Myelodysplastic Syndrome (MDS)
Conditions
Keywords
MGM453, Phase II, sabatolimab, TIM-3, venetoclax, azacitidine, Myelodysplastic syndrome, MDS
Brief summary
The purpose of the study was to find out if the new drug sabatolimab when given in combination with azacitidine and venetoclax, was safe and had beneficial effects in participants with high or very high risk myelodysplastic syndrome (MDS) who were not suitable for treatment with intensive chemotherapy or a stem-cell transplant (HSCT).
Detailed description
Approximately 76 people with high or very high risk myelodysplastic syndrome (MDS) and age ≥ 18 years were to be asked to join this study but due to the decision by Novartis to halt recruitment the study did not enroll the approximately 76 participants. The primary purpose of Part 1 (Safety run-in) was to rule out excessive toxicity of sabatolimab, when administered in combination with azacitidine and venetoclax. The primary purpose of the combined cohort 2 of the Safety run-in (Part 1) and Expansion (Part 2) was to have evaluated efficacy of sabatolimab, when administered in combination with azacitidine and venetoclax in adult participants with high or very high risk MDS. But due to the decision by Novartis to halt recruitment at the end of the Safety run-in, the study enrolled participants in Part 1 only. This study was to have consisted of two parts: Safety Run-in Part: The first approximately 18 participants to have joined the study would have been part of the safety run-in. The first approximately 6 participants would have been enrolled to the lower dose given every four weeks sabatolimab safety run-in cohort. After these participants would have completed 2 cycles of treatment a decision would have been made to confirm whether the chosen combination of sabatolimab with azacitidine and venetoclax was considered safe to continue with approximately 12 participants, to have been enrolled to the higher dose given every four weeks safety run-in cohort. After these participants would have completed 2 cycles of treatment a decision would have been made to confirm whether the chosen combination of sabatolimab with azacitidine and venetoclax was considered safe to continue with expansion part of the study. Expansion Part (which did not occur): After the safety run-in part would have confirmed that the study treatment (higher dose of sabatolimab given every four weeks with azacitidine and venetoclax) was safe, about 58 more participants would have been enrolled in the expansion part to better investigate the efficacy of the study treatment.
Interventions
DRUGsabatolimab
Sabatolimab was administered at a low dose (Safety run-in (Part 1) cohort 1) or a high dose (Safety run-in (Part 1) cohort 2) via i.v. infusion over 30 minutes on Day 8 of every treatment cycle. Cycle = 28 days
DRUGazacitidine
A standard dose of azacitidine was given subcutaneously or intravenously every day for seven consecutive days on days 1-7 of a confirmed treatment cycle. In keeping with standard clinical practice, the alternative schedules for five consecutive days on days 1-5, followed by a two day break, then two consecutive days on days 8-9 was permitted (alternative schedule).
DRUGvenetoclax
Venetoclax film-coated tablets was administered at a dose of 400 mg orally or corresponding reduced dose for concomitant use with P-gp inhibitors or moderate or strong CYP3A4 inhibitors, once a day, from C1D1 to C1D14 during the treatment cycle. No ramp-up for venetoclax was necessary.
Sponsors
Novartis Pharmaceuticals
Study design
Allocation
NA
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Signed informed consent must be obtained prior to participation in the study 2. Age ≥ 18 years at the date of signing the informed consent form (ICF) 3. Morphologically confirmed diagnosis of myelodysplastic syndrome (MDS) based on 2016 WHO classification (Arber et al, 2016) by local investigator assessment with one of the following Prognostic Risk Categories, based on the revised International Prognostic Scoring System (IPSS-R) (Greenberg et al 2012): * Very high (\> 6 points) * High (\> 4.5-6 points) 4. Not immediately eligible for hematopoietic stem-cell transplantation (HSCT) or intensive chemotherapy at the time of screening due to individual clinical factors such as age, comorbidities and performance status, donor availability (de Witte et al 2017) 5. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2
Exclusion criteria
1. Prior exposure to TIM-3 directed therapy or any BCL-2 inhibitor (including venetoclax) at any time 2. Prior therapy with immune check point inhibitors (e.g. anti-CTLA4, anti-PD-1, anti-PD-L1, or anti-PD-L2) or cancer vaccines is not allowed if the last dose of the drug was administered within 4 months prior to start of treatment 3. Previous first-line treatment for very high risk or high risk myelodysplastic syndromes (based on IPSS-R,Greenberg et al 2012 and Arber et al, 2016) with any antineoplastic agents, approved or investigational, including for example chemotherapy, lenalidomide and hypomethylating agents (HMAs) such as decitabine or azacitidine However, a one single cycle of HMAs treatment only started prior to enrollment is allowed. 4. Live vaccine administered within 30 days prior to start of treatment 5. Current use or use within 14 days prior to start of treatment of systemic steroid therapy (\> 10 mg/day prednisone or equivalent) or any immunosuppressive therapy. Topical, inhaled, nasal, ophthalmic steroids are allowed. Replacement therapy, steroids given in the context of a transfusion, are allowed and not considered a form of systemic treatment 6. History of severe hypersensitivity reactions to any ingredient of study drug(s) (azacitidine, venetoclax or sabatolimab) or monoclonal antibodies (mAbs) and/or their excipients 7. Participants with Myelodysplastic syndrome (MDS) based on 2016 WHO classification (Arber et al, 2016) with revised International Prognostic Scoring System (IPSS-R) ≤ 4.5
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Dose Limiting Toxicities (DLTs) - All Grades (Safety run-in Patients Only) | From Cycle 1 Day 8 to end of Cycle 2 (Cycle = 28 Days) | A dose-limiting toxicity (DLT) is defined as an adverse event or abnormal laboratory value considered by the Investigator to be at least possibly related to sabatolimab as a single contributor or in combination with other component(s) of study treatment that occurs during the DLT observation period and meets severity criteria as per protocol. |
| Percentage of Participants (Receiving 800mg Sabatolimab) Achieving Complete Remission (CR) Per Investigator Assessment | up to approx. 23 months | This endpoint assessed Complete Remission (CR) Rate of participants from Cohort 2 of Part 1 and Part 2 according to Investigator assessment per modified IWG-MDS - Cheson 2006 criteria. CR is defined as follows: bone marrow blasts \<=5%, hemoglobin level ≥ 10 g/dL, platelets count ≥ 100\*10\^9/L, neutrophils count ≥ 1.0\*10\^9/L, absence of blasts in peripheral blood. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Response Rate (ORR) of Participants Who Achieved Hematologic Improvement (HI) or Better as Best Response | up to approx. 23 months | The percentage of participants achieving \[CR + mCR + partial remission (PR) + hematologic improvement (HI)\], per modified IWG-MDS Cheson 2006 criteria. Partial response (PR): all complete response (CR) criteria except \>=50% decrease from baseline in blasts in bone marrow AND blast count in bone marrow \>5%. HI (erythroid response or platelet response or neutrophil response) must last at least 8 weeks. |
| Percentage of Participants Who Are RBC/Platelets Transfusion Independent | up to approx. 23 months | Improvement in red blood cells (RBC)/platelets transfusion post-baseline as per International Working Group - Myelodysplastic syndromes (IWG-MDS) by dose level for the safety run-in part (Cohort 1 (400 mg Q4W) and Cohort 2 (800 mg Q4W)) and for participants treated with sabatolimab 800 mg (Q4W) (Cohort 2 of safety run-in and expansion parts). RBC/Platelets transfusion independence is defined as participants having received no RBC/Platelets transfusions during at least 8 consecutive weeks after start of treatment. |
| Duration of Transfusion Independence | up to approx. 23 months | Sum of each period of the transfusion independence for participants with at least one period of transfusion independence post-baseline by dose level for the safety run-in part (Cohort 1 (400 mg Q4W) and Cohort 2 (800 mg Q4W)) and for participants treated with sabatolimab 800 mg (Q4W) (Cohort 2 of safety run-in and expansion parts) for both red blood cells and platelets. RBC/Platelets transfusion independence is defined as participants having received no RBC/platelets transfusions during at least 8 consecutive weeks after start of treatment. |
| Peak Serum Concentration (Cmax) of Sabatolimab | Continuously collected for patients during treatment with sabatolimab up to 150 days after last treatment, approx. 23 months | Maximal concentration of sabatolimab for participants treated with sabatolimab by dose level for the safety run-in part (Cohort 1 (400 mg Q4W) and Cohort 2 (800 mg Q4W)). |
| Trough Serum Concentration (Cmin) Sabatolimab | Continuously collected for patients during treatment with sabatolimab up to 150 days after last treatment, approx. 23 months | Concentration of sabatolimab prior to next dosing or after end of treatment by dose level for the safety run-in part (Cohort 1 (400 mg Q4W) and Cohort 2 (800 mg Q4W)). |
| Anti-drug Antibody (ADA) Prevalence at Baseline and ADA Incidence On-treatment by Dose Level | Continuously collected for patients during treatment with sabatolimab up to 150 days after last treatment, approx. 23 months | Immunogenicity of sabatolimab prior to sabatolimab exposure and during treatment |
| Duration of Complete Remission (CR) | up to approx. 23 months | Duration of complete remission (CR) is defined as time from first occurrence of CR to relapse from CR, progression or death due to any cause whichever occurs first for the safety run-in part (Cohort 2 (800 mg Q4W)). CR is defined as follows: bone marrow blasts \<=5%, hemoglobin level ≥ 10 g/dL, platelets count ≥ 100\*10\^9/L, neutrophils count ≥ 1.0\*10\^9/L, absence of blasts in peripheral blood. Relapse from complete remission (CR)is when at least 1 of the following criteria is met: 1. Return to baseline bone marrow blast percentage. 2. Decrease of ≥ 50% from maximum remission/response levels in neutrophils AND neutrophils \<1.0\*10\^9/L. 3. Decrease of ≥ 50% from maximum remission/response levels in platelets AND platelets \<100\*10\^9/L. 4. Decrease from maximum remission/response levels in Hgb concentration by ≥ 1.5g/dL AND Hgb \< 10g/dL. 5. Becoming transfusion dependent |
| Progression-Free Survival (PFS) | up to approx. 23 months | Time from start of treatment to disease progression (including transformation to acute leukemia per WHO 2016 classification), relapse from CR or death due to any cause, whichever occurs first for the safety run-in part (Cohort 2 (800 mg Q4W)). |
| Duration of Complete Response (CR)/Marrow Complete Response (mCR) | up to approx. 23 months | Duration of CR/mCR is defined as time from first occurrence of CR/mCR to relapse from CR, progression or death due to any cause whichever occurs first for the safety run-in part (Cohort 2 (800 mg Q4W)). |
| Duration of Response for Participants Who Achieved Hematologic Improvement (HI) or Better | up to approx. 23 months | The duration of response was derived for participants treated with sabatolimab at the higher dose who achieved HI or better as per investigator assessment and is defined from the first occurrence of complete response (CR), marrow complete response (mCR), partial response (PR) or hematologic improvement (HI) until relapse, progression or death due to any reason for the safety run-in part (Cohort 2 (800 mg Q4W)). |
| Leukemia-Free Survival (LFS) | up to approx. 23 months | Time from start of treatment to transformation to acute leukemias per investigator assessment \[as defined as ≥ 20% blasts in bone marrow/ peripheral blood (per WHO 2016 classification) or diagnosis of extramedullary acute leukemia or death due to any cause, whichever occurs first for the safety run-in part (Cohort 2 (800 mg Q4W)). |
| Event-Free Survival (EFS) | up to approx. 23 months | Time from start of treatment to lack of reaching CR within the first 6 cycles, relapse from CR or death due to any cause, whichever occurs first for the safety run-in part (Cohort 2 (800 mg Q4W)). |
| Overall Survival (OS) | Date of start of treatment to date of death due to any reason, for up to approx. 23 months | Time from start of treatment to death due to any cause for the safety run-in part (Cohort 2 (800 mg Q4W)). |
| Changes in Fatigue (Part 2 - Expansion) | throughout study until progressive disease, death or study discontinuation, approx. 3 years | Changes in fatigue as measured by the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue for participants treated with sabatolimab at the higher dose of the expansion part only. Measurements would have been taken via scores from 0 (not at all) to 4 (very much). The higher the score, the better the Quality of Life. |
| Time to Complete Remission(CR)/Marrow Complete Remission (mCR) | up to approx. 23 months | Time to CR/mCR is defined as time from start of treatment to first occurrence of CR or mCR as per investigator assessment for the safety run-in part (Cohort 2 (800 mg Q4W)). |
| Percentage of Subjects Achieving a Complete Remission (CR) + Morphologic Complete Remission (mCR): Safety run-in (Part 1) | up to approx. 23 months | Assessed the durability of complete remission (CR) or morphologic complete remission (mCR) rate. mCR is defined as \<=5% blasts and blast count decrease by \>=50% compared to baseline as per modified IWG-MDS Cheson 2006 criteria. |
Countries
Belgium, France, Germany, Greece, Hungary, Italy, Spain
Participant flow
Recruitment details
Ten centers across 7 countries enrolled a total of 20 participants in this study.
Pre-assignment details
Prior to dosing at Cycle 1 Day 1, participants who fulfilled all the inclusion/exclusion criteria were enrolled via IRT and a treatment number was provided for the study treatments sabatolimab, venetoclax, and azacitidine.
Participants by arm
| Arm | Count |
|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) Part 1 Cohort 1: Safety run-in cohort of a lower dose of sabatolimab in combination with fixed dose of venetoclax and azacitidine. | 5 |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) Part 1 Cohort 2: Safety run-in cohort of a higher dose of sabatolimab in combination with fixed dose of venetoclax and azacitidine. | 15 |
| Total | 20 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 2 | 7 |
| Overall Study | Death | 0 | 1 |
| Overall Study | HSCT Planned | 2 | 3 |
| Overall Study | Physician Decision | 1 | 0 |
| Overall Study | Post Study Access to Treatment | 0 | 1 |
| Overall Study | Progressive Disease | 0 | 2 |
| Overall Study | Withdrawal by Subject | 0 | 1 |
Baseline characteristics
| Characteristic | Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Total |
|---|---|---|---|
| Age, Continuous | 67.2 Years STANDARD_DEVIATION 11.28 | 69.3 Years STANDARD_DEVIATION 9.45 | 68.8 Years STANDARD_DEVIATION 9.67 |
| Race/Ethnicity, Customized Unknown | 1 Participants | 1 Participants | 2 Participants |
| Race/Ethnicity, Customized White | 4 Participants | 14 Participants | 18 Participants |
| Sex: Female, Male Female | 0 Participants | 4 Participants | 4 Participants |
| Sex: Female, Male Male | 5 Participants | 11 Participants | 16 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 5 | 1 / 15 | 1 / 5 | 5 / 14 |
| other Total, other adverse events | 5 / 5 | 15 / 15 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 3 / 5 | 14 / 15 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Percentage of Participants (Receiving 800mg Sabatolimab) Achieving Complete Remission (CR) Per Investigator Assessment
This endpoint assessed Complete Remission (CR) Rate of participants from Cohort 2 of Part 1 and Part 2 according to Investigator assessment per modified IWG-MDS - Cheson 2006 criteria. CR is defined as follows: bone marrow blasts \<=5%, hemoglobin level ≥ 10 g/dL, platelets count ≥ 100\*10\^9/L, neutrophils count ≥ 1.0\*10\^9/L, absence of blasts in peripheral blood.
Time frame: up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment. If a participant were assigned to a specific cohort without any administration of sabatolimab, but received venetoclax or azacitidine, the participant is included in the analysis.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Percentage of Participants (Receiving 800mg Sabatolimab) Achieving Complete Remission (CR) Per Investigator Assessment | 1 Participants |
Primary
Rate of Dose Limiting Toxicities (DLTs) - All Grades (Safety run-in Patients Only)
A dose-limiting toxicity (DLT) is defined as an adverse event or abnormal laboratory value considered by the Investigator to be at least possibly related to sabatolimab as a single contributor or in combination with other component(s) of study treatment that occurs during the DLT observation period and meets severity criteria as per protocol.
Time frame: From Cycle 1 Day 8 to end of Cycle 2 (Cycle = 28 Days)
Population: Dose determining set (DDS): The DDS included all participants from the FAS enrolled in the Safety run-in part who met the minimum exposure criterion and had sufficient safety evaluations or experienced a dose limiting toxicity (DLT) during the first two cycles.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Rate of Dose Limiting Toxicities (DLTs) - All Grades (Safety run-in Patients Only) | Number of participants with at least one event | 0 Participants |
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Rate of Dose Limiting Toxicities (DLTs) - All Grades (Safety run-in Patients Only) | Blood and lymphatic system disorders (Thrombocytopenia) | 0 Participants |
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Rate of Dose Limiting Toxicities (DLTs) - All Grades (Safety run-in Patients Only) | Nervous system disorders (Haemorrhage intracranial) | 0 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Rate of Dose Limiting Toxicities (DLTs) - All Grades (Safety run-in Patients Only) | Number of participants with at least one event | 2 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Rate of Dose Limiting Toxicities (DLTs) - All Grades (Safety run-in Patients Only) | Blood and lymphatic system disorders (Thrombocytopenia) | 1 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Rate of Dose Limiting Toxicities (DLTs) - All Grades (Safety run-in Patients Only) | Nervous system disorders (Haemorrhage intracranial) | 1 Participants |
Secondary
Anti-drug Antibody (ADA) Prevalence at Baseline and ADA Incidence On-treatment by Dose Level
Immunogenicity of sabatolimab prior to sabatolimab exposure and during treatment
Time frame: Continuously collected for patients during treatment with sabatolimab up to 150 days after last treatment, approx. 23 months
Population: Immunogenicity (IG) analysis set: included all participants in the Full Analysis Set with a non-missing baseline IG sample or at least one non-missing post-baseline IG sample. A non-missing IG sample was a sample that was analyzed and not ADA-inconclusive.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Anti-drug Antibody (ADA) Prevalence at Baseline and ADA Incidence On-treatment by Dose Level | Treatment-boosted ADA-positive | 0 Participants |
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Anti-drug Antibody (ADA) Prevalence at Baseline and ADA Incidence On-treatment by Dose Level | ADA incidence (i.e., ADA positive) on-treatment | 1 Participants |
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Anti-drug Antibody (ADA) Prevalence at Baseline and ADA Incidence On-treatment by Dose Level | ADA prevalence at baseline | 0 Participants |
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Anti-drug Antibody (ADA) Prevalence at Baseline and ADA Incidence On-treatment by Dose Level | Treatment-induced ADA-positive | 1 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Anti-drug Antibody (ADA) Prevalence at Baseline and ADA Incidence On-treatment by Dose Level | Treatment-boosted ADA-positive | 1 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Anti-drug Antibody (ADA) Prevalence at Baseline and ADA Incidence On-treatment by Dose Level | Treatment-induced ADA-positive | 1 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Anti-drug Antibody (ADA) Prevalence at Baseline and ADA Incidence On-treatment by Dose Level | ADA prevalence at baseline | 2 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Anti-drug Antibody (ADA) Prevalence at Baseline and ADA Incidence On-treatment by Dose Level | ADA incidence (i.e., ADA positive) on-treatment | 2 Participants |
Secondary
Changes in Fatigue (Part 2 - Expansion)
Changes in fatigue as measured by the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue for participants treated with sabatolimab at the higher dose of the expansion part only. Measurements would have been taken via scores from 0 (not at all) to 4 (very much). The higher the score, the better the Quality of Life.
Time frame: throughout study until progressive disease, death or study discontinuation, approx. 3 years
Population: As expansion phase was not opened, there is no data as nothing was analyzed.
Secondary
Duration of Complete Remission (CR)
Duration of complete remission (CR) is defined as time from first occurrence of CR to relapse from CR, progression or death due to any cause whichever occurs first for the safety run-in part (Cohort 2 (800 mg Q4W)). CR is defined as follows: bone marrow blasts \<=5%, hemoglobin level ≥ 10 g/dL, platelets count ≥ 100\*10\^9/L, neutrophils count ≥ 1.0\*10\^9/L, absence of blasts in peripheral blood. Relapse from complete remission (CR)is when at least 1 of the following criteria is met: 1. Return to baseline bone marrow blast percentage. 2. Decrease of ≥ 50% from maximum remission/response levels in neutrophils AND neutrophils \<1.0\*10\^9/L. 3. Decrease of ≥ 50% from maximum remission/response levels in platelets AND platelets \<100\*10\^9/L. 4. Decrease from maximum remission/response levels in Hgb concentration by ≥ 1.5g/dL AND Hgb \< 10g/dL. 5. Becoming transfusion dependent
Time frame: up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment. Analysis is based on participants with CR.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Duration of Complete Remission (CR) | NA months |
Secondary
Duration of Complete Response (CR)/Marrow Complete Response (mCR)
Duration of CR/mCR is defined as time from first occurrence of CR/mCR to relapse from CR, progression or death due to any cause whichever occurs first for the safety run-in part (Cohort 2 (800 mg Q4W)).
Time frame: up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment. Analysis is based on participants with CR or mCR.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Duration of Complete Response (CR)/Marrow Complete Response (mCR) | 5.60 months |
Secondary
Duration of Response for Participants Who Achieved Hematologic Improvement (HI) or Better
The duration of response was derived for participants treated with sabatolimab at the higher dose who achieved HI or better as per investigator assessment and is defined from the first occurrence of complete response (CR), marrow complete response (mCR), partial response (PR) or hematologic improvement (HI) until relapse, progression or death due to any reason for the safety run-in part (Cohort 2 (800 mg Q4W)).
Time frame: up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment. Analysis is based on participants with CR, mCR, PR or HI.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Duration of Response for Participants Who Achieved Hematologic Improvement (HI) or Better | 5.60 months |
Secondary
Duration of Transfusion Independence
Sum of each period of the transfusion independence for participants with at least one period of transfusion independence post-baseline by dose level for the safety run-in part (Cohort 1 (400 mg Q4W) and Cohort 2 (800 mg Q4W)) and for participants treated with sabatolimab 800 mg (Q4W) (Cohort 2 of safety run-in and expansion parts) for both red blood cells and platelets. RBC/Platelets transfusion independence is defined as participants having received no RBC/platelets transfusions during at least 8 consecutive weeks after start of treatment.
Time frame: up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment. If a participant were assigned to a specific cohort without any administration of sabatolimab, but received venetoclax or azacitidine, the participant is included in the analysis. Analysis is based on participants with at least one period of transfusion independence post-baseline.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Duration of Transfusion Independence | Packed Red Blood Cells | 16.43 Weeks | Standard Deviation 0.808 |
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Duration of Transfusion Independence | Platelets | 18.93 Weeks | Standard Deviation 2.727 |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Duration of Transfusion Independence | Platelets | 24.02 Weeks | Standard Deviation 16.423 |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Duration of Transfusion Independence | Packed Red Blood Cells | 23.11 Weeks | Standard Deviation 12.636 |
Secondary
Event-Free Survival (EFS)
Time from start of treatment to lack of reaching CR within the first 6 cycles, relapse from CR or death due to any cause, whichever occurs first for the safety run-in part (Cohort 2 (800 mg Q4W)).
Time frame: up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Event-Free Survival (EFS) | 0.03 months |
Secondary
Leukemia-Free Survival (LFS)
Time from start of treatment to transformation to acute leukemias per investigator assessment \[as defined as ≥ 20% blasts in bone marrow/ peripheral blood (per WHO 2016 classification) or diagnosis of extramedullary acute leukemia or death due to any cause, whichever occurs first for the safety run-in part (Cohort 2 (800 mg Q4W)).
Time frame: up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Leukemia-Free Survival (LFS) | 7.59 months |
Secondary
Overall Response Rate (ORR) of Participants Who Achieved Hematologic Improvement (HI) or Better as Best Response
The percentage of participants achieving \[CR + mCR + partial remission (PR) + hematologic improvement (HI)\], per modified IWG-MDS Cheson 2006 criteria. Partial response (PR): all complete response (CR) criteria except \>=50% decrease from baseline in blasts in bone marrow AND blast count in bone marrow \>5%. HI (erythroid response or platelet response or neutrophil response) must last at least 8 weeks.
Time frame: up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment. If a participant were assigned to a specific cohort without any administration of sabatolimab, but received venetoclax or azacitidine, the participant is included in the analysis.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Overall Response Rate (ORR) of Participants Who Achieved Hematologic Improvement (HI) or Better as Best Response | 4 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Overall Response Rate (ORR) of Participants Who Achieved Hematologic Improvement (HI) or Better as Best Response | 13 Participants |
Secondary
Overall Survival (OS)
Time from start of treatment to death due to any cause for the safety run-in part (Cohort 2 (800 mg Q4W)).
Time frame: Date of start of treatment to date of death due to any reason, for up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Overall Survival (OS) | NA months |
Secondary
Peak Serum Concentration (Cmax) of Sabatolimab
Maximal concentration of sabatolimab for participants treated with sabatolimab by dose level for the safety run-in part (Cohort 1 (400 mg Q4W) and Cohort 2 (800 mg Q4W)).
Time frame: Continuously collected for patients during treatment with sabatolimab up to 150 days after last treatment, approx. 23 months
Population: PK analysis set: The sabatolimab and venetoclax pharmacokinetic analysis sets included all participants from the Safety Set who provided at least one evaluable sabatolimab/venetoclax PK concentration. No data is reported as only pre-dose samples were collected
Secondary
Percentage of Participants Who Are RBC/Platelets Transfusion Independent
Improvement in red blood cells (RBC)/platelets transfusion post-baseline as per International Working Group - Myelodysplastic syndromes (IWG-MDS) by dose level for the safety run-in part (Cohort 1 (400 mg Q4W) and Cohort 2 (800 mg Q4W)) and for participants treated with sabatolimab 800 mg (Q4W) (Cohort 2 of safety run-in and expansion parts). RBC/Platelets transfusion independence is defined as participants having received no RBC/Platelets transfusions during at least 8 consecutive weeks after start of treatment.
Time frame: up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment. If a participant were assigned to a specific cohort without any administration of sabatolimab, but received venetoclax or azacitidine, the participant is included in the analysis.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Percentage of Participants Who Are RBC/Platelets Transfusion Independent | RBC | 2 Participants |
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Percentage of Participants Who Are RBC/Platelets Transfusion Independent | Platelets | 2 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Percentage of Participants Who Are RBC/Platelets Transfusion Independent | RBC | 5 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Percentage of Participants Who Are RBC/Platelets Transfusion Independent | Platelets | 7 Participants |
Secondary
Percentage of Subjects Achieving a Complete Remission (CR) + Morphologic Complete Remission (mCR): Safety run-in (Part 1)
Assessed the durability of complete remission (CR) or morphologic complete remission (mCR) rate. mCR is defined as \<=5% blasts and blast count decrease by \>=50% compared to baseline as per modified IWG-MDS Cheson 2006 criteria.
Time frame: up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment. If a participant were assigned to a specific cohort without any administration of sabatolimab, but received venetoclax or azacitidine, the participant is included in the analysis.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Percentage of Subjects Achieving a Complete Remission (CR) + Morphologic Complete Remission (mCR): Safety run-in (Part 1) | 4 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Percentage of Subjects Achieving a Complete Remission (CR) + Morphologic Complete Remission (mCR): Safety run-in (Part 1) | 13 Participants |
Secondary
Progression-Free Survival (PFS)
Time from start of treatment to disease progression (including transformation to acute leukemia per WHO 2016 classification), relapse from CR or death due to any cause, whichever occurs first for the safety run-in part (Cohort 2 (800 mg Q4W)).
Time frame: up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Progression-Free Survival (PFS) | 6.77 months |
Secondary
Time to Complete Remission(CR)/Marrow Complete Remission (mCR)
Time to CR/mCR is defined as time from start of treatment to first occurrence of CR or mCR as per investigator assessment for the safety run-in part (Cohort 2 (800 mg Q4W)).
Time frame: up to approx. 23 months
Population: Full Analysis Set (FAS): The Full Analysis Set (FAS) comprises all participants who received at least one dose of study treatment.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Time to Complete Remission(CR)/Marrow Complete Remission (mCR) | 2.33 months |
Secondary
Trough Serum Concentration (Cmin) Sabatolimab
Concentration of sabatolimab prior to next dosing or after end of treatment by dose level for the safety run-in part (Cohort 1 (400 mg Q4W) and Cohort 2 (800 mg Q4W)).
Time frame: Continuously collected for patients during treatment with sabatolimab up to 150 days after last treatment, approx. 23 months
Population: PK analysis set: The sabatolimab pharmacokinetic analysis set included all participants from the Safety Set who provided at least one evaluable sabatolimab PK concentration.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Trough Serum Concentration (Cmin) Sabatolimab | Cycle (C) 1 Day (D) 8 | 0.0 ug/ml | Geometric Coefficient of Variation 0 |
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Trough Serum Concentration (Cmin) Sabatolimab | C2D8 | 23.0 ug/ml | Geometric Coefficient of Variation 137 |
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | Trough Serum Concentration (Cmin) Sabatolimab | C3D8 | 0.0 ug/ml | Geometric Coefficient of Variation 0 |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Trough Serum Concentration (Cmin) Sabatolimab | C2D8 | 30.7 ug/ml | Geometric Coefficient of Variation 41.7 |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Trough Serum Concentration (Cmin) Sabatolimab | C12D8 | 0.0 ug/ml | Geometric Coefficient of Variation 0 |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Trough Serum Concentration (Cmin) Sabatolimab | C3D8 | 34.4 ug/ml | Geometric Coefficient of Variation 72.2 |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Trough Serum Concentration (Cmin) Sabatolimab | C6D8 | 68.6 ug/ml | Geometric Coefficient of Variation 11.5 |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Trough Serum Concentration (Cmin) Sabatolimab | Cycle (C) 1 Day (D) 8 | 0.0 ug/ml | Geometric Coefficient of Variation 0 |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | Trough Serum Concentration (Cmin) Sabatolimab | C9D8 | 71.2 ug/ml | Geometric Coefficient of Variation 33.8 |
Post Hoc
All Collected Deaths
On-treatment deaths were collected from start of study treatment (FPFT) up to 30 days after study drug discontinuation, for a maximum duration of approx. 23 months. Post-treatment survival follow-up deaths were collected from Day 31 after last dose of study treatment to end of study up to approx. 18 months All deaths refer to the sum of on-treatment and post-treatment survival follow-up deaths, up to approx. 23 months
Time frame: On-treatment deaths: up to approx. 23 months, post-treatment deaths: up to approx 18 months
Population: All enrolled patients
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | All Collected Deaths | All deaths | 1 Participants |
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | All Collected Deaths | On-treatment deaths | 0 Participants |
| Sabatolimab (MBG453) 400 mg + AZA + VEN (Part 1 Cohort 1) | All Collected Deaths | Post-treatment deaths | 1 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | All Collected Deaths | All deaths | 6 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | All Collected Deaths | On-treatment deaths | 1 Participants |
| Sabatolimab (MBG453) 800 mg + AZA + VEN (Part 1 Cohort 2) | All Collected Deaths | Post-treatment deaths | 5 Participants |