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Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed.

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Presentation on theme: "Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed."— Presentation transcript:

1 Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed by Mitumprotimut-T Immunotherapy Omer N. Koc, MD; Charles Redfern, MD; Peter H. Wiernik, MD; Fred Rosenfelt, MD; Jane N. Winter, MD; Troy H. Guthrie, MD; Lawrence Kaplan, MD; Peter Holman, MD; John Densmore, MD, PhD; John Hainsworth, MD; Thomas Lin, MD; Rene A. Castillo, MD; Nalini Janakiraman, MD; and Richard G. Ghalie, MD Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia

2 Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed by Mitumprotimut-T Immunotherapy Mitumprotimut-T is a patient-specific and B-cell tumor-specific idiotype (Id) protein chemically conjugated to keyhole limpet hemocyanin (KLH), a potent non-specific immunogenic protein Mitumprotimut-T induces a cellular and humoral immune response to the Id-protein expressed by the patient’s own tumor, leading to active immunization against the tumor while sparing normal B-cells Background Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia.

3 Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed by Mitumprotimut-T Immunotherapy Mitumprotimut-T is co-administered with Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF to further enhance anti-Id immune responses The Id protein is produced by proprietary recombinant technology; ~8 weeks from biopsy to final product Background Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia.

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5 Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed by Mitumprotimut-T Immunotherapy To compare the progression-free survival (PFS) in patients treated with Rituximab followed by mitumprotimut-T (Specifid™, Id-KLH, FavId®) and GM-CSF to historical data with rituximab alone To evaluate the safety of this combination regimen Objectives Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia.

6 Key Inclusion Criteria: – Histologically confirmed Grade 1 or 2 follicular B-cell lymphoma (WHO classification) – Treatment-naïve (T-N), relapsed/refractory (R/R) to chemotherapy, or relapsed following prior ≥ 6-month response to rituximab – ≥8 weeks between completion of any prior lymphoma therapy and start of rituximab on study – Measurable disease (≥2 cm) following node biopsy – Performance status (ECOG) of 0, 1 or 2 Methods Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed by Mitumprotimut-T Immunotherapy Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia.

7 Key Exclusion Criteria: – >3 prior chemotherapy or anti-CD20 regimens – Prior fludarabine – Concurrent immunosuppressive therapy (e.g., high-dose steroids) Methods Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed by Mitumprotimut-T Immunotherapy Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia.

8 Methods Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed by Mitumprotimut-T Immunotherapy Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia. Treatment Regimen: Rituximab: 375 mg/m2 weekly infusion x 4 weeks. Subjects with stable disease (SD) or an objective response (CR or PR) to rituximab were eligible for mitumprotimut-T Mitumprotimut-T: 1 mg sc on Day 1 of each course. Courses administered monthly x6, bimonthly x6, and then every 3 months until disease progression or significant toxicity GM-CSF: 250 mcg/day sc on Days 1-4 of each course; same injection site as mitumprotimut-T CT scans: Obtained every 3 months; read by an independent radiologist blinded to clinical data

9 Study Schema and Treatment Regimen 0 3 6 912 15 18 21 24 Months CT Scans Mitumprotimut-T + GM-CSF Rituximab Mitumprotimut-T Production Biopsy Cytoreduction Induction Maintenance Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia.

10 Patient Characteristics at Study Entry CharacteristicN = 89 Age Median (range)53 (30 – 85) years Gender, n (%) Male 47 (53%) Female42 (47%) Follicular Lymphoma WHO Grade, n (%) Grade 147 (53%) Grade 238 (43%) Grade 32 (2%) Not reported2 (2%) Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia.

11 Patient Characteristics at Study Entry CharacteristicN = 89 Treatment History, n (%) Treatment-naïve (T-N)35 (39%) Relapsed/Refractory (R/R)54 (61%) No. of Prior Systemic Therapies (n = 54 R/R) Median (range)1.5 (1 – 4) FLIPI Risk Group, n (%) Low16 (18%) Intermediate26 (29%) High20 (23%) Not evaluable27 (30%) Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia.

12 Disease Response Assessment 27 patients (30%) had a response improvement during treatment with mitumprotimut-T + GM-CSF: 11 SD converted to PR, 1 SD converted to CR, 15 PR converted to CR. Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia. ~3 Months After Start Rituximab (Before Start of Mitumprotimut-T) Any Time After Start of Mitumprotimut-T + GM-CSF Overall N = 89 T-N N = 35 R/R N = 54 Overall N = 89 T-N N = 35 R/R N = 54 Complete Response 2 (2.2%) 02 (3.7%) 18 (20.2%) 9 (25.7%) 9 (16.7%) Partial Response 41 (46.1%) 24 (68.6%) 17 (31.5%) 37 (41.6%) 18 (51.4%) 19 (35.2%) Objective Response 42 (48.3%) 24 (68.6%) 19 (35.2%) 55 (61.8%) 27 (77.1%) 28 (51.9%) Stable Disease 43 (48.3%) 11 (31.4%) 32 (59.2%) 31 (34.8%) 8 (22.9%) 23 (42.6%) Progressive Disease ‡ 3 (3.4%) 03 (5.6%) 3 (3.4%) 03 (5.6%)

13 Time Course for Achievement of Complete Response Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia. Months From Rituximab Start Cumulative No. of Patients in CR Confirmation by a repeat CT scan was required to meet the criteria for a CR

14 Time to Achieving a Complete Response in Study FavId-04 and in Rituximab Alone Trials in Treatment-Naive Follicular NHL Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia. Cumulative % of Pts. in CR Author/ReferenceNo. of Pts. Total No. (%) of Pts. in CRBy Mo 3 From Mo 3 - 12 From Mo 12 - 33 Study FavId-04359 (26%)0%56%100% Witzig et al, J Clin Oncol 2005;23:1103 3613 (36%)92%100%N/A Colombat et al, Blood 2001;97:101 4920 (41%)65%100%N/A  In published single-agent rituximab trials all patients had achieved a CR by Month 12.  In Study FavId-04, 44% of the CRs were achieved between Month 12 and 33, suggesting an added effect of mitumprotimut-T + GM-CSF beyond of what is achieved with rituximab alone.

15 Progression-Free Survival for All Evaluable Patients (N=89) And for Patients Who Achieved a Complete Response (N=18) Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia. Median follow-up = 51 months (range, 47 – 62 months). Six of 18 (33%) subjects with CR have progressed and one (6%) withdrew from study in CR.

16 Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed by Mitumprotimut-T Immunotherapy Overall 18 of 89 (20.2%) patients treated with rituximab followed by mitumprotimut-T achieved a complete response (CR), including 26% of treatment-naïve patients and 17% of patients with relapsed-refractory disease Of the 18 confirmed CRs, 16 have occurred during the mitumprotimut-T + GM-CSF phase of the study Summary Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia.

17 Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed by Mitumprotimut-T Immunotherapy Conversion to CR has occurred as late as 33 months from start of rituximab Achieving a CR is associated with prolonged disease-free survival; 11 of 18 (61%) of CR patients remain disease-free 47 to 62 months after start of rituximab therapy Most adverse events reported in the study were of severity Grade 1-2; the most common adverse event was injection site reaction (79.6% of patients) Summary Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia.

18 Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed by Mitumprotimut-T Immunotherapy The occurrence of late CRs and the durability of these responses suggest added anti-tumor effect of active immunization with mitumprotimut-T + GM-CSF after rituximab cytoreduction than would be expected with single-agent rituximab therapy Conclusions Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia.

19 Continued Late Conversion to Complete Remission and Durability of Remission in Patients with B-cell Follicular Lymphoma (FL) Treated with Rituximab Followed by Mitumprotimut-T Immunotherapy These findings are relevant when considering an ongoing Phase 3 registration trial where patients with follicular lymphoma randomized to receive mitumprotimut-T or placebo, both with GM-CSF, following cytoreduction with rituximab achieved a best CR rate of 47% in a blinded interim analysis (Freedman et al, Blood 2006;108:#2756.) Analysis of time to progression, the study primary efficacy endpoint, is expected in July 2008 Conclusions Omer K et al. Abstract #3427. Presented December 10, 2007, at the 49th ASH Annual Meeting in Atlanta, Georgia.


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