TY - JOUR
T1 - A phase 1 study of inotuzumab ozogamicin in pediatric relapsed/refractory acute lymphoblastic leukemia (ITCC-059 study)
AU - Brivio, Erica
AU - Locatelli, Franco
AU - Lopez-Yurda, Marta
AU - Malone, Andrea
AU - Díaz-de-Heredia, Cristina
AU - Bielorai, Bella
AU - Rossig, Claudia
AU - van der Velden, Vincent H J
AU - Ammerlaan, Anneke C J
AU - Thano, Adriana
AU - van der Sluis, Inge M
AU - den Boer, Monique L
AU - Chen, Ying
AU - Sleight, Barbara
AU - Brethon, Benoit
AU - Nysom, Karsten
AU - Sramkova, Lucie
AU - Øra, Ingrid
AU - Vinti, Luciana
AU - Chen-Santel, Christiane
AU - Zwaan, Christian Michel
N1 - © 2021 by The American Society of Hematology.
PY - 2021/3/25
Y1 - 2021/3/25
N2 - This phase 1 study investigated the recommended phase 2 dose (RP2D) of inotuzumab ozogamicin (InO), a CD22-directed antibody-drug conjugate, in pediatric patients with multiple relapsed/refractory (R/R) CD22
+ acute lymphoblastic leukemia (ALL). Patients (age ≥1 year or <18 years) received 3 doses of InO (days 1, 8, and 15) per course. Dose escalation was based on dose-limiting toxicities (DLTs) during course 1. Dose level 1 (DL1) was 1.4 mg/m
2 (0.6, 0.4, 0.4 mg/m
2) and DL2 was 1.8 mg/m
2 (0.8, 0.5, 0.5 mg/m
2). Secondary end points included safety, antileukemic activity, and pharmacokinetics. Twenty-five patients (23 evaluable for DLTs) were enrolled. In course 1, the first cohort had 1 of 6 (DL1) and 2 of 5 (DL2) patients who experienced DLTs; subsequent review considered DL2 DLTs to be non–dose-limiting. Dose was de-escalated to DL1 while awaiting protocol amendment to re-evaluate DL2 in a second cohort, in which 0 of 6 (DL1) and 1 of 6 (DL2) patients had a DLT. Twenty-three patients experienced grade 3 to 4 adverse events; hepatic sinusoidal obstruction syndrome was reported in 2 patients after subsequent chemotherapy. Overall response rate after course 1 was 80% (95% confidence interval [CI], 59% to 93%) (20 of 25 patients; DL1: 75% [95% CI, 43% to 95%], DL2: 85% [95% CI, 55% to 98%]). Of the responders, 84% (95% CI, 60% to 97%) achieved minimal residual disease (MRD)-negative complete response, and 12-month overall survival was 40% (95% CI, 25% to 66%). Nine patients received hematopoietic stem cell transplantation or chimeric antigen receptor T cells after InO. InO median maximum concentrations were comparable to simulated adult concentrations. InO was well tolerated, demonstrating antileukemic activity in heavily pretreated children with CD22
+ R/R ALL. RP2D was established as 1.8 mg/m
2 per course, as in adults. This trial was registered at https://www.clinicaltrialsregister.eu as EUDRA-CT 2016-000227-71. Key Points: • The recommended phase 2 dose of InO for pediatric patients with ALL was established at 1.8 mg/m
2 per course. • Of the patients with multiple R/R ALL, 85% reached CR after 1 course of single-agent InO at the RP2D, 100% of whom had MRD negativity.
AB - This phase 1 study investigated the recommended phase 2 dose (RP2D) of inotuzumab ozogamicin (InO), a CD22-directed antibody-drug conjugate, in pediatric patients with multiple relapsed/refractory (R/R) CD22
+ acute lymphoblastic leukemia (ALL). Patients (age ≥1 year or <18 years) received 3 doses of InO (days 1, 8, and 15) per course. Dose escalation was based on dose-limiting toxicities (DLTs) during course 1. Dose level 1 (DL1) was 1.4 mg/m
2 (0.6, 0.4, 0.4 mg/m
2) and DL2 was 1.8 mg/m
2 (0.8, 0.5, 0.5 mg/m
2). Secondary end points included safety, antileukemic activity, and pharmacokinetics. Twenty-five patients (23 evaluable for DLTs) were enrolled. In course 1, the first cohort had 1 of 6 (DL1) and 2 of 5 (DL2) patients who experienced DLTs; subsequent review considered DL2 DLTs to be non–dose-limiting. Dose was de-escalated to DL1 while awaiting protocol amendment to re-evaluate DL2 in a second cohort, in which 0 of 6 (DL1) and 1 of 6 (DL2) patients had a DLT. Twenty-three patients experienced grade 3 to 4 adverse events; hepatic sinusoidal obstruction syndrome was reported in 2 patients after subsequent chemotherapy. Overall response rate after course 1 was 80% (95% confidence interval [CI], 59% to 93%) (20 of 25 patients; DL1: 75% [95% CI, 43% to 95%], DL2: 85% [95% CI, 55% to 98%]). Of the responders, 84% (95% CI, 60% to 97%) achieved minimal residual disease (MRD)-negative complete response, and 12-month overall survival was 40% (95% CI, 25% to 66%). Nine patients received hematopoietic stem cell transplantation or chimeric antigen receptor T cells after InO. InO median maximum concentrations were comparable to simulated adult concentrations. InO was well tolerated, demonstrating antileukemic activity in heavily pretreated children with CD22
+ R/R ALL. RP2D was established as 1.8 mg/m
2 per course, as in adults. This trial was registered at https://www.clinicaltrialsregister.eu as EUDRA-CT 2016-000227-71. Key Points: • The recommended phase 2 dose of InO for pediatric patients with ALL was established at 1.8 mg/m
2 per course. • Of the patients with multiple R/R ALL, 85% reached CR after 1 course of single-agent InO at the RP2D, 100% of whom had MRD negativity.
KW - Antineoplastic Agents, Immunological/adverse effects
KW - Child
KW - Child, Preschool
KW - Female
KW - Humans
KW - Infant
KW - Inotuzumab Ozogamicin/adverse effects
KW - Male
KW - Neoplasm Recurrence, Local/drug therapy
KW - Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85097392477&partnerID=8YFLogxK
U2 - 10.1182/blood.2020007848
DO - 10.1182/blood.2020007848
M3 - Journal article
C2 - 33067614
SN - 0006-4971
VL - 137
SP - 1582
EP - 1590
JO - Blood
JF - Blood
IS - 12
ER -