A Study of Teclistamab With Other Anticancer Therapies in Participants With Multiple Myeloma MAJESTEC-2

What's the purpose of this trial?

The purpose of this study is to characterize the safety and tolerability of teclistamab when administered in different combination regimen and to identify the optimal dose(s) of teclistamab combination regimens.

This trial is currently open and accepting patients.

What will happen during the trial?

You may be able to join this trial if you:

The following criteria is a partial list of reasons why patients may be eligible to participate in this clinical trial. Further evaluation with a medical professional is required.

Inclusion Criteria:

  • Have documented initial diagnosis of multiple myeloma according to international myeloma working group (IMWG) diagnostic criteria
  • Meet treatment regimen-specific requirements as follows: Treatment Regimen A (teclistamab [tec]-daratumumab [dara]-pomalidomide [pom]) only: Participant has relapsed or refractory multiple myeloma and has received at least 1 prior line of therapy, including exposure to a proteasome inhibitor (PI) and lenalidomide; Treatment Regimen B (tec-dara-lenalidomide [len]-bortezomib [bor]) only: Participant has newly diagnosed or relapsed/refractory multiple myeloma and is naive to treatment with lenalidomide; Treatment Regimen C (tec-nirogacestat [niro]) only: Participant has relapsed or refractory multiple myeloma and has 1) received 3 or more prior lines of therapy or 2) is double refractory to a PI and an immunomodulatory drug (IMiD) and triple exposed to a PI, an IMiD, and an anti-cluster of differentiation (CD)38 monoclonal antibody (mAb)
  • Have measurable disease at screening as defined by at least one of the following: serum M-protein level greater than or equal to (>=) 1.0 gram/deciliter (g/dL); or urine M-protein level >= 200 milligram (mg)/24 hours; or light chain multiple myeloma: serum immunoglobulin (Ig) free light chain (FLC) >=10 milligram/deciliter (mg/dL) and abnormal serum Ig kappa lambda FLC ratio
  • A woman of childbearing potential must have a negative serum (beta human chorionic gonadotropin [hCG]) pregnancy test at screening and a negative urine or serum pregnancy test within 24 hours before the start of study treatment administration
  • A woman must agree not to donate eggs (ova, oocytes) for the purposes of assisted reproduction during the study and for at least 100 days after the last dose of study treatment

Exclusion Criteria:

  • Prior treatment with any therapy that targets B-cell maturation antigen (BCMA)
  • Live, attenuated vaccine within 4 weeks before the first dose of study treatment, unless approved by sponsor
  • Received a cumulative dose of corticosteroids equivalent to >= 140 mg of prednisone within the 14-day period before the start of study treatment administration
  • Active central nervous system (CNS) involvement or exhibition of clinical signs of meningeal involvement of multiple myeloma. If either is suspected, brain magnetic resonance imaging (MRI) and lumbar cytology are required
  • Known to be seropositive for human immunodeficiency virus

Additional Trial Information

Phase 1

Enrollment: 146 patients (estimated)

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Published Results

Teclistamab in Combination with Subcutaneous Daratumumab and Lenalidomide in Patients with Multiple Myeloma: Results from One Cohort of MajesTEC-2, a Phase1b, Multicohort StudyClinically Relevant Abstract

December 10, 2022

32 patients received tec-dara-len (0.72 mg/kg, n=13; 1.5 mg/kg, n=19). At the data cutoff (July 11, 2022), median follow-up was 5.78 months (mo; range, 1.0–10.4) and median treatment duration was 4.98 mo (range, 0.10–10.35). Median age was 62 years (range, 38–75); 87.5% were male. All patients had received prior MM treatment; median prior LOT was 2 (range, 1–3), and 31.3% were anti-CD38 exposed. The most frequent AE was CRS (81.3% [n=26]). All CRS events were grade 1/2, and 95% of the events occurred during cycle 1 treatment doses. Median time to onset was 2 days (range, 1–8) and median duration was 2 days (range, 1–22). No ICANS events were reported. Other frequent AEs (≥25.0% across both dose levels) were neutropenia (75.0% [n=24]; grade 3/4: 68.8% [n=22]), fatigue (43.8% [n=14]; grade 3/4: 6.3% [n=2]), diarrhea (37.5% [n=12]; all grade 1/2), insomnia (31.3% [n=10]; grade 3/4: 3.1% [n=1]), cough (28.1% [n=9]; all grade 1/2), hypophosphatemia (25.0% [n=8]; all grade 1/2), and pyrexia (25% [n=8]; grade 3/4: 6.3% [n=2]). The frequency of febrile neutropenia was 12.5% (n=4). Infections occurred in 24 patients (75.0%; grade 3/4: 28.1% [n=9]). The most common infections were upper respiratory infection (21.9% [n=7]), COVID-19 (21.9% [n=7]), and pneumonia (21.9% [n=7]). Three patients (9.4%) had COVID-19 pneumonia. One patient (3.1%) discontinued due to an AE (COVID-19) considered unrelated to study drugs; this patient died due to COVID-19. The overall response rate (ORR) was 13/13 evaluable patients (median follow-up, 8.61 mo) at 0.72 mg/kg and 13/16 evaluable patients (median follow-up was less mature at 4.17 mo) at 1.5 mg/kg. Very good partial response or better was achieved in 12 patients at the 0.72 mg/kg dose and was not mature for the 1.5 mg/kg group. Median time to first response was 1.0 mo (range, 0.7–2.0). Preliminary pharmacokinetic concentrations of tec in combination with dara-len were similar to those seen with tec monotherapy. Tec-dara-len treatment led to proinflammatory cytokine production (induction of interleukin-6, soluble interleukin-2Rα, interferon-γ, and tumor necrosis factor-α) and T-cell activation (upregulation of programmed cell death protein-1 and CD38 on peripheral T cells).

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