Efficacy of Subcutaneous Epcoritamab versus Axi‐cel in R/R DLBCL CAR T‐Naive and CAR T‐eligible patients: An Indirect Comparison

Abstract

Introduction: Epcoritamab, an off-the-shelf, subcutaneous CD3xCD20 T-cell–engaging bispecific antibody that redirects T cells to eliminate malignant CD20+ B cells, showed single-agent efficacy in patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) with a manageable safety profile. The phase 1/2 EPCORE NHL-1 trial (NCT03625037) of epcoritamab in patients with R/R DLBCL who received ≥2 prior lines of systemic therapy showed high complete response (CR) and minimal residual disease rates. Methods: This matching-adjusted indirect comparison included published data on overall response rate (ORR), CR rate, and overall survival (OS) for axi-cel (ZUMA-1 trial, N = 101) and individual patient-level data (IPD) for epcoritamab (EPCORE NHL-1 trial). Patients in EPCORE NHL-1 with prior CAR T therapy were excluded as ZUMA-1 included only patients without prior CAR T therapy. Analyses were adjusted for imbalances in baseline characteristics between IPD from EPCORE NHL-1 and aggregate data from ZUMA-1. Propensity score weights were applied to estimate risk differences for ORR and CR rate; weighted Cox proportional-hazards models were used to estimate OS hazard ratio (HR). Subgroup analyses of CAR T-eligible patients assessed patients with more similar clinical characteristics. Results: Compared with the ZUMA-1 population, the majority of patients enrolled in EPCORE NHL-1 (N = 86) were men (61.6% vs. 23.8%) with a median age of 69.5 y (vs. 58.0 y), and were refractory to ≥2 consecutive lines of therapy (62.8% vs. 53.5%). Among the CAR T-adjusted matched population, response rates were not statistically different in those treated with epcoritamab versus axi-cel (ORR: 73.4% vs. 74.3%, respectively; difference in ORR: −0.8%; P = 0.927; CR rate: 48.5% vs. 54.5%; difference in CR rate, −6.0%; P = 0.583). In a subgroup of CAR T-naive patients that were CAR T eligible and treated with epcoritamab (n = 50), response rates also did not significantly differ from those in patients treated with axi-cel (ORR 72.7% vs. 74.3%, respectively; difference in ORR: −1.6%; P = 0.873; CR rate: 47.7% vs. 54.5%; difference in CR rate, −6.8%; P = 0.576). In all CAR T-naive patients, OS was not statistically different between those treated with epcoritamab versus axi-cel (HR: 0.695; 95% CI: 0.351, 1.376; P = 0.297). Likewise, the CAR T-eligible subpopulation treated with epcoritamab did not have statistically different OS versus axi-cel (HR: 0.708; 95% CI: 0.309, 1.626; P = 0.416). Conclusions: Findings from this cross-study comparison suggest that epcoritamab is a promising, emerging, novel therapy with no statistically significant difference in efficacy versus axi-cel in patients with highly refractory, hard-to-treat DLBCL. Additional analyses are needed to better understand the therapeutic potential of epcoritamab as an off-the shelf, subcutaneously delivered core therapy for these patients. Encore Abstract - previously submitted to EHA 2023 The research was funded by: Epcoritamab is jointly developed by Genmab A/S and AbbVie Inc.; AbbVie and Genmab are sponsoring this study. Keyword: Aggressive B-cell non-Hodgkin lymphoma Conflicts of interests pertinent to the abstract. C. Thieblemont Consultant or advisory role: AbbVie, BeiGene, BMS/Celgene, Roche, Janssen, Kite/Gilead, Novartis, Regeneron, and Takeda C. P. Fox Consultant or advisory role: GenMab and AbbVie Other remuneration: Steering Committee: GenMab A. Wang Consultant or advisory role: AbbVie, BeiGene, BMS/Celgene, Roche, Janssen, Kite/Gilead, Novartis, Regeneron, and Takeda K. Sail Employment or leadership position: AbbVie Stock ownership: AbbVie A. Alshreef Employment or leadership position: AbbVie Stock ownership: AbbVie M. Moran Employment or leadership position: AbbVie Stock ownership: AbbVie A. Mutebi Employment or leadership position: Genmab Stock ownership: Genmab J. Blaedel Employment or leadership position: Genmab Stock ownership: Genmab V. Chirikov Employment or leadership position: OPEN Health, which received funding support from AbbVie to conduct the research G. Salles Consultant or advisory role: AbbVie, Bayer, BeiGene, BMS/Celgene, Epizyme, Genentech/Roche, Genmab, Incyte, Janssen, Kite/Gilead, Loxo, Miltenyi, MorphoSys, Novartis, Rapt, Regeneron, and Takeda