Abstract 4179: High valency of IGM-2323, a CD20xCD3 IgM bispecific T cell engager, displaces rituximab binding and induces potent B lymphoma cell killing
Authors: Hart Kevin C. , Logronio Kathryn , Li Mandy , Yakkundi Poonam , Manlusoc Marigold , Li Keyu , Hinton Paul R. , Ng Dean , Leabman Maya K. , Hernandez Genevive , Manley Thomas , Sinclair Angus M. , Carroll Stephen F. , Keyt Bruce A. , Kotturi Maya F. 
Published: June 2022

Abstract
Rituximab-containing treatment regimens are the standard of care for patients with non-Hodgkin’s lymphoma (NHL). However, the majority of patients ultimately experience disease relapse or progression indicating resistance to rituximab therapy. IGM-2323 is an engineered high-affinity, high-avidity anti-CD20 pentameric IgM antibody with an anti-CD3 scFv fused to the joining chain. IGM-2323 offers a novel treatment strategy in NHL through two mechanisms: 1) the recruitment of T cells to kill CD20-expressing tumor cells through T cell dependent cellular cytotoxicity (TDCC) and, 2) complement-dependent cytotoxicity (CDC). We evaluated the activity of IGM-2323 in the presence of rituximab since rituximab can persist in patients after treatment discontinuation, and it can bind to an overlapping epitope on CD20 as IGM-2323. We hypothesized that the high valency of IGM-2323 could displace rituximab, thus enabling potent B cell killing by IGM-2323 even in the presence of high concentrations of rituximab. The affinity of IGM-2323 and its corresponding bivalent anti-CD20 IgG antibody to recombinant human CD20 protein were measured by surface plasmon resonance. IGM-2323 bound to human CD20 with an apparent 300-fold higher binding affinity (KD) and ~100-fold slower off-rate (kdis) than the bivalent anti-CD20 IgG. Human B cell lines with a range of CD20 expression levels, including a CD20-low rituximab-resistant Ramos cell variant, were pre-treated with escalating concentrations of rituximab, and subsequently evaluated in vitro for cell binding, TDCC, and CDC by IGM-2323. At high concentrations of rituximab, which correspond to reported peak serum concentrations (Cmax) found in rituximab-treated patients, IGM-2323 displaced the binding of rituximab on human B cell lines. In contrast, binding of a bispecific CD20xCD3 IgG was severely inhibited by the Cmax of rituximab. In TDCC assays with healthy donor effector T cells, pre-treatment with high concentrations of rituximab only modestly inhibited IGM-2323 activity. Furthermore, only a minor impact to the maximum killing activity (Emax) of IGM-2323 was observed at the Cmax of rituximab. In contrast, rituximab pre-treatment resulted in a distinctly lower Emax of a bispecific CD20xCD3 IgG. Live cell imaging of CDC kinetics was utilized to quantify the extent of CDC by IGM-2323 with or without rituximab. Pre-treatment with rituximab enhanced CDC of IGM-2323 compared to single agent activity. Our preclinical data indicate that IGM-2323 maintains activity in the presence of rituximab. IGM-2323 is currently being studied in a phase 1 clinical trial in relapsed/refractory NHL, where it has been generally well tolerated, with both complete and partial responses observed (NCT04082936). Clinical studies will continue to evaluate these findings, including the treatment of patients with circulating serum levels of rituximab.
Citation Format: Kevin C. Hart, Kathryn Logronio, Mandy Li, Poonam Yakkundi, Marigold Manlusoc, Keyu Li, Paul R. Hinton, Dean Ng, Maya K. Leabman, Genevive Hernandez, Thomas Manley, Angus M. Sinclair, Stephen F. Carroll, Bruce A. Keyt, Maya F. Kotturi. High valency of IGM-2323, a CD20xCD3 IgM bispecific T cell engager, displaces rituximab binding and induces potent B lymphoma cell killing [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4179.