A phase 1a/b, multi-regional, first-in-human study of CS5001, a novel anti-ROR1 ADC, in patients with advanced solid tumors and lymphomas.
Authors: Lemech Charlotte Rose , Zuniga Richard , Barve Minal A. , Song Yuqin , Zhang Jian , Zhou Keshu , Zhang Liling , Shen Lin , Bishnoi Sarwan , Cherng Hua-Jay Jeffery , Zhou Caicun , Li Wenyu , Wang Jingru , Zhu Xiaoli , Zhu Dan , Li Fei , Shen Zhenwei , Yang Jason 
Published: June 2024

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Background: Receptor tyrosine kinase-like orphan receptor 1 (ROR1) is an embryonic tyrosine kinase-like molecule implicated in multiple pathways promoting oncogenic signaling. ROR1 is overexpressed in a broad spectrum of solid tumors and hematological malignancies while notably absent in normal tissues. CS5001 is an antibody drug conjugate (ADC) composed of a human anti–ROR1 IgG1 monoclonal antibody which is site-specifically conjugated to a pyrrolobenzodiazepine dimer prodrug through a proprietary lysosomal cleavable β-glucuronide linker. Here, we report preliminary phase 1a results of CS5001 in patients (pts) with advanced solid tumors and lymphomas. Methods: This is a global, first-in-human, phase 1a/b study evaluating the safety, pharmacokinetics (PK), and anti-tumor activity of CS5001 in pts with advanced solid tumors and lymphomas. CS5001 was administered intravenously Q3W with a 42-day-DLT period. In phase 1a (dose escalation), pts who had progressed on or been intolerant to standard therapies were enrolled without baseline ROR1 expression testing; accelerated titration followed by Bayesian Optimal Interval design was employed; in parallel with dose escalation, additional pts were enrolled to selected dose levels deemed safe to further evaluate safety and efficacy. Results: As of 15 Jan 2024, 49 pts with lymphomas (n=17) and solid tumors (n=32) were treated across 8 dose levels (7 to 125 μg/kg). Median age was 57 years. Most (n=40, 81.6%) pts had received ≥3 lines of prior anti-tumor treatment. No DLT was observed and MTD was not reached. Treatment-related adverse events (TRAEs) occurred in 29 pts (59.2%); the most common TRAE was fatigue (n=8, 16.3%). Grade 3 TRAEs occurred in 7 pts (14.3%), with fatigue, gamma-glutamyltransferase increased and pneumonia being the most common (occurring in 2 pts [4.1%] each). No grade 4-5 TRAEs were reported. Drug exposure of CS5001 was proportional to dose in general, with an apparent half-life of about 5 days. The PK profile of CS5001 was similar to that of total antibody, indicating good stability of the ADC in the circulation. Among the 34 pts with post baseline tumor assessment (13 lymphomas and 21 solid tumors), objective responses were observed in pts at dose level 5 or above (n=23), including 2 complete responses (1 Hodgkin lymphoma [HL] and 1 diffuse large B-cell lymphoma) and 3 partial responses (2 HL and 1 pancreatic cancer). Stable diseases were observed in 3 pts (2 colorectal cancer and 1 renal cancer). Dose escalation is still ongoing, and more data will be available at the conference presentation. Conclusions: CS5001 was well tolerated with no DLT identified, PK characteristics were as expected, and encouraging antitumor activities were observed in various advanced solid tumors and lymphomas. Current data support continued evaluations for the recommended phase 2 dose and subsequent phase 1b dose expansion. Clinical trial information: NCT05279300 .