Study of Teclistamab in Combination in Elderly Patients With Multiple Myeloma

Study Overview
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Brief Summary
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The primary hypothesis of this study is that teclistamab SC in combination with daratumumab SC or lenalidomide will be safe and induce a high rate of VGPR or better in newly diagnosed multiple myeloma patients This is an open-label, multicenter, non-comparative, 2-cohort, 2-stage with interruption of enrollment for an efficacy and safety interim analysis, interventional Phase 2 study evaluating the efficacy and safety of a combination with Tec-Dara (Cohort A) or Tec-Len (Cohort B) in patients with newly diagnosed multiple myeloma who are not eligible for SCT.

Official Title
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A Phase 2 Study of Teclistamab in Combination With Daratumumab or Lenalidomide in Elderly Patients With Newly Diagnosed Multiple Myeloma

Conditions
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Multiple Myeloma

Intervention / Treatment
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* Drug: Teclistamab
* Drug: Daratumumab
* Drug: Lenalidomide


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient must be at least ≥65 years of age at the time of informed consent with documented multiple myeloma as defined by the criteria below: Multiple myeloma diagnosis according to IMWG diagnostic criteria Measurable disease at Screening as defined by any of the following: Serum monoclonal paraprotein (M-protein) level ³ 0.5 g/dL; or Urine M protein level ³ 200 mg/24 hours; or Serum Ig FLC ³ 10 mg/dL and abnormal serum Ig kappa/lambda FLC ratio Have an ECOG performance status score of 0-2 Not considered for high-dose chemotherapy and autologous SCT Have clinical laboratory values meeting the criteria during the Screening Phase. A male patient must wear a condom (with spermicidal foam/gel/film/cream/suppository) when engaging in any activity that allows for passage of ejaculate to another person during the study and for a minimum of 4 weeks after the last dose of lenalidomide or for a period of 3 months after the last dose of other study treatments, whichever occurs later. If the male patient's partner is a female of childbearing potential, she must also be practicing a highly effective method of contraception. If the male patient is vasectomized, he still must wear a condom (with or without spermicidal foam/gel/film/cream/suppository), but his female partner is not required to use contraception. 7. A male patient must agree not to donate sperm for the purpose of reproduction during the study and for a minimum of 4 weeks after the last dose of lenalidomide or for period of 3 months after receiving the last dose of other study treatments, whichever occurs later. 8. Must sign an ICF (or their legally acceptable representative must sign in accordance with local requirements) indicating that the patient understands the purpose of, and procedures required for, the study and is willing to participate in the study. 9. Must be willing and able to adhere to the lifestyle restrictions specified in this protocol. Exclusion Criteria: Medical Conditions CNS involvement or clinical signs of meningeal involvement of multiple myeloma. If either is suspected, negative whole brain MRI and lumbar cytology are required. Plasma cell leukemia, Waldenström's macroglobulinemia, POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes), or primary light chain amyloidosis. Any ongoing myelodysplastic syndrome or B cell malignancy (other than multiple myeloma). Any history of malignancy, other than multiple myeloma, which is considered at high risk of recurrence requiring systemic therapy Any active malignancies (ie, progressing or requiring treatment change in the last 24 months) other than multiple myeloma. Stroke, transient ischemic attack, or seizure within 6 months prior to signing ICF. Presence of the a cardiac conditions. Tec-Dara-specific COPD with a FEV1 <50% of predicted normal. Note that FEV1 testing is required for patients with known or suspected of having COPD or asthma and patients must be excluded if FEV1 <50% of predicted normal. Moderate or severe persistent asthma within the past 2 years or uncontrolled asthma of any classification. Note that FEV1 testing is required for patients known or suspected asthma and patients must be excluded if FEV1 <50% of predicted normal. Prior/Concomitant Therapy Radiotherapy within 14 days or focal radiation within 7 days. Received a cumulative dose of corticosteroids equivalent to ≥140 mg of prednisone within 14-days before the first dose of study drug (does not include pretreatment medications). Received a live, attenuated vaccine within 4 weeks before the first dose of study drug. Non-live or non-replicating vaccines authorized for emergency use (eg, COVID-19) are allowed. Any prior therapy for multiple myeloma or smoldering myeloma other than a short course of corticosteroids prior to signing ICF (not to exceed 40 mg of dexamethasone, or equivalent per day for a maximum of 4 days, total of 160 mg dexamethasone or equivalent). Contraindications or life-threatening allergies, hypersensitivity, or intolerance to any study drug or its excipients. Diagnostic Assessments HIV positive. Hepatitis B infection. Active hepatitis C infection as measured by positive HCV-RNA testing. Other Exclusions Women of childbearing potential Patient had major surgery or had significant traumatic injury within 2 weeks prior to the start of administration of study treatment, or will not have fully recovered from surgery., or has major surgery planned during the time the patient is expected to be treated in the study or within 2 weeks after administration of the last dose of study treatment. Concurrent medical or psychiatric condition or disease that is likely to interfere with study procedures or results. Patient plans to father a child while enrolled in this study or within 3 months after the last dose of study intervention. Person under guardianship, trusteeship or deprived of freedom by a judicial or administrative decision.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Tec-Dara<br>For patients assigned to cohort A (Tec-Dara) patients will receive Tec-Dara until documented PD or unacceptable toxicity | Drug: Teclistamab<br>* Teclistamab will be administered via a subcutaneous injection (SC)<br>* Other names: JNJ-64007957;Drug: Daratumumab<br>* Daratumumab will be administered via a subcutaneous injection (SC)<br>|
| Experimental: Tec-Len<br>For patients assigned to cohort B (Tec-Len) patients will receive Tec-Len until documented PD or unacceptable toxicity | Drug: Teclistamab<br>* Teclistamab will be administered via a subcutaneous injection (SC)<br>* Other names: JNJ-64007957;Drug: Lenalidomide<br>* Lenalidomide will be administered orally<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of very good partial response (VGPR) or better according to the IMWG criteria in patients with newly diagnosed multiple myeloma after 4 cycles of treatment with Tec-Dara or Tec-Len |  | At the end of 4 th cycle (each cycle is 28 days), an average 4 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Treatment-emergent adverse events according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE, Version 5.0). |  | From date of randomization until the date of first documented progression,assessed up to 5 years | 
| Overall response rate(PR or better) as defined by the IMWG response criteria |  | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 5 years | 
| Very good partial response or better, defined as VGPR or CR according to the IMWG criteria at the time of data cutoff |  | TFrom date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 5 years | 
| Complete response or better, defined as negative immunofixation of serum and urine, and disappearance of any soft tissue plasmacytomas, and <5% plasma cells in bone marrow* |  | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 5 years | 
| Time to response |  | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 5 years | 
| Duration of response |  | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 5 years | 
| Time from randomization to discontinuation of therapy for any reason including death, progression or toxicity |  | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 5 years | 
| Overall survival time | OS, measured from the date of the first dose of study treatment to the date of the patient's death. If the patient is alive or the vital status is unknown at last contact, then the patient's data will be censored at the date the patient was last known to be alive | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 5 years | 
| TTTF, defined as the time from the date of the first dose of study treatment to discontinuation of therapy for any reason including death, progression, toxicity |  | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 5 years | 
| TTNT, defined as the time from date of the first dose of study treatment to the start of the next-line treatmentTime-to-next treatment |  | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 5 years | 
| Rate of minimal residual disease (MRD)-negativity (at level of 10-5 and 10-6 by NGS) at 6 months |  | at 6 months | 
| Rate of Sustained MRD-negativity-(at level of 10-5 and 10-6 by NGS) |  | at 18 months (12 months after the initial MRD time point). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Newly diagnosed Multiple Myeloma, Elderly patients, Teclistamab, Daratumumab, Lenalidomide, Toxicity