ALBERT

Description: Introduction Tafasitamab (MOR208) is an Fc-enhanced, humanized, monoclonal antibody that binds to the human B cell surface antigen CD19. CD19 is broadly and homogeneously expressed across different B cell malignancies, including diffuse large B cell lymphoma (DLBCL), and amplifies B cell receptor signaling and induces tumor cell proliferation. Tafasitamab is currently in clinical development in patients with relapsed or refractory DLBCL in combination with the immunomodulatory drug lenalidomide (L-MIND study) and the chemotherapeutic agent bendamustine (B-MIND study). The modes of action of tafasitamab comprise antibody-dependent cellular cytotoxicity (ADCC), antibody-dependent cellular phagocytosis (ADCP) and direct cytotoxicity (apoptosis). Tafasitamab carries two amino acid exchanges in the Fc region to increase its affinity to Fcγ receptors, including FcγRIIIa. FcγRIIIa plays a key role in mediating ADCC and is expressed on the surface of natural killer (NK) cells, as well as the majority of γδ T cells. MG4101 (a novel therapeutic agent consisting of cryopreserved, ex vivo-expanded, highly activated NK cells) has demonstrated potent anticancer activity in preclinical in vitro and in vivo studies. Currently, MG4101 is in clinical development in patients with malignant lymphoma and advanced solid tumors. Here, we have characterized two FcγRIIIa receptor-expressing cell types, γδ T cells and NK cells (MG4101), as effector cells for tafasitamab in vitro and explored the concept of supplementing MG4101 during tafasitamab therapy using disseminated in vivo models of non-Hodgkin's lymphoma. Methods γδ T cells (CD3+/γδ T cell receptor+) were derived from different donors by stimulation of peripheral blood mononuclear cells with zoledronate/IL-2 for 9-10 days. These were applied as effector cells in in vitro ADCC assays with tafasitamab in Mino and Jeko-1 mantle cell lymphoma (MCL) cell lines, as well as primary patient-derived chronic lymphocytic lymphoma (CLL) and MCL cells. Further, effector cell activity of MG4101 was assessed using tafasitamab-mediated ADCC assays in Raji and Ramos Burkitt's lymphoma cells. The concept of combining tafasitamab with allogeneic effector cell therapy in vivo was studied in two therapeutic survival models of disseminated lymphoma in SCID mice. In the Raji model, tafasitamab (0.05 µg/mouse) was given on Day 1 after intravenous (IV) tumor inoculation, while MG4101 (2x107 cells/mouse) was given on Days 1, 3, 6, 8 and 10. In the Ramos model, tafasitamab (10 mg/kg) and MG4101 (2x107 cells/mouse) were applied twice weekly for 3 weeks starting on Days 3 and 4, respectively, after IV tumor inoculation. Results Tafasitamab in combination with γδ T cells showed distinctly increased ADCC in Mino and Jeko-1 target cells in vitro, compared with a negative control IgG1 antibody. ADCC assays with patient-derived CLL and MCL target cells confirmed tafasitamab-mediated cytotoxic activity and demonstrated a clear enhancement in activity compared with the non-Fc-enhanced version of tafasitamab that was unable to induce substantial cytotoxicity. In vitro ADCC assays with tafasitamab and MG4101 on Raji and Ramos cell lines confirmed potent effector cell activity of the ex vivo-expanded, cryopreserved, allogeneic NK cells. In the disseminated Raji survival model, combination therapy with a single low dose of tafasitamab (0.05 µg) and MG4101 resulted in a distinct increase in survival of the mice with an increased life span (ILS) of 100% compared with monotherapy (ILS of 57% for tafasitamab and 50% for MG4101). Of note, the combination demonstrated a substantial and more than additive enhancement in survival in the more therapeutic Ramos survival model (Figure 1). Combination therapy with tafasitamab (10 mg/kg) and MG4101 NK cells resulted in superior antitumor activity (ILS of 103%) compared with either tafasitamab monotherapy (ILS of 49%) or MG4101 alone (ILS of 25%). Conclusions FcγRIIIa-expressing immune cell types, including NK cells and γδ T cells, are potent effector cells for tafasitamab-mediated ADCC. Combination therapy with tafasitamab and allogeneic MG4101 NK cells in vivo demonstrated a more than additive survival benefit compared with tafasitamab or MG4101 monotherapy in a disseminated therapeutic lymphoma model. Combination of tafasitamab supplemented with immune effector cells could represent a promising new approach for lymphoma therapy. Disclosures Her: GC LabCell: Employment, Patents & Royalties. Cho:GC LabCell: Employment, Patents & Royalties. Hwang:GC LabCell: Employment, Equity Ownership, Patents & Royalties. Boxhammer:MorphoSys AG: Employment, Patents & Royalties. Steidl:MorphoSys AG: Employment. Patra:MorphoSys AG: Employment. Schanzer:MorphoSys AG: Employment. Endell:MorphoSys AG: Employment, Patents & Royalties.

Description: Introduction Tafasitamab (MOR208) is a CD19-targeting, Fc effector function-enhanced antibody that has shown promising clinical activity in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). For patients newly-diagnosed with DLBCL, R-CHOP regimens combining the anti-CD20 antibody, rituximab (RTX) with chemotherapy is the standard of care; however, 30-40% of patients experience relapse with a high mortality rate. CD20 is not as broadly expressed as CD19 on B-cell lymphomas, and CD19 expression is preserved on CD20-negative tumor sub-populations and following CD20-targeting therapy (Horna, et al. EHA 2020). These findings support the evaluation of immunotherapies combining anti-CD19 and anti-CD20 antibodies to target all malignant lymphoma cells. To further explore the rationale for adding tafasitamab to a RTX-containing regimen, we analyzed the effect of this combination on antibody-dependent cellular cytotoxicity (ADCC), antibody-dependent cellular phagocytosis (ADCP), and tumor B-cell viability in vitro. Additionally, protein expression of the oncogenic transcription factor c-Myc was investigated to gain deeper insight into the molecular effects mediated by RTX and tafasitamab. Methods A comprehensive panel of 11 aggressive lymphoma cell lines was analyzed (9 DLBCL and 2 Burkitt's lymphoma). For the ADCC assays, tumor cells were incubated with tafasitamab and/or RTX at saturating concentrations in the presence of natural killer cells from healthy human donors at effector-to-target (E:T) ratios of 0.5:1 to 3:1 for 2 hours. Cytotoxicity was assessed by quantification of DAPI-positive, CFSE-labeled target cells. For the ADCP assays, lymphoma cells were incubated with tafasitamab and/or RTX at saturating concentrations in the presence of in vitro differentiated macrophages derived from healthy human donors at an E:T ratio of 2:1 for 3 hours. Phagocytosis was assessed by quantification of double-positive events (CFSE-labeled macrophages and CellTrace Violet-stained target cells). C-Myc protein levels were measured following the treatment of tumor cells with tafasitamab and/or RTX for 17-48 hours. CD19/CD20 surface expression, ADCC and ADCP rates, as well as intracellular c-Myc protein levels were analyzed by flow cytometry. Direct effects of antibody treatment on cell viability were assessed by the determination of ATP levels upon incubation of lymphoma cells for 24-96 hours. Results Increased ADCC activity for the combination of tafasitamab and RTX compared with the respective monotherapies was observed in 4/11 cell lines. For the remaining cell lines, the combination activity was similar to the most active monotherapy (tafasitamab: 5/11, RTX: 2/11). Furthermore, in 5/11 cell lines, the combination of tafasitamab and RTX resulted in enhanced ADCP activity compared with the monotherapies. Similar to ADCC, the combination activity in the other cell lines was comparable to the most active monotherapy (tafasitamab: 2/11, RTX: 4/11). Interestingly, a slight correlation between ADCC/ADCP activity and CD19/CD20 surface expression levels was observed. Treatment of tumor cells with the respective antibodies without effector cells showed a beneficial combinatorial effect of tafasitamab with RTX on the reduction of cell viability in 3/8 cell lines, whereas 2 cell lines were primarily sensitive to tafasitamab and 3 were sensitive to RTX. This observed difference in the activity profile of tafasitamab versus RTX suggests different mechanisms for induction of direct cytotoxicity (Figure 1). To further elucidate the molecular basis of the observed direct effects on cell proliferation, expression levels of c-Myc were assessed. A correlation between decreased cell viability and reduction of c-Myc expression was demonstrated. This finding is in line with the role of c-Myc in the regulation of cellular processes, such as proliferation and apoptosis. Conclusions The co-treatment of tafasitamab with RTX demonstrated superiority compared with the respective monotherapies for at least one and up to all three of the modes of action tested (ADCC, ADCP, or direct impact on cell viability) in 9/11 lymphoma cell lines. These data demonstrate that the combination of tafasitamab and RTX mediates increased tumor cell death in vitro via different mechanisms of action and support the clinical evaluation of this antibody combination in patients with DLBqCL. Disclosures Patra: MorphoSys AG: Current Employment. Augsberger:MorphoSys AG: Current Employment. Ginzel:MorphoSys AG: Current Employment. Polzer:MorphoSys AG: Current Employment. Landgraf:MorphoSys AG: Current Employment. Bartel:MorphoSys AG: Current Employment. Ness:MorphoSys AG: Current Employment. Steidl:MorphoSys AG: Current Employment. Heitmüller:MorphoSys AG: Current Employment. Schanzer:MorphoSys AG: Current Employment. Endell:Morphosys: Current Employment.