A Study of Subcutaneous Daratumumab Regimens in Combination With Bispecific T Cell Redirection Antibodies for the Treatment of Participants With Multiple Myeloma

Study Overview
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Brief Summary
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The purpose of this study is to identify recommended Phase 2 doses (RP2Ds) for each treatment combination (between daratumumab plus talquetamab and teclistamab plus daratumumab with or without pomalidomide) and to characterize the safety of each RP2D for selected treatment combinations.

Detailed Description
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Multiple myeloma is a malignant plasma cell disorder characterized by osteolytic lesions, increased susceptibility to infections, hypercalcemia, and renal failure. Overall rationale of study is that daratumumab in combination with talquetamab or teclistamab may lead to enhanced clinical responses in treatment of relapsed or refractory multiple myeloma through multiple mechanisms of action. Daratumumab is human immunoglobulin G1 kappa monoclonal antibody (IgG1k) that binds with high affinity to a unique epitope on cluster of differentiation 38 (CD38) in a variety of hematological malignancies including multiple myeloma. Talquetamab and teclistamab are bispecific T cell redirection antibodies. Talquetamab binds to cluster of differentiation 3 (CD3) receptor complex on T cells and to G protein-coupled receptor family C group 5-member D (GPRC5D), a 7-transmembrane receptor protein on plasma cells and teclistamab binds to human and cynomolgus-CD3 and B cell maturation antigen (BCMA). Purpose of study is to evaluate safety of daratumumab, with or without pomalidomide, in combination with talquetamab and teclistamab, and to evaluate preliminary antitumor activity of each combination. Study consists of a screening period, treatment period (Part 1: dose escalation and Part 2: dose expansion) and a post treatment follow-up period (after end of treatment and up to 16 weeks after last dose. End of study is defined as last study assessment for last participant in study. Total duration of study is approximately 2.4 years. Efficacy, safety, pharmacokinetics (PK), immunogenicity, and biomarkers will be assessed at specified time points. Participants safety will be monitored throughout study by Study Evaluation Team (SET). SET consists of members of sponsor's study team and participating investigators.

Official Title
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A Phase 1b Study of Subcutaneous Daratumumab Regimens in Combination With Bispecific T Cell Redirection Antibodies for the Treatment of Subjects With Multiple Myeloma

Conditions
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Multiple Myeloma

Intervention / Treatment
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* Drug: Daratumumab
* Drug: Talquetamab
* Drug: Teclistamab
* Drug: Pomalidomide


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Documented initial diagnosis of multiple myeloma according to International Myeloma Working Group (IMWG) diagnostic criteria Must have either of the following: a) received at least 3 prior lines of therapy including a proteasome inhibitor (PI) (greater than or equal to [>=] 2 cycles or 2 months of treatment) and an immunomodulatory drug (IMiD) (>=2 cycles or 2 months of treatment) in any order during the treatment or b) disease that is double refractory to a PI and an IMiD Measurable disease at screening as defined by any of the following: Serum monoclonal protein (M-protein) level >=1.0 grams per deciliter (g/dL) (in non- immunoglobulin G (IgG) myeloma, an M-protein level >=0.5 g/dL); or Urine M-protein level >=200 milligrams (mg)/24 hours; or Light chain multiple myeloma: Serum immunoglobulin (Ig) free light chain (FLC) >=10 milligrams per deciliter (mg/dL) and abnormal serum Ig kappa lambda FLC ratio Eastern Cooperative Oncology Group (ECOG) performance status grade of 0 or 1 at screening and at Cycle 1, Day 1 predose Female participants of childbearing potential must have a negative highly-sensitive serum beta-human chorionic gonadotropin (beta-hCG) pregnancy test (less than [<] 5 international units per milliliter [IU/mL]) at screening and a negative urine or serum pregnancy test within 1 day before the first dose of study drug Exclusion Criteria: Treatment in the prior 3 months with an anti- cluster of differentiation 38 (CD38) therapy (example, daratumumab), or discontinuation of a prior anti-CD38 therapy at any time due to an adverse event related to the anti-CD38 therapy Live, attenuated vaccine within 4 weeks prior to the first dose of study drug unless approved by sponsor Active Central nervous system involvement or exhibits clinical signs of meningeal involvement of multiple myeloma. If either is suspected, brain magnetic resonance imaging (MRI) and lumbar cytology are required Seropositive for hepatitis B (defined by a positive test for hepatitis B surface antigen [HBsAg]). Participants with resolved infection must be screened using real-time polymerase chain reaction (PCR) measurement of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) levels. Those who are PCR positive will be excluded Active hepatitis C infection as measured by positive hepatitis C virus- ribonucleotide (HCV)-RNA testing. Participants with a history of Hepatitis C virus antibody positivity must undergo HCV-RNA testing

Ages Eligible for Study
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Minimum Age: 18 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: Part 1: Dose Escalation<br>Participants will be assigned to either a combination of 1) daratumumab plus teclistamab or 2) daratumumab plus talquetamab or 3) daratumumab plus talquetamab plus pomalidomide or 4) daratumumab plus teclistamab plus pomalidomide. | Drug: Daratumumab<br>* Participants will receive daratumumab.<br>* Other names: JNJ-54767414, Darzalex;Drug: Talquetamab<br>* Participants will receive talquetamab.<br>* Other names: JNJ-64407564;Drug: Teclistamab<br>* Participants will receive teclistamab.<br>* Other names: JNJ-64007957;Drug: Pomalidomide<br>* Participants will receive pomalidomide.<br>|
| Experimental: Part 2: Dose Expansion<br>Participants will be treated with the RP2D(s) for selected treatment combinations determined in Part 1. | Drug: Daratumumab<br>* Participants will receive daratumumab.<br>* Other names: JNJ-54767414, Darzalex;Drug: Talquetamab<br>* Participants will receive talquetamab.<br>* Other names: JNJ-64407564;Drug: Teclistamab<br>* Participants will receive teclistamab.<br>* Other names: JNJ-64007957;Drug: Pomalidomide<br>* Participants will receive pomalidomide.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Part 1: Number of Participants With Dose Limiting Toxicity (DLT) | The dose limiting toxicities are based on drug related adverse events and defined as any of the following events: hematological or non-hematological toxicity of grade 3 or higher. | Up to 52 Weeks | 
| Part 1: Number of Participants With Dose Limiting Toxicity by Severity | The dose limiting toxicities are based on drug related adverse events and defined as any of the following events: hematological or non-hematological toxicity of grade 3 or higher. | Up to 52 Weeks | 
| Part 2: Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs) | An AE is any untoward medical occurrence in a clinical study participant administered a medicinal (investigational or non-investigational) product. An AE does not necessarily have a causal relationship with the intervention. SAE is any AE that results in: death, persistent or significant disability/incapacity, requires inpatient hospitalization or prolongation of existing hospitalization, is life-threatening experience, is a congenital anomaly/birth defect, and suspects transmission of any infectious agent via a medicinal product. | Up to 48 Weeks | 
| Part 2: Number of Participants With Adverse Events and SAEs by Severity | An AE is any untoward medical occurrence in a clinical study participant administered a medicinal (investigational or non-investigational) product. An AE does not necessarily have a causal relationship with the intervention. SAE is any AE that results in: death, persistent or significant disability/incapacity, requires inpatient hospitalization or prolongation of existing hospitalization, is life-threatening experience, is a congenital anomaly/birth defect, and suspects transmission of any infectious agent via a medicinal product. | Up to 48 Weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Serum Concentration of Daratumumab | Serum concentration of daratumumab will be assessed. | Up to 52 Weeks | 
| Serum Concentration of Talquetamab | Serum concentration of talquetamab will be assessed. | Up to 52 Weeks | 
| Serum Concentration of Teclistamab | Serum concentration of teclistamab will be assessed. | Up to 52 Weeks | 
| Biomarker Assessment of Daratumumab | Serum cytokine concentrations will be measured at the time of drug infusion of daratumumab for biomarker assessment. | Up to Cycle 7 Day 1 (each cycle of 28-days) | 
| Biomarker Assessment of Talquetamab | Serum cytokine concentrations will be measured at the time of drug infusion of talquetamab for biomarker assessment. | Up to Cycle 7 Day 1 (each cycle of 28-days) | 
| Biomarker Assessment of Teclistamab | Serum cytokine concentrations will be measured at the time of drug infusion of teclistamab for biomarker assessment. | Up to Cycle 7 Day 1 (each cycle of 28-days) | 
| Number of Participants With Anti-Drug Antibodies to Daratumumab | Number of participants with anti-drug antibodies to daratumumab will be assessed. | Up to 52 Weeks | 
| Number of Participants With Anti-Drug Antibodies to Talquetamab | Number of participants with anti-drug antibodies to talquetamab will be assessed. | Up to 52 Weeks | 
| Number of Participants With Anti-Drug Antibodies to Teclistamab | Number of Participants with anti-drug antibodies to teclistamab will be assessed. | Up to 52 Weeks | 
| Overall Response Rate (ORR) | ORR is defined as the percentage of participants who have a partial response (PR) or better according to the International Myeloma Working Group (IMWG) criteria. | Up to 48 Weeks | 
| Clinical Benefit Rate | Clinical benefit rate (ORR + minimal response [MR]) is defined as the of participants who have a MR or better according to the IMWG criteria. | Up to 48 Weeks | 
| Duration of Response (DOR) | DOR is defined as the time from the date of initial documentation of a response (PR or better) to the date of first documented evidence of progressive disease, as defined in the IMWG criteria. | Up to 48 Weeks | 
| Time to Response | Time to response is defined as the time between date of first dose of study drug and the first efficacy evaluation that the participant has met all criteria for PR or better. | Up to 48 Weeks |