SEATTLE–(BUSINESS WIRE)–Juno Therapeutics, Inc. (NASDAQ: JUNO), a biopharmaceutical company developing innovative cellular immunotherapies for the treatment of cancer, today announced updated data from the TRANSCEND trial of JCAR017 in relapsed and refractory (r/r) aggressive B cell non-Hodgkin lymphoma (NHL) in a presentation at the 2017 Annual Meeting of the American Society for Clinical Oncology (ASCO).
JCAR017 is Juno’s investigative chimeric antigen receptor (CAR) T cell product candidate that targets CD19, a protein expressed on the surface of almost all B cell malignancies, and uses a defined composition of CD4 to CD8 T cells and a 4-1BB costimulatory domain, which differentiates it from other current CD19-directed CAR T product candidates.
“Today’s update of data from the TRANSCEND trial shows continued compelling results in patients with a wide range of aggressive NHL,” said Sunil Agarwal, M.D., Juno’s President of Research and Development. “We are encouraged by the high rates of durable responses and the early survival data in these patients. We are also encouraged by the early safety data—a majority of patients treated experienced no cytokine release syndrome or neurotoxicity of any grade, which suggests the potential for outpatient administration.”
The data presented today by principal investigator Jeremy Abramson, M.D., of Massachusetts General Hospital Cancer Center, were from the multicenter TRANSCEND trial (ASCO Abstract #7513), a Phase 1 study that has treated 71 patients with r/r aggressive B cell NHL, including those with diffuse large B cell lymphoma (DLBCL), follicular lymphoma grade 3B, or mantle cell lymphoma (MCL). This was a dose-finding study of JCAR017, following fludarabine/cyclophosphamide lymphodepletion. Patients were evaluated for pharmacokinetics, disease response, and safety outcomes, including those commonly associated with CAR T cell therapy, such as cytokine release syndrome (CRS) and neurotoxicity (NT). Patients in this study included those excluded from other trials, including those with ECOG 2 performance status, central nervous system (CNS) involvement of their lymphoma, and those relapsed after allogeneic bone marrow transplant.
Two analysis groups were presented for the DLBCL cohort, core and full. The core analysis (N=44) includes patients that represent the population that will move forward into the upcoming pivotal trial, which will begin in the second half of 2017. This includes patients with DLBCL (de novo and transformed from follicular lymphoma) that are ECOG Performance Status 0-1. The full analysis represents all r/r patients in the DLBCL cohort (N=55), including the 11 patients with poor performance status or niche subtypes of aggressive NHL. Both analysis groups are with conforming product, with at least one month follow up, and with a data cutoff date of May 4, 2017, for this presentation.
Key data and findings:
- Combining data across dose levels:
- Overall response rate (ORR) is 86% (38/44) and the complete response (CR) is 59% (26/44).
- Three-month ORR is 66% (21/32) and CR is 50% (16/32). Of three-month responders followed up at least six months, 90% (9/10) remain in response.
- Early data suggest a dose response relationship at three months:
- Dose level 1 (50 million cells) ORR is 58% (11/19) and CR is 42% (8/19).
- Dose level 2 (100 million cells) ORR is 78% (7/9) and CR is 56% (5/9).
- 97% (37/38) of responding patients are alive and in follow up as of May 4, 2017.
- 2% (1/44) experienced severe CRS and 18% (8/44) experienced severe NT.
- 66% (29/44) did not experience any CRS or NT. No deaths were reported from CRS or NT.
- There was one Grade 5 adverse event of diffuse alveolar damage, which the investigator assessed as related to fludarabine, cyclophosphamide, and JCAR017 treatment, occurring on day 23 in an 82-year-old subject who refused mechanical ventilation for progressive respiratory failure while neutropenic on growth factors and broad spectrum antibiotics and antifungals.
- Combining data across dose levels:
- Best ORR is 76% (41/54) and CR is 52% (28/54).
- Three-month ORR is 51% (21/41) and CR is 39% (16/41).
- 2% (1/55) experienced severe CRS and 16% (9/55) experienced severe NT. 60% (33/55) did not experience any CRS or NT. No deaths reported from CRS or NT.
- Early data do not suggest a dose toxicity relationship at the doses tested:
- Severe CRS rate is 3% (1/30) at dose level 1 and 0% (0/19) at dose level 2.
- Severe NT rate is 20% (6/30) at dose level 1 and 11% (2/19) at dose level 2.
- 11% (6/55) received tocilizumab and 24% (13/55) received dexamethasone.
- The most frequently reported treatment-emergent adverse events were neutropenia (35%), CRS (35%), and fatigue (31%).
Product was available for 98% (86/88) of patients apheresed, and product that met specification was available for 89% (78/88) of patients.
About Juno’s Chimeric Antigen Receptor (CAR) and T Cell Receptor (TCR) Technologies
Juno’s CAR and TCR technologies genetically engineer T cells to recognize and kill cancer cells. Juno’s CAR T cell technology inserts a gene for a particular CAR into the T cell, enabling it to recognize cancer cells based on the expression of a specific protein located on the cell surface. Juno’s TCR technology provides the T cells with a specific T cell receptor to recognize protein fragments derived from either the surface or inside the cell. When either type of engineered T cell engages the target protein on the cancer cell, it initiates a cell-killing response against the cancer cell. JCAR014 and JCAR017 are investigational product candidates and their safety and efficacy have not been established.
Juno Therapeutics is building a fully integrated biopharmaceutical company focused on developing innovative cellular immunotherapies for the treatment of cancer. Founded on the vision that the use of human cells as therapeutic entities will drive one of the next important phases in medicine, Juno is developing cell-based cancer immunotherapies based on chimeric antigen receptor and high-affinity T cell receptor technologies to genetically engineer T cells to recognize and kill cancer. Juno is developing multiple cell-based product candidates to treat a variety of B cell malignancies as well as solid tumors. Several product candidates have shown compelling clinical responses in clinical trials in refractory leukemia and lymphoma conducted to date. Juno’s long-term aim is to leverage its cell-based platform to develop new product candidates that address a broader range of cancers and human diseases. Juno brings together innovative technologies from some of the world’s leading research institutions, including the Fred Hutchinson Cancer Research Center, Memorial Sloan Kettering Cancer Center, Seattle Children’s Research Institute (SCRI), the University of California, San Francisco, and The National Cancer Institute. Juno Therapeutics has an exclusive license to the St. Jude Children’s Research Hospital patented technology for CD19-directed product candidates that use 4-1BB, which was developed by Dario Campana, Chihaya Imai, and St. Jude Children’s Research Hospital. Juno’s product candidate JCAR017 was developed in collaboration with SCRI and others.
About the Juno-Celgene Collaboration
Celgene Corporation and Juno Therapeutics formed a collaboration in June 2015, under which the two companies will leverage T cell therapeutic strategies to develop treatments for patients with cancer and autoimmune diseases with an initial focus on chimeric antigen receptor (CAR) and T cell receptor (TCR) technologies. In April 2016, Celgene exercised its option to develop and commercialize the Juno CD19 program outside North America and China.