SUMMARY

• MonumenTAL-1 (MMY1001) is an ongoing, open-label, phase 1/2 study evaluating the efficacy and safety of TALVEY in patients with relapsed or refractory multiple myeloma (RRMM) after ≥3 prior lines of therapy, including a proteasome inhibitor (PI), an immunomodulatory drug, and an anti-cluster of differentiation 38 (CD38) monoclonal antibody.^1-4
  • Key inclusion and exclusion criteria in the MonumenTAL-1 study protocol are summarized below.⁵

CLINICAL DATA – Monumental-1 study

MonumenTAL-1 (MMY1001; NCT03399799, NCT04634552) is a phase 1/2 study of TALVEY in patients with RRMM. The study was conducted in 3 parts; the primary objectives are listed below.^1-5

• Part 1 (phase 1; dose escalation): to characterize the safety of TALVEY and determine the recommended phase 2 dose (RP2D)s and schedule.
• Part 2 (phase 1; dose expansion): to further characterize the safety of TALVEY at the RP2Ds.
• Part 3 (phase 2): to evaluate the efficacy of TALVEY at the RP2Ds.

Shown below is a summary of the study design for the phase 2 portion (part 3) of the study.

Study Design/Methods (Part 3)

• Patients were enrolled into 1 of the following 3 cohorts⁵:
  • Cohort A: 0.4 mg/kg SC QW, not previously exposed to T Cell Redirection (TCR) therapies such as chimeric antigen receptor modified T-cells (CAR-T) or bispecific antibodies
  • Cohort B: 0.4 mg/kg SC QW or 0.8 mg/kg SC Q2W, have been previously exposed to TCR therapies
  • Cohort C: 0.8 mg/kg SC Q2W, not previously exposed to TCR therapies
• Key Inclusion Criteria (Part 3)
  • ≥18 years of age⁵
  • Documented initial diagnosis of multiple myeloma (MM) per International Myeloma Working Group criteria⁵
  • Measurable disease: MM must be measurable by central laboratory assessment⁵:
    • Serum monoclonal paraprotein (M-protein) level ≥1.0 g/dL or urine M-protein level ≥200 mg/24 hours; or
    • Light chain multiple myeloma without measurable disease in the serum or the urine: Serum immunoglobulin free light chain (FLC) ≥10 mg/dL and abnormal serum immunoglobulin kappa lambda FLC ratio.
    • If central laboratory assessments are not available, relevant local laboratory measurements must exceed the minimum required level by at least 25%.
  • Prior treatment⁵:
    • Cohort A and Cohort C: ≥3 prior lines of therapy that included at least one PI, an immunomodulatory drug, and an anti-CD38 monoclonal antibody, and not previously exposed to T-cell redirection therapies.
    • Cohort B: ≥3 prior lines of therapy that included at least one PI, an immunomodulatory drug, and an anti-CD38 monoclonal antibody, and have been previously exposed to T-cell redirection therapies.
  • Eastern Cooperative Oncology Group (ECOG) performance status score of 0-2.⁵
  • Hematology and chemistry parameters at screening are presented in Table: Clinical Laboratory Values at Screening.⁵

• Key Exclusion Criteria (Part 3)
  • Prior grade 3 or higher cytokine release syndrome (per Lee Criteria 2014⁶) related to any T-cell redirection or any prior G protein-coupled receptor family C group 5 member D (GPRC5D) targeting therapy⁵
  • Prior antitumor therapy prior to the first dose of the study drug is as follows⁵:
    • Gene-modified adoptive cell therapy (eg, CAR-T, natural killer [NK] cells) within 3 months
    • Targeted therapy, epigenetic therapy, or treatment with an investigational drug or an invasive investigational medical device within 21 days or at least 5 half-lives, whichever is less
    • Monoclonal antibody treatment for MM within 21 days
    • Cytotoxic therapy within 21 days
    • Proteasome inhibitor therapy within 14 days
    • Immunomodulatory agent therapy within 7 days
    • Radiotherapy within 14 days. However, if palliative focal radiation is used, the patient is eligible irrespective of the end date of radiotherapy.
    • Cohort A and Cohort C: exposed to a CAR-T or T-cell redirection therapy at any time
    • Cohort B: T-cell redirection therapy within 3 months
  • Vaccinated with live, attenuated vaccine within 4 weeks or as recommended by the product manufacturer prior to the first dose, during treatment, or within 100 days of the last dose of TALVEY.⁵
  • Toxicities from previous anticancer therapies should have resolved to baseline levels or to Grade 1 or less except for alopecia or peripheral neuropathy.⁵
  • Received a cumulative dose of corticosteroids equivalent to ≥140 mg of prednisone within the 14-day period before the first dose of study drug (does not include pretreatment medication).⁵
  • Received either of the following⁵:
    • An allogenic stem cell transplant within 6 months before the first dose of the study drug. Patients who received an allogeneic transplant must be off all immunosuppressive medications for 6 weeks without signs of graft versus host disease.
    • An autologous stem cell transplant ≤12 weeks before first dose of study drug.
  • Central nervous system involvement or clinical signs of meningeal involvement of multiple myeloma. If either is suspected, negative whole brain magnetic resonance imaging and lumbar cytology are required.⁵
  • Plasma cell leukemia (>2.0 x 10⁹/L plasma cells by standard differential), Waldenström’s macroglobulinemia, POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) syndrome, or primary amyloid light chain amyloidosis.⁵
  • Any serious underlying medical condition, such as⁵:
    • Evidence of serious active viral, bacterial, or uncontrolled systemic fungal infection.
    • Active autoimmune disease or a documented history of autoimmune disease, with the exception of vitiligo, resolved childhood atopic dermatitis, and prior Grave’s disease that is currently euthyroid based on clinical symptoms and laboratory testing.
    • Psychiatric conditions (e.g., alcohol or drug abuse), severe dementia, or altered mental status.

literature search

A literature search of MEDLINE^®, Embase^®, BIOSIS Previews^®, and Derwent Drug File databases (and/or other resources, including internal/external databases) was conducted on 02 July 2024.