg MWF (n=6), 37.5 µg QD (n=12), 62.5 µg QD (n=10), and 75 µg QD (n=4), all on a 14 day on/14 day off dosing schedule. Systemic exposure of cemsidomide increased dose proportionally. At all dose levels, cemsidomide produced expected degradation of IKZF1 and IKZF3. To date only one dose-limiting toxicity has been observed (one pt in the 62.5 µg QD cohort experienced Grade 4 neutropenia lasting &gt;7 days). 59% of pts experienced a grade ≥3 TEAE. Grade 3-4 TEAEs occurring in ≥10% of patients included neutropenia (34%), anemia (28%), infections (19%), lymphopenia (16%), and thrombocytopenia (13%). No pts experienced grade 3/4 fatigue, nausea, or vomiting. 5 pts have had treatment-related SAEs and 3 pts had an AE resulting in treatment discontinuation. As of the July 25th, 2024 efficacy cutoff, IMWG responses have been observed at all dose levels. The overall response rate among the 32 pts treated in dose escalation and expansion cohorts is 22% (1 sCR, 1 VGPR, and 5 PRs) with an additional 5 pts achieving minimal response (MR) for a clinical benefit rate of 38% (MR or better). To date, 2/4 (50%) pts in the 75 µg cohort have had a PR with expansion at 75 µg ongoing.

Conclusions: Initial results from this ongoing phase 1 trial of cemsidomide in combination with DEX demonstrate encouraging efficacy and tolerability as an all-oral therapy in a heavily pre-treated MM population, with the majority of pts having received a CAR-T or bispecific antibody. As anticipated in MM, grade 3-4 toxicities consist largely of myelosuppression, which has been manageable. Given a favorable emerging safety profile and promising anti-myeloma activity, cemsidomide is potentially well suited to combine with other modalities, including proteosome inhibitors, monoclonal antibodies, antibody drug-conjugates and bispecific antibodies. Dose escalation will continue until an MTD and/or the recommended phase 2 doses are identified. Updated data will be presented at the conference.