This is a Phase 1, open-label dose escalation study evaluating the safety and clinical efficacy of Talquetamab in combination with Belantamab mafodotin for a time-limited interval followed by Belantamab mafodotin and Pomalidomide maintenance. The study will enroll subjects with Multiple Myeloma that have previously been treated with at least one prior line of therapy and have been treated with IMiDs, proteasome inhibitors, and anti-CD38 therapies either in combination or as single agent and are relapsed or are refractory to, or intolerant of, established therapies with clinical benefit in Multiple Myeloma. Talquetamab will be administered with step up dosing on day 1, 3, 5 with or without day 7 pending target dose (TD1) of Talquetamab (Tal) in dose level. Two weeks after TD1, patients will enroll on C1D1 of Tal (TD2) with Belantamab (Bela). Tal will subsequently be dosed every two weeks. Bela will be administered every 8 weeks on D1 of odd numbered cycles or until resolution of any ocular toxicities to grade 1 or better. After 6 cycles of induction, patients may transition to Bela/Pom maintenance.
After written informed consent is obtained from a participant, they will undergo screening evaluations within 28 days before first dose of study treatment, described above. Results from the disease assessments conducted within 28 days before Step-Up Dose 1 of study treatment performed as standard of care prior to screening may be used to fulfill screening requirements if all required assessments were collected. Trial intervention will continue until progression of disease or drug discontinuation due to intolerable AEs. For participants in adequate response (Very Good Partial Response (VGPR) or better) after \>6 cycles of therapy can change to maintenance Belantamab mafodotin and Pomalidomide. Participants who demonstrate sustained consecutive Measurable Residual Disease (MRD) negativity on separate bone marrow biopsies across \> 1 year apart may hold all study related treatment but should continue monthly study assessments per the maintenance schedule of activities with the exception of the ocular exams. Duration of prophylaxis antimicrobial therapy can be determined by the treating physician but it is recommended to extend to at least 3 months after stopping study drug. Upon permanent discontinuation of trial intervention, each participant will be asked to undergo an end-of-treatment evaluation. 28 days after discontinuation of treatment, each participant will undergo a safety follow-up evaluation. Participants will then be contacted approximately every 2 months for long-term follow-up to assess survival status, receipt and type of subsequent anticancer therapy, and disease status. At end of trial enrollment, a long term overall survival follow-up is planned to be conducted. Talquetamab (Tal) will be administered with step up dosing on day 1, 3, 5 with or without day 7 (dependent on target dose (TD) level of 0.4mg/kg or 0.8mg/kg) of Talquetamab. Two weeks after TD1, participants will enroll on Cycle 1, Day 1 of Tal (TD2) with Belantamab. Tal will subsequently be dosed every two weeks. Belantamab will be administered every 8 weeks on Day 1 of odd numbered cycles or until resolution of any ocular toxicities to Grade 1 or better. After 6 cycles of induction, participants may transition to Belantamab/Pomalidomide (Bela/Pom) maintenance. As stated above, patients who maintain MRD negativity for at least 1 year may also hold treatment. The study will be conducted in 2 parts: 1. Part 1 Dose Escalation: Participants will be treated in cohorts with a BOIN design evaluating tolerability of Tal+Bela therapy at 3 planned dose levels including two intermediate levels of either Tal or Bela escalation. Titration will proceed until completion of DL3 or any pre-defined stopping criteria are met. 2. Part 2 Dose Expansion: Once the maximum tolerated dose (MTD) of combination therapy is determined, expansion cohorts of up to 12 participants will be enrolled across 2 dose levels to determine the optimal biological dose and confirm safety and secondary efficacy endpoints. Dose limiting toxicities will be assessed during the first cycle of treatment.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
50
Talquetamab dosed at 0.4mg/kg or 0.8mg/kg every 2 weeks
Belantamab mafodotin dosed at 1.4mg/kg or 1.9 mg/kg every 8 weeks
Pomalidomide dosed at 4mg Day 1- 21 of 28 day cycles
Frequency and severity of treatment emergent adverse events (TEAEs)
Treatment-emergent adverse events (TEAEs) are defined as any adverse events (AEs) that begin or worsen on or after the start of study treatment through 28 days after the last dose of treatment drug. All AEs will be listed. Only TEAEs will be summarized. TEAEs will be summarized by Medical Dictionary for Regulatory Activities (version 23.1 or later) System Organ Class and Preferred Term. Separate tabulations will be produced for all TEAEs.
Time frame: Through the first 28 days of treatment
Maximum tolerated dose (MTD)
Maximum tolerated dose (MTD) is determined by the number of dose limiting toxicities (DLTs) during the first 28 days after the first administration of study treatment (Cycle 1) of each cohort. A DLT is defined as any adverse event (AE) that occurs during the DLT evaluation period which is considered related to study treatment, and also meets any of the criteria, as determined by the Data Safety Monitoring Committee (DSMC), with input from the clinical study team.
Time frame: Through the first 28 days of treatment (Cycle 1)
Overall Response Rate (ORR) including partial response (PR), very good partial response (VGPR), complete response (CR) and stringent complete response (sCR)
Overall Response Rate (ORR) to treatment, defined as response to treatment as assessed by investigators using International Myeloma Working Group (IMWG) response criteria, will be tabulated. Point estimates and exact 95% confidence intervals for the percentage of participants achieving ORR will be calculated and summarized.
Time frame: up to 2 years after discontinuation of treatment
Best Overall Response (BOR)
Best overall response (BOR) to treatment, defined as the best response to treatment from the start of study treatment until disease progression, as assessed by investigators using IMWG response criteria will be tabulated. Point estimates and exact 95% confidence intervals for the percentage of participants will be calculated and summarized.
Time frame: up to 2 years after discontinuation of treatment
Duration of Response (DOR)
Duration of response to treatment, defined as the time from first evidence of response to earlier date of disease progression or death due to any cause, as assessed by investigators using IMWG response criteria, will be tabulated. Point estimates and exact 95% confidence intervals for the percentage of participants achieving ORR (PR, VGPR, CR, sCR) as well as MRD negativity rate will be calculated and summarized.
Time frame: up to 2 years after discontinuation of treatment
Rate of Measurable Residual Disease negativity (MRD-) rate at 1 year
Rate of measurable residual disease negativity (MRD-), as assessed by investigators using IMWG response criteria, will be tabulated. Time-to-event endpoints will be estimated using Kaplan-Meier methods, if appropriate.
Time frame: up to 1 year
Rate of sustained Measurable Residual Disease negativity (MRD-) rate at 1 year
Rate of sustained measurable residual disease negativity (MRD-), as assessed by investigators using IMWG response criteria, will be tabulated. Time-to-event endpoints will be estimated using Kaplan-Meier methods, if appropriate.
Time frame: up to 1 year
Time to Progression (TTP)
Time to Progression defined as the duration of time from the start of treatment to the documentation of disease progression or recurrence. Time-to-event endpoints will be estimated using Kaplan-Meier methods, if appropriate.
Time frame: up to 2 years after discontinuation of treatment
Time to Next Treatment (TTNT)
Time to Next Treatment (TTNT) defined as the duration of time from the start of one therapeutic treatment to a subsequent line of therapy. Time-to-event endpoints will be estimated using Kaplan-Meier methods, if appropriate.
Time frame: up to 2 years after discontinuation of treatment
Time to Response (TTR)
Time to response (TRR), defined as the duration of time from the start of treatment to the first occurrence of disease response as assessed by investigators using IMWG response criteria, will be tabulated. Point estimates and exact 95% confidence intervals for the percentage of participants will be calculated and summarized.
Time frame: up to 2 years after discontinuation of treatment
Progression Free Survival (PFS)
Progression free survival (PFS), defined as the length of time from the start of treatment until disease progression as assessed by investigators using IMWG response criteria, will be tabulated. Time-to-event endpoints will be estimated using Kaplan-Meier methods, if appropriate.
Time frame: up to 2 years after discontinuation of treatment
Overall Survival (OS)
Overall survival (OS) defined as the time from the start of treatment until death from any cause, will be tabulated. Time-to-event endpoints will be estimated using Kaplan-Meier methods, if appropriate.
Time frame: up to 2 years after discontinuation of treatment
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